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Alan Rice

Human being. I'm a PhD student studying molecular evolution at a university in Ireland. Likes: sugar, data & science. Dislikes: peas & cats. I don't know how I made it this far either. (he/him)

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Something has always irked be about the Irish Blood Transfusion Service (IBTS). Here’s what they have to say about banning men who have had sex with other men (MSM) from donating blood:

In order to assure the continued safety of the blood supply, we currently ask those people who may have a particularly high risk of carrying blood-borne viruses not to give blood. This includes men who have ever had sex with another man / men. The reason for this exclusion rests on specific sexual behaviour (such as anal and oral sex). There is no exclusion of gay men who have never had sex with a man nor of women who have sex with women. The decision is not based on sexuality or orientation, only specific actions. -IBTS

Yes, gay and bisexual men in Ireland are the most likely individuals to be diagnosed with HIV in Ireland, accounting for roughly half (82/165) of new cases in the first half of 2013. That’s evidence I’m not going to dispute. The IBTS states two reasons for excluding this group of potential donors:

  • IBTS does not believe that performing more detailed interviews prior to donation nor other risk assessments at donation clinics is effective or feasible. For those donors who test positive for HIV or other infections, the risk behaviour that likely led to the infection may not be admitted for some time after the donor is contacted. This does not give IBTS confidence that information would be freely provided as part of a more extensive pre-donation interview.
  • The issue of monogamous partners is difficult. Evidence from heterosexual partnerships suggests that ‘innocent’ partners are very often entirely unaware that their partner / spouse is unfaithful. IBTS considers therefore that individuals can only attest to their own behaviour when donating and not speak for their partner. -IBTS

To me the highlighted sentence reads as accusing MSM of actively lying or providing false information. Why non-MSM individuals are more truthful in confidential questionnaires is unknown to me. In fact one young gay man was asked to travel from Galway to Dublin to be interrogated about his sex life after donating due to an “anonymous query”. Having never been sexual active and donating for 3 years since he turned 18, Tomás Heneghan was asked if he understood the questions and was told he’d have to wait for confirmation for when he could donate again. Why was he considered less truthful in the confidential information he imparted before a voluntary procedure?

HIV infections do not produce effective markers to test against until some weeks/months after infection. Which brings me to my main point of the illogical filtering system the IBTS has in place. So, the IBTS does not allow any man who’s had oral or anal sex with another man to ever donate, with or without using a condom, BUT if another man instead had unprotected sex with a confirmed HIV positive woman he’d only have to wait 12 months before donating. How does that work? You can ignore the population HIV infection rates here for a second, we’re talking about one person never being allowed to donate if he had protected sex with a man who’s regularly tested and confirmed HIV negative and another person who can donate after 12 months if they have unprotected sex with someone who is definitely HIV positive. I don’t understand the logic here, why exclude one category entirely forever when they may never have come into contact with the virus and let the other group of people who definitely have some real risk of HIV infection donate after 12 months? The higher population risk doesn’t make sense in this context, in the words of the IBTS “The decision is not based on sexuality or orientation, only specific actions” and here one action clearly carries a higher risk than the other, yet they’re treated like opposites.

The IBTS states that:

While there is always a need for new blood donors and for existing and previous donors to continue to provide support to the transfusion service, blood supply is not expected to increase greatly should, for example, a finite limit for deferral of 12 months since last MSM activity be introduced. -IBTS

I would imagine that there are more men who’ve had sex with another man at some stage and haven’t in the last 12 months than there are people who’ve had non-MSM sex with someone they know to be HIV positive. So if MSM are not a large enough group to include why is there a dedicated question for non-MSM HIV positive sex on the crowded questionnaire? Just ask one general question potential HIV contact. In November 2011, NHS Blood and Transplant, the Scottish Blood Transfusion Service and the Welsh Blood Transfusion Service all made the change to allow MSM donate after a 12 month period. The IBTS specifically mentions that the Northern Ireland Health Minister recommends the ban stays in place. This is the young earth creationist, evolution rejecting, anti-gay adoption Health Minister. Clearly the person to listen to on matters of science, health and equality…

It’s hard to attribute a kind motive to the above contradictory discrimination when previously the IBTS has attributed gay people as a future source of new infections, states that MSM are more likely to lie on confidential questionnaires, and holds up an anti-science, anti-gay Health Minister as a reason to continue this policy introduced at a time when HIV testing wasn’t available.

