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BLOOD DONATIONS

by John Hunt

      The information originally on this page is believed to have been correct in January 1997.

      The contributors listed at the end of this article have been asked during April 2000 to confirm whether these details are still correct.

Contents, (links on this page)

Introduction
Council of Europe Recommendations
Development of Homophobia with State Support
Table of Blood Donation Exclusion Criteria
Key and Abbreviations
Notes on Individual Table Entries
Specific Observations
General Observations
National Blood Authorities + Representatives


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Introduction


This survey of blood exclusion practices in selected countries was begun in March 1996. Since then there has been a tightening of procedures in some countries: with the result that now most of the countries included in the survey claim to have a lifetime ban on donations by men who have ever had sex with another man at any time in their lives.

It is interesting to note that, while there is considerable uniformity in current practices with regard to IV drug users, there is less uniformity with regard to gay men, and still less with regard to prostitutes. This seems to imply that not only medical criteria are being applied when determining who to ban, and that national cultural values are being incorporated.

Canada and the USA ignore sexual contact prior to the advent of AIDS, (which they set at 1977); New Zealand imposes a ten-year exclusion period on gay men; and Australia currently stands out as having the least discriminatory policy, with "just" a one-year ban on donations following gay sex.

This is not the end of the story, however. In Switzerland the Federal Government decreed in June 1996 that there was no need for discriminating against donors on grounds of sexuality; (although the Swiss Red Cross has not yet heeded the ruling). In the Netherlands a Government Commission has been considering since November 1995 whether the current ban there constitutes discrimination. (17-August-1997: The Dutch gay group COC are now pursuing this) In Belgium, discrimination against gay donors was lifted by law in October 1994: although it was reinstituted in summer 1996, despite the recommendation of the physicians in the Belgian Commission. Spanish regional authorities are apparently not discriminating at all. (Greece states that there is a lifetime ban on gay donors: although leaflets given to donors refer explicitly to sexual behaviour since 1977.) -- Thus it would appear that the proportion of countries where official support for a lifetime ban is total is at most ten out of 20.

Some countries refer in donor literature to the use of condoms, safe(r) sex practices, or risk behaviour. Generally, however, there is no definition of what actually constitutes sex. Does this mean just anal (or vaginal) sex? (If so, many gay men would immediately become eligible as donors, as anal sex is, despite misinformed public opinion, by no means universally practised.) Is oral sex included? (This is not usually considered to be an HIV transmission route, unless perhaps semen is swallowed.) Some gay men limit their activity to mutual masturbation, which, in terms of risk of infection, is on a par with celibacy: yet this does not appear to be mentioned in any of the donor literature.


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Council of Europe Recommendations


The Council of Europe has published recommendations
R(95)14 On the Protection of Health of Donors and Recipients in the area of Blood Transfusion,
and
R(95)15 On the Preparation, Use, and Quality Assurance of Blood Components,
(both adopted on the 12-October-1995). The former 'recalls' "the importance of good donor selection, avoiding any possible discrimination". Article 20 (ibid.) states that "[r]eduction of the risk for the recipient depends primarily upon measures to inform and educate donors which should be as clear and comprehensive as possible"; and article 21 refers to "persons belonging to categories who by virtue of their medical history or current activities or behaviour present a high risk of transmission of infectious diseases". [Emphasis added.] -- Sexual activity over a year ago can be considered neither medical history nor current behaviour. Discrimination on such grounds therefore contravenes the dictum of avoiding any possible discrimination. Blanket bans do little to inform or educate; and omitting any indication of which sexual practices represent risk behaviour is neither clear nor comprehensive.

R(95)15 is more explicit, (Part B, Chapter 1, §9), listing 8 pages of criteria and actions relating to various infections. The subsection on AIDS (p.19) states:

"All blood donors should be provided with accurate and updated information on HIV transmission and Aids so that those indulging in unsafe sex practices or other risk behaviour exposing them to potential infectious sources will refrain from donating. … All blood donors found to have a confirmed positive marker for HIV should be informed, as part of a full counselling procedure, that they should not give further donations."

[The subsection "Intoxication, alcohol, and drugs" (p.22) unfortunately depends on national law for its interpretation. -

"Persons clearly under the influence of alcohol should be deferred until sober. Illicit drug taking if admitted or suspected (in particular, i.v. drug abuse at any time) must debar."

"Illicit drug taking" in the UK will preclude users of cannabis, who presumably would not be debarred from donating in the Netherlands. Additionally: are donations by alcoholics to be welcomed when they are sober?]


