Field of Science

There's no evidence for NI Health Minister lifetime ban on MSM blood donation

It's not often that I talk about politics on this blog. In fact I don't think I have even mentioned it before but in some instances when infectious diseases and politics collide I feel I have to do so. 

One such instance happened today when Edwin Poots a local politician in the Northern Ireland Assembly finally released his decision on whether our blood donation services would accept blood from men who have sex with men. We had been waiting nearly a year for this. 

Edwin Poots, NI Health Minister

We cannot accept blood from men who have sex with men

It's safe to say that sadly Edwin came to the decision that our local Health Service cannot accept blood from men who have sex with men (MSM). In fact he would have even wished that this whole-life ban on blood donation was extended to all 'high risk groups'. 

"I think that people who engage in high-risk sexual behaviour in general should be excluded from giving blood," the minister said.
"And so someone who has sex with somebody in Africa or sex with prostitutes, I am very reluctant about those people being able to give blood."

This was released in an interview for a national news program. Normally I ignore the ramblings of local politicians but in this case Edwin is our Health Minister and at the end of the day has control over the kinds of health services we get.

His decision, which flies in face of what has happend in England, Scotland and Wales who reduced their ban to 12 months post sex (see below), was based upon two pieces of research that "strengthened his position". He never gave any more details about this work which worries me slightly. Now I like the idea that our politicians are basing decisions upon evidence but I'm not sure this research actually exists and if it does it clearly made little impact on the independent review that came out last year (see below).

Poots' statement has rightly drawn criticism from other politicians who correctly state that we have a robust screen program for all blood coming in and brought up that it is not right to discriminate like this. 

But we really need more blood

All this news come at a rather poor time only a week after UK's National Blood week and World Blood Donor Day. These events are set up to celebrate those who actually give blood products and looks to inspire and encourage more and more people to do so. This is necessary because we are in a pretty bad situation here in the UK and in Northern Ireland especially. In fact we even have to import blood in from England, Scotland and Wales to cover our needs. The stat is that only about 5% of all people who CAN give blood do so. And here is a UK health minister effectively turning down blood from the 1.8 million gay or bisexual men across Northern Ireland. Edwin Poots stated that it's potentially unsafe for these "at-risk" peoples to donate blood but is this really true?

As a little background to this story, in September 2011 the health ministers across England, Scotland and Wales - spurred by independent research (see here)- finally lifted the lifetime ban on blood donation from MSM. 

The data from the report was: 

Risks of transmission*from the BBC report

  • Lifetime exclusion - risk of one infection in every 4.41 million donations
  • Five-year time limit - risk of one infection in every 4.39 million donations
  • One-year time limit - risk of one infection in every 4.38 million donations
  • No limit - risk of one infection in every 3.48 million donations
You can see that 1) NO exclusion criteria are perfect. Even with lifetime exclusion there is still some risk of blood-donation infections. But also 2) that changing from a lifetime to a 5 or 1 year limit barely increases the risk of infection (from one in 4.41 million donations to one in 4.38 million donations). This translates into an increase of one infection per 30,000 donations and was deemed to be insignificant given the number of new blood into the transfusion services.

They changed it so that only those men who have had homosexual sex in the last 12 months would be stopped donating. The previous ban had been implemented from the 1980's before the time of HIV testing. Currently all blood is screened for evidence of HIV, hepatitis B and C infection through the detection of anti-viral antibodies. The problem with this method of testing is that in some people it can take up to a year to develop antibodies against a particular virus. That means that if you were to test someone and they showed up negative you couldnt be entirely certain whether they were or weren't virus infected. This is known as the 'window-period' of HIV infection and hence the 12 month restriction which limits the numbers of false-negative results. 

What about the evidence

As the ability of virus testing got better and better we were able to reduce the indefinite ban on MSM donations which along with equality issues made up the impetus to lift the ban last year. There is even evidence to back this safety record up from an Australian study reported in 2010

No evidence of a significantly increased risk of transfusion-transmitted human immunodeficiency virus infection in Australia subsequent to implementing a 12-month deferral for men who have had sex with men.

Here's more evidence,

Relative risk of reducing the lifetime blood donation deferral for men who have had sex with men versus currently tolerated transfusion risks.

And even more:

Scientific background on the risk engendered by reducing the lifetime blood donation deferral period for men who have sex with men.

The 12 month ban on blood from MSM brings them up to date with the recommendations for blood from other "at-risk" groups. But the problem with this is that even still those MSM are still more discriminated against than a heterosexual male who has had multiple instances of unprotected sex. This position is defended because the increase in risk of infection (see data above) is deemed to significant and unwarranted. Despite this people have called that our blood donation deference criteria should be based on individuals and not on groups.  

But the England, Scotland and Wales 12 month ban is certainly a step in the right direction in terms of providing better care for those people who need blood and in limiting discrimination against MSM. So why is Northern Ireland different? I am really not sure but what I do know is that it will definitely negatively impact our local health services by the reducing the pool of safe blood to be transfused. In light of not seeing our Ministers' evidence I cant really comment on it. Maybe he'll release it. Maybe. What I do hope is that this act has not been motivated by personal religious views and bigotry which has cropped up time and time again.

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