For Ireland, the view of IBTS is that taking all of these aspects into account a permanent deferral for men with a history of MSM behaviour is justified. -IBTS


UPDATE: I emailed the IBTS regarding these queries and the response was less than helpful to be honest. My original email (which I don’t have a copy of) asked about 12 month deferral for non-MSM HIV positive sex and linked to this post.

    Subject: IBTS’s policy on MSM
    ****** <******@ibts.ie> Mon, Feb 17, 2014 at 5:38 PM
    To: alanmrice@gmail.com
    Hi Alan,

    Thank you for your query.

    I have enclosed a copy of the IBTS’s MSM guideline here for your information.
    MSM

    Exclusion of Men who have Sex with Men from Blood Donation

    Information last updated:7th November 2011.

    The Irish Blood Transfusion Service (IBTS) has a responsibility to ensure that there is a sufficient supply of safe blood to meet the needs of patients.

    This includes a duty to minimise the risk of a blood transfusion transmitting an infection to patients – the European Union directive requires that “all necessary measures have been taken to safeguard the health of individuals who are the recipients of blood and blood components.”

    In order to assure the continued safety of the blood supply, we currently ask those people who may have a particularly high risk of carrying blood-borne viruses not to give blood. This includes men who have ever had sex with another man / men. The reason for this exclusion rests on specific sexual behaviour (such as anal and oral sex). There is no exclusion of gay men who have never had sex with a man nor of women who have sex with women. The decision is not based on sexuality or orientation, only specific actions.

    The reasons for IBTS maintaining its current policy of permanently excluding men who have ever had sex with men from blood donation are as follows:

    Blood safety starts with the selection of donors before they give blood. By excluding persons with behaviours known to present a particularly high risk of blood-borne viruses, we are already reducing the risk of infected blood entering the blood supply.
    Every blood donation is tested for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and human T-lymphotropic virus (HTLV). However, despite improvements in blood screening tests, a small number of infected donations may be missed because of the ‘window period’ between getting the infection and the test showing a positive result. The medical literature contains many recent examples. See further reading on http://www.hpsc.ie/hpsc/

    While safer sex, through the use of condoms, does reduce the transmission of infections, it cannot eliminate the risk altogether. Men who have sex with men are disproportionately affected by HIV according to recent Irish data.

    IBTS does not believe that performing more detailed interviews prior to donation nor other risk assessments at donation clinics is effective or feasible. For those donors who test positive for HIV or other infections, the risk behaviour that likely led to the infection may not be admitted for some time after the donor is contacted. This does not give IBTS confidence that information would be freely provided as part of a more extensive pre-donation interview.
    The issue of monogamous partners is difficult. Evidence from heterosexual partnerships suggests that ‘innocent’ partners are very often entirely unaware that their partner / spouse is unfaithful. IBTS considers therefore that individuals can only attest to their own behaviour when donating and not speak for their partner.

    While there is always a need for new blood donors and for existing and previous donors to continue to provide support to the transfusion service, blood supply is not expected to increase greatly should, for example, a finite limit for deferral of 12 months since last MSM activity be introduced. The safety of blood transfusions and the supply of blood to patients in Ireland are two independent essential functions of the IBTS.

    With effect from 7th November 2011, the following UK Blood Services: NHS Blood and Transplant, the Scottish Blood Transfusion Service and the Welsh Blood Transfusion Service changed the permanent exclusion of MSM from donating blood to a 12 month fixed period deferral from the most recent relevant sexual contact. This decision was made by the UK Health Ministers following advice received from the Advisory Committee on the Safety of Blood, Tissues and Organs (SABTO).

    The IBTS has reviewed the report produced by SABTO, but has decided not to make a change to its current permanent exclusion of MSM. The Health Minister for Northern Ireland has recommended that no change is made to their permanent exclusion at present.

    For other infections that cannot yet be tested for, or that are currently undiscovered, and may be preferentially transmitted by MSM behaviour [in the same way as HIV and hepatitis B are] it will clearly not be effective. Other countries have a permanent deferral after MSM behaviour, including the USA and the Netherlands.