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Development of Homophobia with State Support


An interesting historical summary of homophobia was sent to me in 1996: an extract from a speech by Lord Russell, speaking in the House of Lords on the Bill to outlaw discrimination against lesbian, gay and bisexual employees. -

"When I look for signs of homophobia (in the 17th century), I find remarkably little.

"In the reign of King James I, one would have expected, with a homosexual on the throne and a côterie of fellow homosexuals around him, that one would find a good deal of it.

"I do not find any homosexual assaults in assize records ... One does not get it coming into depositions about tavern brawls. If I look for cases of homosexual blackmail in the 17th century, I do not believe I can find any.

"I think I am entitled to say that that suggests homophobia in the 17th century was a great deal less deep-seated than it is now ...

"That suggests that homophobia is not entirely a deep, instinctive prejudice, that a very large part of it is culturally determined and that it flourishes in a climate of official encouragement ... "


The effects of this discrimination by blood transfusion authorities upon the perception of the general public (and hence on their beliefs and resultant behaviour) serve only to reïnforce existing homophobia. This should not be overlooked by anyone claiming that this discrimination is medically justified. -- Would it be acceptable (medically and politically) to ban donations by Jewish males, say, on the grounds that they might transmit a viral agent for Kaposi's Sarcoma? If not, why should discrimination against gay men be tolerated?

Attempts to justify the ban on gay donors appear to appeal to statistics ("most sexual transmission in western countries is homosexual rather that heterosexual"). Any discrimination based on statistics will unfairly and needlessly reject members of the group; and will simultaneously lull the discriminators into a false sense of security, as threats from other sources are ignored or overlooked.

I am suggesting not that all gay men should be invited to donate blood, but that we should not all be subject to an irrational blanket ban. The goal of protecting recipients of blood products will not be served by blind prejudice.


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Table of Blood Donation Exclusion Criteria


Country
Gay men/ "Men who have sex with men"
Prostitutes
IV Drug users
Sex with gay man (women only)
Sex with prostitute
Sex with IV drug user
Regional variations in
practice
%age of donors paid
"Ballot form" available
When confirmed / updated
Australia 1 year no ban [e1] life 1 year no ban [e1] 1 year [a1] nil no confirmed
3-Apr-2000
Austria life [a2] life [a2] life [a2] life 6 mth [a3] life yes nil yes Reply awaited
Belgium -- French-speaking regions only life [b1] 6 months
???
life 6 months [b3] 6 months [b3] 6 months [b3] no nil [b2] updated
10-Apr-2000
Canada 1977 (*) 1977 (*) life 1 year 1 year 1 year no nil yes confirmed
13-Apr-2000
Denmark life life life life life life no nil no Reply awaited
Finland life 1 year life [fi1] 1 year 1 year 1 year no nil no confirmed
3-Apr-2000
France [fr1] life life life life life life ??? nil no Reply awaited
Germany life life life life life life no nil yes updated
13-Apr-2000
Greece life [gr1] life [gr1] life [gr1] life [gr1] [gr2] life [gr1] no nil yes confirmed
6-Oct-2000
Ireland (Eire) life life life 1 year 1 year 1 year no nil no confirmed
2-May-2000
Italy [it1] [it1] [it1] 1 year 1 year 1 year no nil no confirmed
11-Apr-2000
Netherlands [n1] life 1 year life life 1 year life no nil no Reply awaited
New Zealand 10 years 10 years 2 years 2 years 2 years 2 years no nil no Reply awaited
Norway life life life 6 months 6 months 6 months [nor1] nil no confirmed
6-Apr-2000
Portugal life life life 1yr / life 1 year 1 year no nil in some centres Reply awaited
Spain ??? ??? ??? ??? ??? ??? ??? ??? ??? Reply awaited
Sweden life life life 6 months 6 months 1 year no no no updated
25-Apr-2000
Switzerland life life life life 1 year life no nil yes updated
13-Apr-2000
UK [n/c] life life life 1 year 1 year 1 year no nil no Reply awaited
USA [n/c] 1977 (*) 1977 (*) life 1 year 1 year 1 year ??? ??? ??? Confirmation awaited


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Key and Abbreviations


* Sex prior to the date indicated is considered irrelevant; sex after that date entails a lifetime ban.
IV intravenous
life lifetime ban, regardless of when any 'risk behaviour' may have ceased
n/c data originally supplied by national authority (or embassy); but confirmation has not been obtained
Columns 2-4 denote any exclusion applicable to: men who have ever had sex with men; to prostitutes; to intravenous drug users.
Columns 5-7 denote exclusion criteria applicable to anyone who has knowingly had sex with a member of the above groups.
Column 8 are there variations in practice, e.g. between different blood collection authorities?
Column 9 what percentage (on average) of donors receive any recompense for their donation?
Column 10    do donors have the opportunity to give blood, but to indicate on a form which they themselves seal that the sample should be used for testing only? This avoids answering delicate questions in a situation which could be potentially embarassing or lead to harassment or victimisation.


