Blood donation, who are we really discriminating against?
In my last blog I wrote about the complex matter of blood donation rules and gay men. I looked at the question of whether the rules are discriminatory – men cannot currently give blood if they have had sex with another man in the previous 12 months. The conclusion was that they are not discriminatory if they are a reasonable and evidence-based attempt to protect the safety of the blood supply. Is the 12 month deferral for gay men reasonable and evidence-based? We suspect it may no longer be so and the rules need to be reviewed to ensure no discrimination is taking place.
There are, however, groups excluded by the blood donation rules permanently – anyone who has ever been paid with money or drugs for sex and anyone who has ever injected drugs. The case against these permanent exclusions is far clearer – they are discrimination pure and simple, without any rational justification. However, sex workers and people who inject drugs are not groups protected from discrimination under the Equality Act, unlike gay men. It was the threat from NAT of legal action under the Equality Act which helped push SaBTO (the relevant body which decides on blood donation rules) to review the former permanent exclusion on gay men. It is depressing that in the absence of such legal leverage for these marginalised groups, SaBTO reverts to inaction, allowing totally unjustifiable exclusions to remain in place.
The sharing of injecting equipment is a significant route of HIV transmission globally and in some countries, for example Russia, it is the main driver of the epidemic. But in the UK relatively few people who inject drugs are diagnosed with HIV and prevalence is at about 1.2%, significantly below that for gay men for example (at 5%). Of course other blood borne viruses such as hepatitis C have a much higher prevalence – about two in five people who inject psychoactive drugs such as heroin or mephedrone have hepatitis C, and half of them are not aware of the fact. But the blood supply can also be screened for hepatitis C and the window period to detect antibodies is three months. It is hard to see how this justifies an exclusion of someone who last injected drugs 30 years ago! But SaBTO has so far refused even to look at the issue.
There is similarly poor evidence to justify the permanent exclusion of sex workers. The quality of the data around blood borne viruses and sex workers in the UK is not as robust as that for gay men or people who inject drugs. But all the studies which have taken place of sex workers who are not also injecting drugs suggest significantly lower rates of HIV than amongst gay men and lower rates of hepatitis C than amongst people who inject drugs. SaBTO rejected the recommendation from the last review to end this permanent exclusion – NAT has recently written to SaBTO calling again for both these permanent exclusions to end.
But why does it matter? After all, blood donation is a voluntary activity. Does it really harm anyone if their blood donation is refused. Yes at a personal level we believe it does. Blood donation is promoted as a core act of civic responsibility, an expression of our care for each other in society. Exclusion undermines that sense of involvement, acceptance and belonging – as we have seen, there can be reasons why nevertheless it has to happen, but it should only be done with very good reason.
Even more importantly, unjustifiable exclusions are simply expressions of stigma and discrimination, and coming from such an official source further entrench negative social attitudes. Whether in dealings with police and other public services, in media reporting, in job hunting, in social relationships, people who have engaged or are engaging in sex work or injecting drugs often face many barriers and hostility. The blood donation rules tacitly condone such discrimination. The permanent exclusion of anyone who has ever, even once, even decades ago, done these things is literally stigma in its purest form – imposing a mark of shame which cannot be erased. However, isn’t it SaBTO who should be ashamed?
If you found this blog interesting, check out Yusef's earlier blog, Blood donation and gay men - the wrong focus?