Tracing a bloodline of stigma: The history behind the GBMSM blood ban

As countries overturn remnants of the GBMSM blood ban, it calls into question why a policy shaped by ignorance and fear persisted for over 40 years.

bags of blood

During the 1980’s, at the height of the AIDS epidemic, a blood ban on high risk groups, such as gay, bisexual and men who have sex with men (GBMSM), was enacted in response to ineffective screening processes. Due to government bodies initial dismissal of the virus and silencing of queer voices, healthcare systems were unequipped to handle this ever-evolving situation and restrictions on donations emerged as one solution. 

Speaking about the introduction of the lifetime blood ban for GBMSM in Ireland, a spokesperson from the Irish Blood Transfusion Service said, “This was introduced in the 1980’s with the emergence of HIV which was associated with high risk sexual activity which included men that had sex with men and heterosexual sex in countries of high prevalence (Sub Saharan, Africa and SE Asia).”

“Users of non-prescribed injected recreational drugs and their partners were also considered high risk. At the time the association between HIV and transfusion was first noted, tests for HIV were non-existent and, when introduced, there was a long period of risk between acquiring the disease and the test becoming positive (the window period),” they further stated. 

Global responses to the AIDS epidemic were severely hindered by a clear lack of information regarding the virus. Despite numerous countries implementing rigorous testing and restrictions on blood donations, French scientists concluded that the Wellcome Laboratories AIDS diagnostic kit, favoured by the National Blood Transfusion Service Board, was unable to detect a new strain of the virus during the 1980’s. 

With global healthcare systems buckling under an ever growing pressure, public conversations slowly spiraled around fears of infection. Against this dread infused climate, queer bodies came under vicious scrutiny. Every man who had sex with men were deemed at risk and, as such, unhealthy by default.

The blood ban emerged among portrayals of sex outside a strictly monogamous heterosexual relationship as a threat to society, encapsulated by a Limerick Bishop: “In our very nearly upside down world, good sex itself is under siege.” This moral panic pulled blame away from social, political and economic factors that exasperated the epidemic into a crisis.

By targeting men who had sex with men, the blood ban enforced a narrative of the AIDS epidemic that centred predominantly cis homosexual men. It further isolated and, as such, stigmatises the experiences of those outside this grouping.  

In January 1987, the British Medical Association clashed with the National Blood Transfusion Service over who should be permitted to donate blood. The BMA argued that any man or woman who had casual sex over the past four years should not give blood. However, the organisation eventually backed down and supported solely excluding high risk groups, stating, “It is vitally important that this risk should remain negligible. So far the guidelines to donors, combined with testing, have proved highly effective in safeguarding this position.” 

Further illustrating this global crusade against GBT+ men to protect blood supplies, in 1987, Russian authorities announced they would be screening donors for HIV and carrying out systematic checks among high-risks groups. Head of the Virology Institute at the Soviet Academy of Medical Sciences, Viktor Zhdanov, stated, “A healthy family life is diametrically opposed to sexual perversion and every citizen should know that sexual perversion is not only immoral but also dangerous.”

This vilification of queer bodies, especially in regards to sex between men, has continued to inform blood donation policies throughout the past 40 years. Although the lifetime ban has been lifted in many countries, it was replaced with a deferral process requiring GBMSM to abstain from sex for a set period of time before donating. 

Deferral periods for blood donations range from three months to five years dependent upon the country, with a vast majority implementing a one year policy. Italy, Spain and a few other places scrapped all restrictions solely targeting GBMSM in favour of an individual risk assessment procedure, which the UK are moving towards around the summer of 2021

Ireland replaced the lifetime ban with a one year deferral period in January 2017. Speaking about how this change came about, the IBTS spokesperson stated, “In 2016, the previous Medical and Scientific Director convened a workshop of international experts to examine the evidence around the deferrals for men that have sex with men. The outcome of this meeting was a recommendation that the lifetime ban be removed and the deferral for one year introduced.”

“The time frame was introduced on the basis of best international practise which, at that time, varied from 12 months to lifetime bans with a few exceptions (just Spain and Italy) that had individual assessment selection criteria,” the spokesperson continued. 

After the lifting of the lifetime ban, activist Tomás Heneghan became the first openly GBMSM to give blood. Two years prior, he had brought a High Court challenge against IBTS, the Minister of Health, and the State after being told that he was permanently “deferred” from donating because he had a sexual encounter with another man.

Heneghan opened up about what led him towards taking legal action, “I wanted to know why this ban was in place, what was the actual scientific and medical reason for it. I spent hours, days, weeks and months researching the issue. I needed to know why the ban existed and I wanted an apology for what I viewed as homophobic treatment by a national health service.”