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Notes on Individual Table Entries


a1 Australia Centres in some states may have longer deferral periods, if required under local legislation or regulation.
a2 Austria Lifetime ban for "HIV risk behaviour". Most centres give concrete examples (as col.s 2-4): some do not.
a3 Austria Sex with a prostitute may entail a ban of anything from 6 months to life, depending upon the centre.
b1 Any donor who has had a change of sexual partner within the last 6 months is temporarily excluded. Discrimination against gay donors ceased in October 1994; but was reinstituted in summer 1996, (despite the opinion of the physicians in the Belgian Commission), following a draft European Recommendation on plasma donation.
b2 As from October 1996, donors are able to leave a message on an answering machine, quoting the donation identification no., to have their donation blocked.
b3 Permanent exclusion if this is a regular partner.
e1 Eligible as a donor, unless the individual is also a member of some other excluded category.
fi1 Questions include:
Have you or your partner ever injected drugs;
in the past 12 months, have you paid or received payment for sex, or been injected with a used needle;
in the past two months, have you had sex with someone other than your regular partner?
fr1 Donors who have had a change of partner in the past 6 months are also excluded, unless they have used condoms.
gr1 Donors receive a leaflet which enquires about these practices since 1977: but official policy is that activity prior to 1977 also entails a lifetime ban.
gr2 This is not an explicit question, but is assumed to be covered by the "sex with people with risk behaviour" category.
it1 Donors receive a letter which refers to "temporary or permanent" exclusion for various criteria, including gay sex and sex with strangers. If would-be donors do not decide to exclude themselves, the decision would appear to be at the discretion of the attendant physician. Donation may be permitted one year after the most recent risk behaviour. However, although Italian law sets a precise limit of 12 months for exposure to hepatitis, there is none specifically for potential HIV infection.
n1 This information is based on information supplied in July 1996, and relates to a revised guideline, for implementation in January 1997. Additionally, a commission is currently investigating whether the blanket ban on gay men constitutes discrimination.
nor1 Regional variations relate not to these issues, but to which nationalities are acceptable as donors.
  Details have changed since the January 1997 edition.


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Specific Observations


Spain

Copies of legislation are inconclusive. No further information from the Ministry has been forthcoming. However, it is reported that, while donations by gay men were forbidden by central government until last year, the new regional governments are not discriminating on grounds of sexuality.

"At the beginning of the AIDS crisis, around 1984, a Government decree issued by the Ministry of Health (who was running the blood banks at the time and was responsible for the blood donation campaigns) forbade gays to donate their blood. This situation has remained unchanged until last year.

"Meanwhile, as Spain's administrative structure has shifted from a very centralized structure (something like France) to a reasonably decentralized one (in line with Germany), the management of blood banks has been transferred to the regions (the political / administrative division similar to the German Länder or the Swiss cantons). It is thus now up to the regions to have such regulations changed.

"To my knowledge, after the pressure made by local gay groups, the legislation has already been changed by the Madrid, Catalonia and Asturias regions (something quite relevant for Madrid and Catalonia gather 20 % of the population in Spain). Now, prospective blood donors in Madrid are being given a leaflet to read before the donation. Its text strongly encourages people having had promiscuous sex lives to dismiss the idea of donation. I have the idea that the situation in Catalonia and Asturias is very similar. Fortunately, the wording of such info-sheets leaves no way for discrimination based on sexual orientation." [Quote from Spanish citizen]

UK

The U.K. National Blood Service state that they aim to avoid discrimination against "risk groups", by considering risk behaviour. Sadly, however, this objective is not being met, as traditional British prudishness in refusing to discuss the mechanics of sex means that even gay men who limit their behaviour to well-established safer sex practices are immediately rejected as donors if they admit to being gay.

It is possible that at some point blood authorities may be forced to reconsider their position simply on grounds of supply and demand. In the U.K., heterosexual transmission already accounts for c. 20% of HIV cases. Various reports this year have suggested that, whilst the rate of HIV prevalence is levelling off amongst gay men, there is a significant increase amongst pregnant women in England and Wales; and that HIV-E, reputedly better adapted to vaginal transmission than other strains, has already been detected in patients in this country.

