Blood donation rules: no sense then or now

Picture of a man giving bloodOn Thursday it was announced that the rules governing who can give blood in the UK was changed; previously, any man who had ever had sex with a man was permanently excluded; the new rules state that he is banned for a year. This rule was put in place in the 1980s to curb the spread of HIV through blood donation; today, greater awareness of safe sex and better methods of HIV detection mean the lifetime ban is no longer necessary. A permanent ban still applies to former prostitutes and intravenous drug users. Meanwhile, another controversy continues over whether those who suffer from ME should be excluded, and why a ban has only recently been introduced. (Note: sexual acts discussed in the full entry.)

The rules on who can give blood are to be found on the UK blood service’s website here. An explanation on the ban on “men who have sex with men” (MSM) is to be found here and there is a FAQ in a separate column on that page. The FAQ does not adequately answer questions as to why the same sexual acts that result in exclusion when both participants are men do not result in exclusion when one party is female. Anal sex is a known risk to health for the very good reason that the back passage is ridden with germs which can be passed to the person penetrating them, and can easily absorb germs passed into it much as it absorbs medicine passed in suppository form (not very common in the UK, very common in mainland Europe). This is true regardless of the sex of the person penetrated, so it is a mystery why this act does not exclude heterosexual participants from giving blood, particularly if they have had several partners.

So, it makes little sense to exclude young gay men, who were yet to be born at the time of the 1980s AIDS epidemic and who have only ever had sex with one other person of a similar age, particularly if they have never had anal sex, but not to exclude older heterosexuals who have participated in the same risky sexual acts which spread HIV in the first place and may have had more than one partner going back decades. It might be a better idea to specifically exclude older gay men (born before about 1985) and older heterosexuals who have ever had anal sex. However, as has been widely pointed out, all this requires the honesty of the donors; there are currently no laws dictating who can give blood and who cannot, and there is no way of policing the unobserved pasts of whose who come to donate.

Of course, some might approve on the basis that excluding active male homosexuals sends a message of moral disapproval, but that is not the point of the ban: the point is to protect public health, and excluding a lower-risk group (young gay men) but not a higher-risk one (older, promiscuous heterosexuals) does not serve that purpose very well.

I have also noticed an ongoing discussion of why exactly people with ME (or diagnosed with Chronic or Post-Viral Fatigue Syndrome) or who have ever had it are asked not to give blood in the UK, as in Ireland and many other countries. The exclusion started in November 2010, and according to the Welsh Blood Service, the reason is that it is now understood that the illness can relapse and remit, so someone who thinks they have recovered might still have it in their system. The reasoning given is “as a precaution to protect the donor’s safety by ensuring the condition is not made worse by donating blood”, and the same applies to other “relapsing conditions or neurological conditions of unknown or uncertain origin, such as Multiple Sclerosis (MS) and Parkinson’s disease”. The ME community widely believes the real reason is the discovery of XMRV as a possible cause of ME, something not stated in any of the British blood literature, although the Irish Blood Transfusion Service does acknowledge that XMRV was a factor in changing the rules there. However, in the UK, even a positive XMRV test (in a healthy person) does not result in exclusion from giving blood.

I suspect most ME patients would not give blood anyway; some would not be able to make it to the donation venue or be able to justify the journey even if they could. However, the reason ME is an exclusion factor and XMRV is not is that those with ME are ill, and people who are ill should not give blood, particularly if it is not known whether they still have whatever caused the illness in their system; what role XMRV has in causing ME, or any other illness for that matter, is not at all certain, something many people on the ME boards seem unable to contemplate. There are other viruses strongly linked to ME, such as enteroviruses which are spread through faecal matter, such as by those who do not wash their hands properly after using the loo or by flushing a toilet without putting the seat cover down. There is of course another way for someone (particularly a man) to take one of these viruses into the bloodstream, which is another reason why the rules announced this past week do not make a great deal of sense and should have been changed in the other direction.

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