“Britain had changed its policy three years earlier. Other countries around the world were changing too. But in Ireland it seemed to be a case of ‘nothing to see here’. So, I took the only road left open to me. If no one could justify the lifetime ban to me and no one was taking responsibility for changing it, then I would have to make them face the problem head on,” Heneghan continued. 

Following the decision to reduce the lifetime blood ban to a one year deferral process, Heneghan withdrew his case from court. However, he believes the change has not gone far enough and that Ireland must take on an individual risk assessment policy for donations. He stated, “It takes people as individual human beings and determines their potential risk to the blood supply on the basis of their individual behaviour.”

Heneghan went on to add, “Because I deserve to be treated as an equal citizen and have my contribution to society measured properly, through science in this case, I will continue to fight the ban on men who have sex with men until we achieve a fair, safe, effective and scientific blood donation system in this country.”

Around the world, people have challenged these restrictions through art, grassroots movements, and legal action. After almost four years in the Supreme Court, Brazil abolished the 12 month deferral period on GBT+ men donating blood in 2020.

Supreme court minister Edson Fachin wrote in his vote, “Instead of the State enabling these people to promote good by donating blood, it unduly restricts solidarity based on prejudice and discrimination.” 

Among the global GBMSM blood ban protests, artists stand in open defiance to the stigma grafted onto queer bodies through works such as an Alan Turing portrait, ‘Blood is Blood’ t-shirts, and Visceral: The Poetry of Blood. In Ireland, photographer Brian Teeling has been designing a community driven ‘End The Gay Blood Ban’ campaign. 

Teeling spoke on the need for action against the GBMSM blood ban, “It’s part of the architecture of shame and legacy of discrimination that has hovered over our community like a pitch-black pall since the formation of this nation. Its omnipresence is suffocating at times but we have shown as a community that we are resilient and we can unite when it’s needed to chip away at this mosaic of bias.”

The artist recalls a time during his late teens/early 20’s when he went to donate blood with a straight friend. He said, “Reading the questionnaire left me crushed. I at once felt dirty, poisonous and worthless. Like the claret in my veins was worth nothing to no one. Thinking back, watching my friend donate and be treated by the nurses like a hero afterwards made me feel lower than low. Subhuman even.”

Looking back on this experience, Teeling concluded, “This was at a difficult period of my life where I was coming to terms with my sexuality. Self-destruction and a predilection to oblivion were all the rage in my clouded mind. This instance compounded my feelings of shame and isolation. I’m annoyed with myself for not having spoken out about it sooner.”

Smiley face with upside blood drop eyes, designed by Brian Teeling for End Gay Blood Ban campaign
Image by Brian Teeling

Regarding future blood donation policies, Teeling considers individual risk assessments the best way forward. He outlined that this was “not just for the benefit of MSM but also to protect and enhance the blood supply. When the IBTS looks at the evidence available, it should consider best-practice and adapt. That is their responsibility.”

“Complete medical conservatism and visions of entropy have no place in the progress of our healthcare system, especially when it comes to sexual health in this country. We are miles behind so many other countries,” Teeling concluded.

In June 2020, the IBTS established a Social Behaviours Review Group to assess the current policy on GBMSM donating blood and whether it must be changed, taking into consideration an individual risk assessment approach. HIV Ireland, represented by MPOWER Programme Manager Adam Shanley, are taking part in the expert advisory group. 

Reflecting on the GBMSM blood ban, Shanley stated, “We believe that the highest priority must always be to ensure the safety and reliability of the blood supply and that any decision around donor criteria must be based on the most recent scientific evidence available. Public confidence in the blood supply is absolutely key. However, we called for a review of the current policy because we believe those in place do not consider advancements in the accuracy of testing technology.” 

“Modern HIV diagnostics have developed with such sophistication that they have reduced the window period (in blood donor testing facilities) for the virus to 9 – 12 days. This gives rise to the question of whether it is reasonable to maintain 12-month deferral criteria for donors who are considered at an elevated risk of acquiring HIV when a recent infection can be detected within days,” Shanley continued. 

Due to COVID-19, global healthcare systems are being forced to swiftly adapt their policies, which resulted in the US Food and Drug Administration reducing the GBMSM blood donation deferral period from one year to three years. In response to the pandemic, Shanley has called for action regarding sexual health services in Ireland,“An urgent ongoing priority for HIV Ireland is to achieve an end to new HIV transmissions in Ireland. We have all the tools we need to do this but they’re not getting to the people who need them.”

Speaking on the link between accessible sexual health services and ending the GBMSM blood ban, Shanley said, “While fairer blood donation policy is something we are engaged in achieving – we need to focus on the bigger picture and rally behind reducing the unacceptably high rates of HIV our community is experiencing. After all, by ending HIV, we also move toward ending inequalities in blood donation policy.”

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