USA

Prisoners who have been incarcerated for three days or longer are banned from donating for 12 months. Quite on what grounds is not clear, since this is not consistent with the U.S. exclusion periods for either gay men or I.V. drug users.

Recent figures from the San Francisco Department of Health indicate that c. 50% of gay men there remain HIV negative; so that the national incidence of infection amongst gay men throughout the USA is probably less than 10%, (and even less in most other countries in the survey).


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General Observations


  1. Attempts to ask donors about the history of their partners are highly suspect. Donors may know, (or may like to believe that they know): but the reality is that often they will not. In today's society, with divorce rates around 40%, and many heterosexual couples choosing not to enter marriage, the concept of a single, monogamous, stable relationship is just not applicable to a large proportion of the population. What proportion of donors actually are in a monogamous relationship; and, of those who say they are, what proportion are either lying, or are themselves being deceived by their partners?
  2. A lifetime ban on anyone who has ever worked as a prostitute seems a little hard. In today's harsh economic climate, what proportion of students may try to supplement their meagre grants this way, even if only for a short period? Does such behaviour warrant a lifetime ban?
  3. To try to discriminate between prostitutes and their clients seems rather pointless. Some prostitutes will be very careful about exposing themselves to health risks; some of their clients will not. Viruses such as HIV or hepatitis do not observe the direction of cash flow.
  4. Some countries include routine examination of donors, to check for signs of IV drug use. Unfortunately, simply examining arms is not sufficient, as it is not unknown for users to inject less obvious areas, e.g. thighs, in order to escape detection.
  5. Some authorities are refreshingly direct in the language used in leaflets; others are unfortunately somewhat coy in some areas. E.g. "have you come in close (intimate) contact with someone with yellow jaundice or hepatitis?". Why not spell out the criteria, to avoid confusion and doubt?
  6. Legislation against discrimination on the grounds of sexuality is believed to exist in: Canada, Denmark, France, Ireland, Netherlands, New Zealand, Norway, Spain, Sweden.
  7. Asylum for gay refugees is believed to have been allowed in: Austria, Belgium, Canada, Denmark, Finland, Germany, Netherlands, Norway, Sweden, USA.


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National Blood Authorities + Representatives


Australia
Australia
Dr. Patrick J. Coghlan, Director of Intellectual Capital,
Australian Red Cross Blood Service, Level 1, 304, Nicholson Street, Fitzroy, Victoria 3065.
Fax +61-3.99.34.68.01
Austria
Austria
Frau Dr. E. Zach
Bundesministerium für Gesundheit und Konsumentenschutz, A-1031 Wien.
Fax +43-17.14.92.22
Belgium
Belgium
Dr. Jean Siquet, Médecin-Directeur-Adjoint,
Croix-Rouge de Belgique, rue Dos-Fanchon 41, B-4020 Liège.
Fax +32-43.41.69.23
Belgian Ministry of Health
Canada
Canada
Dr. Graham D. Sher, Vice President,
Canadian Blood Services, 1800, Alta Vista Drive, Ottawa. K1G 4J5
graham.sher@bloodservices.ca
Fax +1-61.37.39.20.99
Denmark
Denmark
Torben Haerslev, MD, Ph.D.,
Sundhedsstyrelsen, Postboks 2020, 1012 København K.
Fax +45-33 93 16 36
Sonja Mikkelsen, sundhedsminister, Junivej 35, 8210 Århus V.
Danish Ministry of Health
Sonja_Mikkelsen@socialdemokratiet.dk
Finland
Finland
Dr. Tom Krusius, Director, Laboratory Services,
Veripalvelu (Finnish Red Cross Blood Transfusion Service), Kivihaantie 7, 00310 Helsinki.
Tom.Krusius@bts.redcross.fi
Fax +358-95.80.13.29
France
France
Mme. Agnès Jeannet,
Agence Française du Sang, 6, rue Alexandre Cabanel, F-75015 Paris.
Fax +33-144.49.66.19
Mme. Dominique Gillot, Secrétaire d'Etat à la santé et aux handicapés
French Ministry of Health
Germany
Germany
Herr Dr. E. Werner,
Bundesministerium für Gesundheit, Hauptgebäude, Am Propsthof 78-a, Bonn.
Fax +49-22.89.41 49.27
Greece
Greece
1) Minister of Health,
Aristotelous Str. 17, 101 87 Athens.
Fax +30-15.23.17.07
2) Prof. Constantina Politis, President Blood Transfusion Cttee
Dracopoulion Blood Transfusion Centre, 4, Alkiviadou Str., 104 39 Athens.
Fax +30-18.82.03.01
Eire
Ireland (Eire)
K. H. du Plessis, FRCPath., Consultant Hæmatologist,
Blood Transfusion Service Board, Pelican House, P.O. Box 97, 40, Mespil Road, Dublin 4.
Fax +353-16.60.34.19
Italy
Italy
Prof. S. M. Aloj, Scientific Attaché,
Italian Embassy, 14, Three Kings' Yard, London. W1Y 2EH
S.Aloj@mailbox.ulcc.ac.uk
Fax 020-74.95.41.71
Italian Ministry of Health
Netherlands
Netherlands
C. M. de Vos, MD, Ph.D., Executive Director of Pharmaceutical Affairs,
Ministerie van Volksgezondheid, Welzijn en Sport, Postbus 5406, 2280 HK Rijswijk.
Fax +31-703.40.78.34
Equal Treatment Commission, Postbus 16001, 3500 DA Utrecht
Fax +31-302.30.06.06
COC Statement about the rôle of the Equal Treatment Commission
Minister mevrouw dr. E. Borst-Eilers
Ministerie van Volksgezondheid, Welzijn en Sport
Mw. Borst-Eilers was voorts voorzitter van het College voor de Bloedtransfusie en voorzitter van de Kerncommissie Ethiek Medisch Onderzoek.
National Ombudsman
New Zealand
New Zealand
Hon. Annette King, Minister of Health
aking@ministers.govt.nz

