A new policy rolled out in the U.K. this week shortening the deferral period for gay and bisexual men seeking to donate blood was met with tepid applause from LGBTQ advocates.
The updated donation rules, which were announced in July, came into effect in Scotland and Wales on Monday and in England on Tuesday. The new policy permits men who have sex with men (MSM) to donate blood if they have abstained from sex for three months. This replaces the previous 12-month deferral policy that has been in place since the lifetime ban was abolished in the U.K. in 2011.
As was the case when the U.S. abolished its MSM lifetime blood ban in 2015 and replaced it with a 12-month deferral period, LGBTQ advocates are welcoming the policy shift while reaffirming their commitment to doing away entirely with deferral periods for MSM, which they say are discriminatory.
"We hope many gay and bisexual men who are now able to donate do so with their peers," Scott Cuthbertson, the development manager of Scottish LGBTQ advocacy group Equality Network, said in a statement. "These new rules are a welcome and significant step forward. We remain concerned, however, that for too many low risk gay and bisexual men these new rules are, in effect, a continued ban."
Nicholas Baker, communications manager at U.K.-based gay men's health charity GMFA, was part of the Safety of Blood, Tissues and Organs (SaBTO) advisory committee, which advised U.K. government ministers and health departments on the issue. He told NBC News he welcomes the new policy but, while recognizing that gay men are disproportionately affected by HIV, believes the deferral periods remain outdated.
"This is an important step forward, but governments should continually review the need for deferral periods based on the effectiveness of testing for infections, STI prevalence and the ability to implement individual risk assessments," he said. "Being able to donate blood is a hugely altruistic thing to do and helps save lives every day."
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Cuthbertson also referenced an individual sexual risk assessment policy that he believes ought to replace the deferral periods. Such a practice has been utilized in Italy since 2001.
"The blood service has committed to explore ways in which a more personalized risk assessment could be introduced," he said. "We look forward to continuing to work with both the blood service and the Advisory Committee on the Safety of Blood, Tissues and Organs to eliminate all unwarranted discrimination from the U.K.'s blood donation rules."
Enduring stigma
In the U.S., advocates are still criticizing the Food and Drug Administration's one-year deferral period for MSM. One such voice is Mark King, who tested positive for HIV in 1985. He said the deferral periods, while getting shorter, are holdovers from an era of panic over AIDS.
"They are just the latest chapter in a narrative that casts gay men as untrustworthy, promiscuous vectors of disease," he told NBC News. "We know scientifically we pose no greater threat than anyone else, but fear is a really powerful thing — especially fear of HIV."
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The FDA's lifetime ban policy on MSM was implemented in 1983 in response to the HIV/AIDS crisis in the U.S. This policy was abolished and replaced by a yearlong deferral period in 2015. Today, HIV can be treated with new medical advancements, and those diagnosed with the virus can reduce their viral load to undetectable. King and other advocates, however, say the stigma against HIV remains.
"I understand this primal fear that has been embedded into our consciousness for two generations," King said. "But we should not be penalized as a people who want to contribute to public health as much as anyone else."
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Jay Franzone, who in 2016 abstained from sex for one year in order to give blood, echoed King on the lingering misconceptions about people living with HIV. He told NBC News that the U.K. shortening the deferral period is a small step in the right direction but not cause to celebrate quite yet.
"Three months is still three months. It's still a discriminatory policy that puts all men who have sexual contact with men in the same bubble as people who are engaging in a variety of risky behaviors," Franzone said. "At the end of the day, it's still a ban."
Alternative models
Today, the global patchwork of laws on blood donations from MSM runs the gamut from absolute bans on any man who has ever had sex with another man to total abolishment of deferral periods in favor of individual risk assessments.
Italy is one nation that has adopted the latter, and many LGBTQ advocates in other countries point to it when it comes to policies on MSM donating blood. Italy abolished its blanket ban on all MSM from donating blood in 2001 by ministerial decree.
As for its effects, a 2013 study published in the Italian medical journal "Blood Transfusion" found changing blood donor screening criteria in Italy from a permanent deferral for MSM to an individual risk assessment had no significant impact on HIV rates in the country.
Italy's individual risk assessment method involves a blood donor filling out a questionnaire about his or her sexual behavior and, when applicable, his or her partner's sexual behavior. The donor is then interviewed by a trained physician for investigation and confirmation of risk exposures. "High risk behavior," such as having casual sex with an HIV-infected or Hepatitis C-infected partner, is then assessed regardless of sexual orientation.
Several other countries, including Spain, Argentina and Mexico, have also adopted an individual risk assessment policy. And more than 20 countries — including the U.S., U.K, Australia and Canada — have replaced lifetime MSM blood bans with deferral periods ranging in length from three months to one year.
Advocates like King say they hope more countries adopt an individual assessment policy.
"We can detect HIV within days of infection now, but people come up with these fantasy scenarios like, 'What if somebody gets infected today and gives blood tomorrow?'" he said. "People hide their fear behind these scenarios that are unlikely, if not impossible."
