■ Associate Professor Anne Mitchell is the director of Gay and Lesbian Health Victoria.  The statement was given on August 12, 2008, to the Tasmanian Anti-Discrimination Tribunal who are hearing a case on the ban on gay men giving blood.

I have been working in HIV/AIDS prevention education and research for over 20 years and in that time I have never seen any evidence to suggest that safe sex does not work to prevent HIV infection.  Safe sex was itself an “invention’ of the gay community in the USA very early in the epidemic and before the discovery of HIV.

The 1983 booklet which is generally accredited with establishing safe sex principles for the first time was written by gay men in response to a crisis (Callen et al., 1983).  The most compelling evidence of all for the effectiveness of safe sex is the simple fact that before the disease was recognised and known to be a sexually transmissible disease spreading in the gay community, a majority of sexually active men were infected.

When safe sex was taken on by men who have sex with men (msm) over the next few years, the escalation in infection rates was pegged back. This made it immediately clear that the risk of HIV infection was not associated with male to male sex per se, rather it was associated with unsafe male to male sex. If safe sex was not effective in preventing HIV we would still be experiencing rates of infection similar to those at the beginning of the epidemic.

In the early years, the 1980s and early 90s, there was no cure nor any treatment for the disease but it was possible to work effectively as an educator and save lives because we did know what caused the disease and knew the ways in which infection could be prevented.

It would be ludicrous to imagine that men who were constantly nursing their friends through terrible and untimely deaths had no interest in adopting behaviours that might spare them a similar fate.  Despite the grief and losses associated with the need to adopt safe sex, it was not long before it became the intrinsic part of gay men’s sexual culture that it is today (Leonard and Mitchell, 2000).

To suggest otherwise would be to imagine gay men to be unduly stupid and careless of the safety of themselves and others, neither of which can be shown to be true. In fact the HIV Futures study of people with HIV infection in Australia which has been carried out every two years since 1997 has regularly found that people with HIV had a strong commitment to protecting their sexual partners and were practising safe sex regularly (Grierson et al.2006).  Msm in the era of AIDS have been one of the most highly scrutinised groups in history and there is ample research evidence to demonstrate high rates of condom use with regular and casual partners.

Msm have a number of ways in which they regularly reduce the risk of HIV transmission in a sexual encounter themselves from being infected with HIV.  The most obvious is to have no sex at all.  Men who have sex with men are equally likely as those who have sex only with women to have periods in their life in which they are not sexually active.  Msm may also engage in sexual activity which is non-penetrative in nature and so does not pose significant risk for HIV transmission.

They may choose only to have penetrative sex with one partner in a relationship in which both parties are monogamous and free of HIV.  Finally they may use condoms for penetrative sex.  There is wide consensus amongst Australian health educators, medical experts and policy makers that these strategies constitute safe sex and that safe sex is effective in reducing all STI transmission, including HIV.

These practices are widely adopted within the gay community and with msm who are not members of the gay community.  Therefore the vast majority of msm are never likely to become infected with HIV.

It is impossible to estimate the number of gay men in the community because of the difficulty of getting people to disclose in a society which is generally homophobic and discriminatory, and because of the fluidity of all aspects of human sexuality.  The Australian Study of Health and Relationships (Smith et al., 2003) which interviewed 20,000 people and is the largest study of this territory ever conducted in Australia, found that only 2% of the population identify as non-heterosexual.

However, when a definition of sexuality which includes the three domains of identity, attraction and experience is used it is more likely to capture msm who do not identify as gay.  In this instance it was shown that about 6 % of men in the sample have had sexual contact with someone of the same sex (Smith et al., 2003).  In rough figures if we take the population of Tasmania to be about 489,000 and assume half of them are male we are looking at a figure of about 15,000 who might be or become men who have sex with men.  Even allowing for some undiagnosed HIV infection, this is clearly many more than the 56 cases of HIV diagnosed in Tasmania between 1993 and 2006.

It is clear that the vast majority of msm in Tasmania do not pose a risk to the security of the blood supply and that deferring men on the basis of having had sex with men in the past twelve months is not a reasonable strategy. Collecting some more specific behavioural data from potential donors is far more likely to lead to reasonable and appropriate deferral.

This is indeed preferable to the current message that having sex with men is a dangerous activity which no amount of effort can make safe.  It is disappointing to see this message coming from a health authority such as the Red Cross.

Thirty years of health policy and funding and thirty years of HIV prevention education in Australia has been put into the message that safe sex is effective and that all people can prevent themselves from getting HIV by adopting safe sex practices.  I do not believe I know of any other organisation which does not accept this important and well-established public health message.

In my opinion it would be preferable if all potential blood donors were screened on the basis of their sexual activity rather than the gender of their partner.  While HIV is not nearly as prevalent in those whose sexual behaviour is exclusively heterosexual, safe sex practices are less common.

If we look at the issue of condom use, The Australian Study of Health and Relationships (De Visser, 2003) found that fewer than half of the respondents who were sexually active had used a condom in the past year.  In the latest survey of the sexual behaviour of senior students in Australian Secondary Schools, it was found that only 40% of the 18 year olds were using condoms (Smith et al 2003).