Peter Hunter, Acting Mgr, Personal Health Services,
Ministry of Health, 133, Molesworth Street, P.O. Box 5013, Wellington.
Fax +64-44.96.23.40
Norway
Norway
Inger Brusel, Consul,
Norwegian Embassy, 25, Belgrave Square, London. SW1X 8QD
Fax 020-72.45.69.93
Portugal
Portugal
1) Dr. Maria de Belem, Minister of Health,
Gabinete da Ministério da Saúde, Av. João Crisostomo, 9; 1000 Lisboa.
dgsaude@dgsaude.min-saude.pt
Fax +351-213.53.66.87
2) Sr. José d'Almeida Gonçalves, Director,
Insituto Português do Sangue, Parque da Saúde, Av. do Brasil, 53; 1700 Lisboa.
Fax +351-217.95.64.92
Spain
Spain
Minister of Health,
Ministerio de Sanidad y Consumo, Paseo del Prado, 18-20; 28071 Madrid.
Fax +34-91.429.35.25
Sweden
Sweden
1) Lars Engqvist, Minister of Health,
SE-103 33 Stockholm.
registrator@social.ministry.se
Fax +46-87.23.11.91
2) Bengt Wadman, MD, Ph.D., Head of Division,
Socialsstyrelsen Örebro, P.O. Box 423, S-701 48 Örebro.
Fax +46-602.88.85
Swedish Dept. of Public Health Sciences
Switzerland
Switzerland
1) Dr. Ch. Schärer, Inspektorat,
Bundesamt für Gesundheitswesen, Bollwerk 27, Postfach, CH-3001 Bern.
Fax +41-313.22.47.49
2) Blutspendedienst SRK, Gutenbergstr. 14, CH-3000 Bern.
bsd@redcross.ch
Fax +41-313.80.81.80
U.K.
U.K.
1) Minister of Health,
Dept. of Health, Richmond House, 79, Whitehall, London. SW1A 2NS
Fax 020-72.10.55.34
2) Dr. E. A. Robinson, Medical Director,
National Blood Authority, Oak House, Reeds Crescent, Watford. WD1 1RH
Fax 01923-48.68.01
3) Dr. V. James, Consultant Hæmatologist, National Blood Service.
Trent Centre, Longley Lane, Sheffield. S5 7JN
Fax 0114-203 4911
Leaflet distributed to donors since Dec. 1995
U.S.A.
U.S.A.
1) Dr. Allen Holt,
National Institute of Health, Bethesda, MD 20892.
holta@ficod.fic.nih.gov
Fax +1-30.14.80.34.14
2) Dr. Joan W. Blair,
Centre for Biologics Evaluation & Research.
blair@a1.cber.fda.gov
IFRC
I.F.R.C.
Peter Carolan, Blood Dept.
International Federation of Red Cross and Red Crescent Societies
carolan@ifrc.org


Triangle



Discrimination against gay blood donors -- Marina Cronin

World Health Organisation

WHO: World Health Day 2000 -- Blood Safety

International Federation of Red Cross and Red Crescent Societies


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Author: John Hunt
©1996-2000 John Hunt
URL: http://www.RoseCottage.me.uk/OutRage-archives/qiblood.htm
Last modified: 22-October-2000