    Finally, while the primary requirement is to protect recipients, it is acknowledged that in order to supply blood for transfusion all decisions are based on a review of the evidence bearing in mind the desire of individuals to donate, the safety of the recipient, and the tolerance of society in general of any transfusion related infection occurring. For Ireland, the view of IBTS is that taking all of these aspects into account a permanent deferral for men with a history of MSM behaviour is justified

    Yours sincerely,
    Dr.******, Medical Officer IBTS.



    Alan Rice <alanmrice@gmail.com> Mon, Feb 17, 2014 at 5:56 PM
    To: “******” <******@ibts.ie>
    Thank you for replying promptly.

    This copy and pasted response from your website does not answer my original query of how someone who has had sex with a HIV+ person is deferred from donating for 12 month yet men who have sex with men (even with a condom) are forever excluded from donating. Is the former action not more likely to risk HIV infection?

    Regards,
    Alan.



    ****** <******@ibts.ie> Mon, Feb 17, 2014 at 6:07 PM
    To: Alan Rice <alanmrice@gmail.com>

    Hi Alan,

    Please read the piece on MSM again.
    You will see that there is more to it than just a risk of HIV infection in MSM behaviour.

    Yours sincerely,
    Dr. ******



    Alan Rice <alanmrice@gmail.com> Mon, Feb 17, 2014 at 6:40 PM
    To: “******” <******@ibts.ie>

    I’m familiar with the piece on MSM.

    I’m not certain if you mean more blood-borne viruses than HIV or if you mean more to the ban than blood-borne viral infection?
    I used HIV as an example, equally non-MSM sex with someone infected with hepatitis is also treated with a 12 month deferral.

    If you mean more than just the risk of blood-borne viruses perhaps you mean that “the risk behaviour that likely led to the infection may not be admitted for some time after the donor is contacted”. I find it hard to believe that MSM behaviour is less likely to be admitted to on a confidential questionnaire for a voluntary donation than any other risk group. HIV testing for MSM is provided free at various clinics around the country and I highly doubt any man would risk infecting a person through donating for a free HIV test.

    “blood supply is not expected to increase greatly should, for example, a finite limit for deferral of 12 months since last MSM activity be introduced” – It is estimated that 6,000 people are living with HIV in Ireland, with about a third unaware of infection. I’d imagine that the number of people who have had non-MSM sex with someone that they know to be HIV+ is much smaller than the number of eligible HIV- MSM.

    The IBTS policy also cites the Northern Ireland young earth creationist, evolution rejecting, anti-gay adoption Health Minister as someone they look to for recommendations on this topic. Yes, clearly the anti-science, anti-gay blood/adoption Health Minister will be a reliable, unbiased source of scientific information and policy regarding MSM blood donations.

    Perhaps I missed a reason why this is more “than just a risk of HIV infection in MSM behaviour”? Why not adopt a similar policy to Scotland, Wales and England on this issue?

    Alan.



    ****** <******@ibts.ie> Tue, Feb 18, 2014 at 8:33 AM
    To: Alan Rice <alanmrice@gmail.com>

    Good morning Alan,

    I do not give my opinion on the Health Minister of NI or the policy in the rest of the UK.
    My role is to deal with email queries in accordance to the medical guidelines of the IBTS.
    If you think you are not getting the answer you want from me, then you should address your query to the medical consultants in the IBTS.

    Thanking you.

    Yours sincerely,
    Dr.*******
    Medical Officer IBTS.



    Alan Rice <alanmrice@gmail.com> Tue, Feb 18, 2014 at 10:08 AM
    To: “******” <******@ibts.ie>

    Good morning ******,

    I understand not commenting on the Health Minister personally, but I hope you can appreciate my concern at the IBTS personally citing him as a reason to continue this policy when he rejects overwhelming scientific evidence in favour of his own personal beliefs.

    I appreciate you taking the time to answer my queries the best you can given your remit, but I have found them to be unsatisfactory. If you could forward my queries to a medical consultant I would be very grateful.

    Kind regards,
    Alan.

I’ve still yet to find out how there’s “more to it than just a risk of HIV infection in MSM behaviour”. These responses seem deliberately opaque and pedantic to avoid answering my queries. It seems the IBTS feel beyond reproach.