Should the doctors trust the donors?

Many european countries have allowed gay men to donate blood, but the otherwise LGBT-friendly country of Denmark is still gives gay men a lifetime ban from donating. But changes to the rule are being discussed.

By Frederik Jensen and Andreas Hemme

As Jan Engberg sits down in the chair and prepares for his 42nd donation at the blood bank in Skejby, the first nurse available, Pia Doormann, starts the procedure. She checks his blood pressure, which is just a little below the normal minimum. But as Jan is in good shape, the procedure can go on.
Jan Engberg works at Aarhus University as a professor in knowledge communication which often includes trips around the world. Some of these areas are considered “high risk” and result in a temporary quarantine. One of these is Italy, which gives the donor a 4 week quarantine due to an increased risk of West Nile Virus.
“I’m donating blood today, as I’m leaving tomorrow. This is one of the things that I like to get done before any trip,” he says.
While a trip to Italy only results in a 4 week quarantine, other risky behaviour is less forgiving. Even though Denmark is generally seen as progressive concerning gay rights, bhe blood banks of Denmark and the legislation they follow does not allow for men who have ever had sex with men, MSM,  to donate blood.
It’s a subject that evokes strong feelings. Several LGBT organizations see it as unnecessary discrimination, some doctors in the field say it has no grounds in modern day research and statistics, while others claim that it would complicate the safety of patients in a situation where it isn’t needed.

Rules should be based on sexual conduct, not sexual orientation

Kim Eriksen at his home in Rødkærsbro, Denmark says that while undergoing treatment for his treatment for HIV he can’t infect others through sexual intercourse, and isn’t affected by the disease in everyday life.
Kim Eriksen at his home in Rødkærsbro, Denmark says that while undergoing treatment for his treatment for HIV he can’t infect others through sexual intercourse, and isn’t affected by the disease in everyday life.

Kim Eriksen, board member of Lambda, a Danish LGBT organization, is gay and of the opinion that the current quarantine rules are discriminatory.
“The quarantine rules should be the same as for heterosexuals, because homosexuals will tell the truth in the screening process, just like the heterosexuals. Giving homosexuals a one-year quarantine would be even more discriminatory. The rules should be equal for everyone!” Says Kim Eriksen.

Aidsfondet Aarhus is a part of the nationwide group which combats stigma through research and information.
Aidsfondet Aarhus is a part of the nationwide group which combats stigma through research and information.

This view is backed up by Andy Grysbæk from the AIDS Foundation, an advocacy group whose goal it is to fight HIV and AIDS, and remove the stigma regarding the disease.
“It shouldn’t be a lifetime quarantine. It should be based on the individual and their risk of having HIV. For heterosexuals there is no problem in asking, trusting and giving quarantines based on their answers. I don’t see why this should be any different for homosexuals,” he says.
Kim Eriksen was infected with HIV 13 years ago, so he’ll never be able to donate blood. But even though he won’t, he still thinks that the current rules are discriminatory, as it stigmatizes the entire gay community.
“I know that I’ll never be allowed to donate blood because of my disease. But even if I wasn’t HIV positive, I couldn’t donate because of my sexuality. The fact that they make these divisions solely based on sexual orientation makes me and the gay community feel like second class citizens,”
Kim Eriksen is not alone in this. LGBT Denmark and Spectrum, two other Danish LGBT organizations, support his opinion, and they also view the current law as discriminatory and outdated. Several parties in the Danish Parliament share this opinion.

Rules are there for a reason
The lifetime ban for homosexual men was instituted in the 1980’s as a way to stop HIV/Aids spreading via blood transfusions. The rule was instituted when the HIV-epidemic was raging and hospitals had big problems considering blood and infections.
“As the male homosexual population had a much higher frequency of HIV, they instituted the ban in all of the West. They discovered that the rule greatly decreased the spread and they concluded that it worked. We were infecting people with blood transfusions before the rule was instituted,” says Henrik Ullum, clinical associate professor at the Department of Clinical Medicine at Rigshospitalet, and a member of the Committee concerning transfusion transmitted infection.
The graph shows the number of HIV-infections based on gender. Women are much less likely to have HIV than men.
This graph shows the infections based on sexual orientation. It’s worth noting that the difference between homosexual and heterosexual sex is very small. That still means that the MSM-population is overrepresented in the statistics as they are a much smaller group.
While the statistics show that both men and women of all sexual orientations report HIV-infections, only the MSM-population is banned. Jens Lundgren, Professor of Viral Diseases at the University of Copenhagen and Chief Physician at the Department of Infectious Diseases at Rigshospitalet, believes that a lifetime ban is uncalled for.

Here Poul Jaszcak explains why he doesn’t think gay people should be allowed to donate blood. 

“A quarantine of 6 months should be more than enough. That should be more than sufficient to locate any diseases in donors,” he says.
Not all doctors share this opinion though. Former chief physician and now a member of the government funded National Ethics Council in Denmark Poul Jazsczak does not believe that the rules should be changed to accommodate the MSM population.
“What comes first and foremost must be the safety of the patients. We should not relax the rules in any way until you can be absolutely 100 % certain. HIV is still very visible in the MSM community. I believe that softer rules would compromise the health and safety of the patients,” he says.

Change the rules to change the debate
blood-donation-in-denmark (3)
Even though Denmark needs to find roughly 25.000 new donors each year, so far it hasn’t been a problem. Clinical associate professor Henrik Ullum says that the goal of a rule change wouldn’t be to find new donors.
“When the blood banks are thinking of changing this, it’s not to recruit new donors. We are doing this to remove some of the debate on the subject. It’s a subject that gets intense emotions and reactions. If we can remove the debate and still have safe blood, then that is what we want,” he says.
In several other countries the quarantine rules have already been changed. Henrik Ullum says that if the experiences in the other countries proves that the changes are safe, Denmark would be ready to follow in their footsteps.
“In Denmark we’re following the progress in other countries. There are big countries who have considered the risks. We would like to take advantage of their experiences,” he says.