June 14 is World Blood Donor Day.
Dr Kevin Rebe of Anova shares some insights about the history of exclusion experienced by gay men when it comes to donating blood.
June 2017 is Blood Donor Month. According to the current SANBS blood donating guidelines, anyone of any sexual orientation or gender identity can donate, provided they “lead a safe sexual lifestyle”. This wasn’t always the case. What were the previous barriers to entry?
Dr Rebe: In years gone by, the SANBS did not allow blood donation from gay or other men who have sex with men (MSM) based on historical data that identified them as the population group with the highest HIV prevalence. Historically MSM have experienced higher rates of HIV infection than their heterosexual peers. However, there are population groups in South Africa whose rates of infection are as high or are similar to MSM e.g. young women attending ante-natal classes.
Even after blood screening for HIV improved massively, and data emerged about other high-risk populations, the SANBS delayed changing their donation criteria from one based on population groups to one based on actual recent sexual activity until 2014.
You took the SANBS head on about their discriminatory perceptions towards gay people. What were some of the things that you did to challenge their stance?
Dr Rebe: I had several disagreements with the transfusion service at the time. The biggest spat occurred at the Academic Grand Rounds at Groote Schuur Hospital in 2006. A representative from the Western Province Blood Transfusion Service spoke at the meeting and described the rules and requirements for blood donors, with gay and other men having sex with men precluded from donating blood unless they had been celibate for 12 months. I was a Registrar in Internal Medicine at the time and challenged the evidence for these rules. My challenge was ineffective, and the transfusion service continued defending the exclusion of MSM, despite the then existent evidence for the safety of blood transfusion screening and an HIV epidemic in the country that was not centred around homosexual people.
Why do you think it’s important that LGBTQI+ people can donate blood?
Dr Rebe: LGBTQI+ people who want to contribute to the betterment of society should be allowed to do so, but more importantly, they should NOT have been singled out as a high-risk group based solely on identifying as same-sex attracted. This was a very prejudiced stance to take; it assumed that all gay men are at high risk of HIV because of their sexual orientation. Some gay men are very risky sexually, but others are not. For example, a monogamous gay couple who are HIV-negative, or a gay man who was celibate for <12 months were not able to donate blood because they were considered high risk. Some groups of heterosexual men and women can also be at very high risk of acquiring or transmitting HIV but were not excluded.
From a medical perspective, why do you feel so strongly about MSM being able to donate?
Dr Rebe: The purpose of screening blood donors (and indeed donated blood) is to keep the blood supply as safe as possible. Risky donors should be excluded based on their behavioural risk of having a disease that could be transferred in blood. We have the knowledge to screen out potential HIV-infected blood donors based on their actual risk of disease (assessed by focused risk screening questions). Also, the technology for HIV screening in blood is now extremely advanced and the window period has been dramatically shortened. There is thus no purpose in excluding any individual from donating, based on their gender identity or sexual orientation. The same safety standards for blood donors now apply to everyone, and this is a much more equitable system.
There is another “softer” but equally important reason not to exclude MSM. Gay and other MSM often experience stigma, discrimination and rejection from a heterosexual world and are made to feel “abnormal or damaged” in some way. Contributing to the good of society (e.g. by donating blood) allows inclusion in society.
From an ethical perspective, why do you feel the same way?
Dr Rebe: Ethically, I think the principle of equity applies. Any adult who understands the need to donate blood should be able to be screened for eligibility. Men and women who engage in behaviours that put them at risk of HIV should be screened out, but no population should be identified and excluded, based on people’s or an organisation’s perception of their risk.
Some feel that you were instrumental in the movement to get SANBS to change this policy. Are you often at the forefront of these types of movements and causes?
Dr Rebe: I don’t think I made any difference at all. As a scientist, I prefer to let the evidence speak for itself and believe that health policies should be based on facts, not opinions. All that happened is that the evidence caught up with the SANBS!
How do you feel about SANBS policy currently?
Dr Rebe: I think the policy is now based on evidence and is far more equitable and fair while still doing the utmost to ensure the safety of donated blood. There is an attempt to access the risk of blood-borne diseases based on actual behaviours rather than identity. I think in some ways, the blood donor guidelines are still a little conservative (e.g. six months of abstinence regarding anal sex when the technology is there to detect early HIV infection in blood much earlier than this.
Do you donate blood?
Dr Rebe: Unfortunately, no. Although I can now donate blood as an openly gay man, I have a non-infectious chronic medical condition that precludes me from ever donating. As an interesting anecdote, I have often discussed blood donation with my MSM / gay patients. Many of them have been longstanding blood donors, even when they were ineligible because they were gay – they simply lied on the SANBS assessment form! Fortunately, that has now become historical.
For more on Blood Donor Day click here.