This can be compared with the figures from the Melbourne Gay Community Periodic Study (2006) which showed only 30% had engaged in unprotected anal intercourse with casual partners in the six months prior to the survey, and that about half of the participants had always used condoms (Hull et al, 2006).  If there was an outbreak of HIV, or a new sexually transmitted virus amongst heterosexuals in Australia it would clearly spread more rapidly than it would in the gay community.

Homophobia, stigma and marginalisation are significant issues for gay people in the Australian community.  An Australia Institute study in 2005 (Flood & Hamilton) found that over 35% of the population over 14 years of age thought that homosexuality was immoral.  When this was broken down by states and territories Tasmania was second only to the Northern Territory in high rates of homophobia with half the population in some areas of the state believing that homosexuality is immoral.

There is no doubt that homophobic attitudes have an impact on the health and wellbeing of gay and lesbian people.  In Australia Hillier and her colleagues (2005) found that in a sample of 1750 same sex attracted young people, the degree to which they had experienced vilification and violence determined how safe they felt, how much they used alcohol and drugs and their likelihood of having self harmed.  Studies world wide have documented alcohol and drug use, depression and self harm as the issues that are most likely to impact on the health of gay and lesbian people (Warner et al,2004; O’Hanlan et al., 1996) and these are the conditions most likely to develop in response to homophobic abuse.

An investigation carried out in Canada in 2001 found that, were it not for these two areas of morbity, the health of gay and lesbian people would be similar to that of heterosexuals.  The same report concluded that homophobia cost Canadian tax payers around $4 billion a year in treating conditions in gay and lesbian people arising from managing the chronic daily stress of experiencing homophobia.

Australia’s largest study of gay and lesbian people (Pitts et al, 2006) found that over 67% of the 5,500 participants modified their behaviour daily in a range of settings for fear of discrimination and violence.  Also in this study 60% of participants had experienced vilification or violence at some time, reinforcing the need for vigilance.  It is not difficult to imagine the impact of this necessary daily censorship in individual lives. .

In the context of these negative consequences of being gay in Australia today, it is hard to make the argument that homosexuality is a “lifestyle choice” since there appears to be dubious benefits and few inducements to any individual to decide to become gay.  There is no evidence anywhere world wide that people become gay by choice and it is more likely in the current social context that young people will struggle to deny their essential selves in the face of so much potential stigmatisation and rejection.  Homosexuality occurs in all societies and cultures to a similar degree, whether or not it is recognised or supported, and being homosexual is a natural and healthy way to be. Hillier and her colleagues (2005) found that over a third of her participants knew they were gay from a very early age, long before they had a name for it.

In its 1994 statement on Homosexuality the American Psychological Society wrote:

“Homosexuality is not a matter of individual choice. Research suggests that homosexual orientation is in place very early in the life cycle, possible even before birth. “

Public policy and public opinion are closely related (Maddison and Partridge, 2007) and an official policy from an authority such as the Red Cross on deferring potential donors on the basis of the gender of their partner would be likely to have a double impact.

In reiterating messages about the unacceptability of homosexuality Red Cross both feeds the stigmatisation already experienced constantly by gay people and reinforces public understandings that gay people are lesser and less responsible beings who can be legitimately rejected from social participation.  Given that those who give blood in Australia do so entirely for altruistic and humanitarian reasons they must experience this rejection of their social responsibility as particularly wounding.

While all blood donors who are deferred or rejected must feel some frustration and disappointment, the rejection of people who have lived in the UK for a period or worked in an abattoir, for example, does not acerbate an already stigmatised condition.  Such people are being deferred not on the basis of their identity but on information obtained which indicates a direct potential threat to the blood supply.

The deferral of men who have sex with men is based on who they are rather than what they have recently done and can be likened to deferral on the grounds of being Jewish or indigenous. It is clear that society would not tolerate such discrimination based on race and ethnicity, and sexual orientation, as I have argued previously, is not different. 

Of all the concerns that relate to the current policy, one of the most important might be the message of judgement and disapproval given to heterosexual men who have sex with men, causing them some difficulty reporting this stigmatised behaviour Caduring the screening process.

If questions about the safety or otherwise of sexual activity were asked in a non-judgemental manner it is far more likely that they would feel able to respond honestly without attracting perceived disapproval.

SEE ALSO

Bio-Ethicists Address Gay Blood Donor Hearings.  Two bio-ethicists today addressed the inquiry underway in Tasmania into gay blood donation. (UK Gay News, August 13, 2008)

Tasmanian ‘Gay Blood’ Inquiry Hears that Safe Sex Works.  An inquiry into the current ban on gay blood donation has heard that safe sex is effective in reducing HIV risk.  Social researcher, Associate Professor Anne Mitchell, today told the Tasmanian Anti-Discrimination Tribunal that risky sexual activity is not as widespread amongst gay and bisexual men as some studies suggest.   (UK Gay News, August 12, 2008)

Gay Blood Ban Hearing: Red Cross Accused of “Scare Tactics”.   Gay activists have accused the Red Cross of scare tactics on the first day of a hearing into Australia’s gay blood ban, in Hobart today.  (UK Gay News, August 7, 2008)

Groundbreaking Gay Blood Ban Case Starts Thursday.  The first full hearing in a groundbreaking gay blood ban case begins in Hobart, Tasmania, on Thursday before the Tasmanian Anti-Discrimination Tribunal.  (UK Gay News, August 5, 2008)