Why can’t more gay and bi men give blood?

Blood donation is an emotive and vitally important issue. Of course it is: we all need blood to live, so donating it saves and transforms countless thousands of lives. NHS Blood and Transplant (NHSBT) says it needs around 135,000 new donors each year to meet patients’ needs.

But at the moment the situation is, well, a bit of a bloody mess.

Simply, not enough men are donating. Last year only 41 per cent of new blood donors in England were male. This shortfall places extra strain on the national blood supply because men’s blood is naturally richer in iron. Because of this richness, only men’s blood is used for complete blood transfusions in newborn babies. Men’s blood also provides the lion’s share of platelets which are used to halt internal bleeding in cancer patients.

But if you’re a man who’s had anal or oral sex with another man in the last three months, you’re currently banned from giving blood. According to NHSBT, ​“this rule applies to every man, regardless of their sexual orientation, whether they’re in a stable relationship or whether they use protection such as condoms or pre-exposure prophylaxis (PrEP)”.

NHSBT says this three-month deferral period, which it upholds according to guidelines imposed by the Department of Health, is necessary ​“to reduce the risk of any very recently acquired infections not being detected on screening and further tests”.

It’s easy to see why the current three-month deferral period leaves many gay and bi men feeling discriminated against. Kevin Taylor-McKnight, a volunteer at Bloodwise, the UK’s leading blood cancer charity, is ​“frustrated and insulted” that he can’t give blood despite being in a long-term relationship for the last 14 years.

“My mum died seven years ago from blood cancer, which is why I volunteer at Bloodwise,” he says. ​“Before she died she needed regular blood transfusions. I would love to be able to donate blood to help others like her. But I can’t.”

Dr Ben Hockenhull, an NHS Anaesthetic Registrar who delivers blood transfusions as part of his job, shares this frustration. ​“It feels incongruous and counterintuitive that, as a gay man, I’m able to be your doctor and your surgeon – I’m able to undertake invasive procedures and operate on you – and yet I’m still unable to give blood.”

At the same time, it’s important to note that the UK’s three-month deferral period for men who have sex with men (MSM) is actually very progressive compared to many western countries.

In the US, Australia, Ireland and Germany, there’s still a 12-month deferral period for MSM wanting to give blood. Until July 2017, there was also a 12-month deferral period in the UK, but in what LGBT charity Stonewall called ​“an important step forward”, the UK government reduced it to three months following a review by SaBTO, the Advisory Committee on the Safety of Blood, Tissues and Organs.

This much-needed review happened following repeated calls from organisations including Stonewall, Terrence Higgins Trust, National Aids Trust and Freedom to Donate, a grassroots group set up by Ethan Spibey when he was a Westminster lobbyist working for a public affairs agency. Spibey founded Freedom to Donate because, like so many gay and bi men, he had felt crestfallen when he found out he couldn’t contribute to the national blood supply which saved his grandfather’s life.

“My dad brought home the forms and when I looked through them, one of the questions was: ​‘Have you had sex with a man in the last 12 months?’ I realised I couldn’t donate blood because the answer was yes – but I wasn’t out to my parents at the time so I made a really terrible excuse that I hated needles and kind of ran away from it,” Spibey recalls.

“I felt guilty and horrible at the same time because it felt like someone was saying: ​‘No, as a gay man we don’t want your blood.’”

As he worked in Westminster and had previously volunteered for Out4Marriage, a campaign which helped to secure same-sex marriage in England and Wales in 2013, Spibey says he had some understanding of how lobbying can work. But even so, Freedom to Donate started out modestly, just him and a few friends campaigning in their spare time.

“We did our homework by poring over government documents on blood donation and worked out an argument which said: ​‘This is why we need a review with gay and bi men at the forefront – because at the moment, you’re missing out on a load of blood.”

In addition to ​“sitting down with Stonewall and the LGBT Foundation” to pool ideas, Spibey says Freedom to Donate launched ​“a combined media and political campaign” calling for a review of the outdated 12-month deferral period.

After 18 months of campaigning, this hard work paid off. In what Spibey describes as ​“a real ​‘pinch me’ moment”, in direct response to a question from the Freedom to Donate campaign, a review was announced in the House of Commons by a health minister.

The review ultimately led to the government reducing the deferral period to three months in July 2017. But Spibey says this was never the campaign’s ​“end goal”. Organisations including Freedom to Donate and Stonewall are now calling for an ​“individualised process of risk assessment”.

Spibey describes this as potentially working a bit like a credit score.

Instead of blanket-banning groups such as MSM who’ve been sexually active in the last three months, all prospective donors could be asked a series of questions to build a fuller picture of the risk they pose.

“The current system is too binary,” states Spibey. ​“If you’re asking a man whether he’s had sex with another man in the last three months, why aren’t you also asking him how regularly he’s had sex with a man in the last three months, how many men he’s had sex with, whether it was protected and whether he’s on PrEP? And why aren’t you asking straight people similar kinds of questions about their sexual history as well?”

More questions obviously means more work for NHS staff carrying out the risk assessment, but Spibey insists it’s worth it.

“In the time taken to ask those extra questions, you’re potentially unlocking thousands of safe donors. That’s why there’s such a need for this.”

L-R: Ruth Hunt (former CEO of Stonewall), TV's Dr Christian, Ian Green, CEO of Terrence Higgins Trust and Ethan Spibey

Organisations including Freedom to Donate, Stonewall and NHSBT are now working together as part of the FAIR (For the Assessment of Individualised Risk) steering group. Their aim is ​“to explore [whether] a more individualised risk assessment approach to blood donor selection policy is possible whilst ensuring the safe supply of blood to patients”. The steering group says it hopes to report its findings to government policy makers ​“towards the end of 2020”.

Stonewall’s Josh Bradlow says the LGBT charity supports the FAIR group’s approach, ​“because essentially it sets out a roadmap for how an individualised process of risk assessment could be introduced in the future. That’s something we’ve always called for.

“We recognise the frustration that many gay and bi men feel, and we feel that frustration too,” Bradlow adds. ​“It feels unjust that, under the current deferral period, men who have sex with men are treated as a blanket group. We’re pleased there is work that is currently ongoing to address this. We recognise that we’re most useful as an organisation when we’re being a critical friend to NHSBT and helping to support them, because it’s only by working together that we can address this.

“It can take time to bring about a health and social care policy change like this one, but we’re going in the right direction.”

In the meantime, it goes without saying that it’s incredibly important for people who are able to donate blood to continue doing so. The current system may be imperfect, but we shouldn’t vent our frustration by undermining its ability to save and transform lives.

As Ethan Spibey notes, it’s also important for gay and bi men who can’t give blood to share with Freedom to Donate their personal reasons for wanting to do so.

“Every story helps us to make the case to government policy-makers on a very personal and human level. Giving blood is such an incredible thing to do, and everyone should have the same opportunity to do it.”

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