New Blood Donation Rules Create System of 'Good Gays' and 'Bad Gays', Say Campaigners

The fact that the UK's new regulations exclude people on PrEP has proved controversial.
JG
London, GB
blood donation
Photo: LINDSEY WASSON / REUTERS

Blood donation rules concerning men who have sex with men are being relaxed across the UK, with the focus shifting towards an individual assessment of risk. For some gay men, this is welcome news, while others argue that the measures risk creating a hierarchy of respectability.

The idea is that the new rules will assess your eligibility to donate based on your behaviour, rather than your identity. Ethan Spibey, founder of Freedom to Donate, tells VICE World News: “This is a significant shift from a policy which simply asked about sexuality [“have you had sex with a man?”] and moved to one whereby everyone, regardless of their sexuality, is asked about their specific sexual behaviour. This unlocks the potential of thousands of gay and bisexual men who previously couldn’t donate.”

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Prior to this, the donation rules stipulated that if you were a man who’d had oral or anal sex with another man in the last three months, you wouldn’t be allowed to donate, regardless of the circumstances in which the sexual contact took place. For example, giving your long-term boyfriend a blowjob was enough to see you barred from donating, despite the fact that oral sex carries an almost negligible risk when it comes to HIV transmission.

Under the new rules, all potential blood donors who have been with their partner for over three months (or only had one partner within this timeframe) will now be allowed to donate, regardless of their sexual orientation. Moreover, anyone who’s had more than one sexual partner within the last three months, regardless of their sexuality, will be allowed to donate, as long as they haven’t had anal sex (an activity that carries a higher risk of HIV transmission).

However, a significant number of people will be deemed ineligible to donate, including those on PrEP (a drug that prevents the transmission of HIV) and people who engage in chemsex. Ben Weil, an academic who specialises in the politics of blood donor activity, has criticised the measures for creating new categories of risk, and in the process propping up a moralising agenda that deems certain gay men respectable and others beyond the pale.

“What we’re seeing is a delineation of ‘good’ gays and ‘bad’ gays,” says Ben. “Good gays are respectable, monogamous, in long-term relationships, have sex in private behind closed doors and are safe to give blood. And literally everybody else is not eligible.”

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“If you use PrEP, which is known to be a highly effective HIV prevention tool, you can’t give blood, as you’re deemed high risk,” he says. “If you’ve had chemsex in the last three months, despite the fact that chemsex refers to an enormous array of practices and is an incredibly vague label, you can’t give blood.”

While there is evidence to support the idea that chemsex practices may be associated with a higher risk of HIV transmission, Ben argues there’s equally compelling data that suggests people who engage in chemsex practices are more likely to use both HIV prevention services and PrEP.

“You might respond, ‘Well, so what?’” says Ben. “But this kind of labelling has significant implications in terms of sexual stigma and how these things are researched and studied.”

The idea that blood donor activism pushes a “good gays who don’t get HIV” and a “bad gays who do” narrative is a long-running critique. Today, the backlash focuses particularly on the fact that these new regulations privilege monogamous gay couples, something Ethan firmly rejects.

“I’ve seen people twisting that,” he says. “But the text says ‘sexual partners’. It doesn’t make any kind of assumptions about relationships, or ask if you’re in a monogamous relationship. The stereotype and generalisation that those people have made about monogamy is entirely wrong and not what the press release says – they should probably read that.”

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The monogamy issue aside, the fact that people on PrEP will not be eligible to donate has proven particularly controversial. But this doesn’t necessarily mean those behind the measures consider PrEP to unsafe or unreliable. Dr Will Nutland, co-founder of Prepster – a group that campaigns for the use of PrEP in the UK – tells VICE World News: “This recommendation does not question the efficacy of PrEP. When PrEP is used as recommended it is almost 100 percent effective.”

The problem is not the efficacy of PrEP, which is by now beyond question, but the possibility that the drug may extend the window where HIV infections don’t show up on a blood taste. If you’ve recently been infected with HIV when you start taking PrEP, this might not show up as soon on an HIV test and give a false negative test result, according to Dr Nutland. “It is pragmatic that this deferral remains in place until the review of those guidelines, supported by current and emerging evidence, has been completed,” he says.

Ethan agrees that people on PrEP not being allowed to donate is “frustrating”, but concedes that it’s based on a lack of current evidence. “It’s not widely available on the NHS and there’s no data on it,” he says. “But we’ve also secured a commitment from them to look at that as the data comes through. It’s definitely something we want to push on.”

For critics of blood donor activism, like Ben, this energy could be better directed elsewhere. “My argument has always been that blood donor activism is an unnecessary political pursuit,” he says. “I understand that being labelled a risk group is sexually stigmatising, and that there’s a homophobic assumption in the blanket categorisation of all men who have sex with men as an HIV risk. But while men who have sex with men are disproportionately at risk of becoming infected with HIV, blood donor activism was only ever going to create a condition where the only argument that could be forwarded is that there are good gay men who don’t get HIV and there are bad gay men who do.”

Ben argues that a better focus for the gay community would be working towards eradicating HIV itself, rather than the rules around blood donation. “The political goal should always have been ending the HIV crisis,” Ben says. “If a gay or bisexual man wants to give blood like heterosexual people do, we need to make it so the risk is the same as for his heterosexual counterpart. That’s how you get the equitable claim to give blood in the United Kingdom.”