Gay blood donors: Want to end the ban? Tell us what you do in bed.

Thanks to a new analysis of infection risk, having sex with another man will no longer permanently bar you from donating blood in the United Kingdom. Pretty soon, it won't bar you from donating blood in the United States, either. We're moving away from a blood screening policy based on sexual orientation.

That's the good news. Here's the bad news: We're moving toward a policy that will require you to disclose a lot more about what you do in bed, how often, and with whom.

Until now, the U.K., like the U.S., has forbidden blood donations by any man who has ever had sex with another man (MSM). The U.K., unlike the U.S., specifies oral or anal sex. This permanent, categorical exclusion was based on the greater risk of HIV and hepatitis infection among such men. It didn't matter that the last time you had sex with a man was 30 years ago. Statistically, you were put in a risk category with guys prowling for fresh meat every night.

Critics, including me, called this policy unwarranted and unfair. And last week, the U.K. Advisory Committee on the Safety of Blood, Tissues and Organs agreed. In a review of evidence, it noted that the "window" period for the relevant viruses?the period during which you might be infected (from a sex act) but not yet show up as infected on donor blood tests?is now nine to 15 days for HIV and 38 to 67 days for hepatitis B. In the case of hepatitis B, blood tests might miss the tail end of the infection as well as the beginning. To avoid this second window, the committee proposed a "deferral" period of one year. If you've had sex with another man in the last year, your blood could be undetectably infected. Past that point, blood tests are reliable, and you can donate.

The committee calculated that under the current lifetime ban on MSM donors, the frequency of HIV-infectious blood escaping detection in England and Wales was one per 4.41 million donations. (See Table 7 on page 36 of the report.) Under a five-year deferral (allowing MSM to donate if they hadn't had oral or anal sex with another man in the last five years), the frequency of infectious blood escaping detection would be one per 4.39 million donations. Under a one-year deferral, it would be one per 4.38 million donations. In short, no difference.

Dropping the deferral altogether, however, would make a difference. Thanks to the window problem, the frequency would rise to one per 3.48 million donations?a 26 percent increase. So the deferral won't be eliminated.

Gay activists are happy that the lifetime ban is ending. But they aren't satisfied with the one-year deferral. All gay men should be allowed to donate, without deferral, "if they always have safe sex with a condom, have only one partner and test HIV negative," argues Peter Tatchell, a leading British gay rights advocate. Ben Summerskill, the chief executive of Stonewall, a gay rights lobby, agrees. "Under the new rules, a gay man in a monogamous relationship who has only had oral sex will still automatically be unable to give blood," Summerskill points out, "but a heterosexual man who has had multiple partners and not worn a condom will not be questioned about his behavior."

These critics are right. The fairest way to minimize the risk of a window-period infection is to assess donors as individuals, not as groups. But that means careful interrogation. The donor questionnaire "should be made more detailed for men who've had sex with men, in order to more accurately identify the degree of risk," says Tatchell. In fact, Summerskill argues, all donors "should be asked similar questions?irrespective of their sexual orientation?that accurately assess their level of risk of infection."

The committee report offers a good illustration of how to get that kind of information. It cites data from the 2000 U.K. National Survey of Sexual Attitudes and Lifestyles, known as NATSAL. That survey found that 45 percent of MSM had never had genital contact with more than one male partner. Three-quarters of these single-partner men had never had anal sex; more than 60 percent had no sexual contact with men in the last year. Among men who'd had sex with men in the previous year, 40 percent had only one partner during that time, 22 percent had no activity with a partner in the last four weeks, and only 40 percent had activity with a new partner during the last four weeks. NATSAL found that the median number of partners reported by MSM in the previous year was two, but the mean was eight. That's a huge gap. It means that a minority of gay men are intensely promiscuous, and they're inflating the average risk data for the majority who aren't.

How did NATSAL get this kind of information? By asking for it. The current U.K. blood donor questionnaire asks, "Are you a man who has ever had oral or anal sex with a man, with or without a condom?" If you say yes, you're told not to give blood. The NATSAL questionnaire goes much deeper. It asks how many sex partners you've had in the last year, the last three months, the last four weeks, and the last seven days. It asks how many times you've had sex during each of these time frames, and how many times you've used a condom. It asks whether your partners were male or female and what kind of sex you had with them: vaginal, oral, or anal. It asks whether you were giving or receiving the oral sex and whether, during anal penetration, you were pitching or catching. It asks these things not just in general but specifically about your most recent encounter.

That's the kind of interrogation you'll have to endure if we're going to assess your precise risk of donating infected blood. And that's why the U.K. committee didn't go that route, even though the interrogations would be confidential. "Studies suggest that the introduction of extensive donor health check questionnaires regarding sexual history will lead to a loss of existing donors," the committee concludes. "As a consequence of these factors, the review group excluded a sexual behavior based deferral at this moment in time."

So there's your challenge. To make specific behaviors, rather than group membership, the basis for donor screening, you'll have to persuade blood collection agencies that they'll lose fewer donors from behavioral interrogation than from excluding or deferring gay men. You'll have to take one for the team?in this case, for the other team. You'll have to surrender some of your privacy as well as your blood. Are you up for that?

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