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"Especially with the country in great need of donation, science should speak louder than stigma in determining who can help."
November 12, 2012 7:10 AM   Subscribe

Tainted: Why Gay Men Still Can't Donate Blood - "Since 1983, Food and Drug Administration (FDA) guidelines have disqualified men who have ever had sex with men (MSM) from donating blood... Uneven application of exclusion to at-risk individuals suggests that risk aversion disproportionately impacts MSMs. For example, a non-MSM individual who has had sexual contact with a commercial sex worker or HIV-positive partner is deferred for only twelve months... The fact that the U.S. upholds a lifetime ban on MSM donation while Australian policy allows MSM individuals to donate a year or less after contact reveals a glaring discrepancy. Both ethics and science point to a flaw in FDA policy. That I could have had sex with 365 partners this year and be a perfectly fine candidate for donating blood, while the MSM next to me wouldn't qualify, betrays a faulty line of logic."

*Macleans - Who's afraid of a gay man's blood? We are:
"Starting in November [2011], the United Kingdom will join South Africa, Australia, New Zealand, Japan and other countries that have lifted the lifetime ban on blood donations from men who have sex with other men (MSM) and instead impose a 12-month deferral period after oral or anal sexual contact with a same-sex partner has occurred. This rule will apply whether or not a condom was used.

The policy change is based on the findings of the independent Advisory Committee on the Safety of Blood, Tissues, and Organs, which reviewed the evidence on donor selection criteria, taking into account improvements in blood testing, monitoring from countries with shortened deferral periods, and donors’ compliance with the ban. They concluded that the science “no longer support[s] the permanent exclusion of men who have had sex with men.”

...In Sweden, Japan, and Australia, the wait is one year. In New Zealand, it’s five. In South Africa, six months from a man’s last same-sex encounter is enough. In Italy, the restriction lasts for four months after sex with a new partner. Canada—along with the US, France and many other countries—continue to refuse MSM donors all together. Why this variation?"
*Wikipedia - Gay male blood donor controversy

*Red Cross Favors Amending Blood Donation Policy by Gay and Bisexual Men: "The FDA maintains that gay and bisexual men should not be allowed to donate blood, but the Red Cross believes there should only be a 12 month deferral"

*CNN - As blood donations decline, U.S. ban on gay donors is examined:
While he is a gay man, Adam Denney thinks he would be the perfect candidate to donate blood. He doesn't use IV drugs. He practices safer sex. He even educates people on how to prevent new HIV infections as a regular volunteer educator with AIDS Volunteers Inc. in Lexington, Kentucky. He thinks his exclusion is unfair. "Yes, gay men are still a high-risk community, but so are minority women, and there are no standards prohibiting them from donating. There would be rightful outrage against that kind of blanket population ban," Denney said. "I am banned based on one reason only, my sexual orientation. It's totally discriminatory."
*Buzzfeed - Hurricane Puts A Blood Ban Back In The Spotlight: "Hurricane Sandy means an urgent need for blood donations. But gay men still can't donate."

(previously: the ban on blood donation)
posted by flex (104 comments total) 29 users marked this as a favorite

 
It mildly frustrates me that in the US the Red Cross won't take my blood because I lived in Nigeria for nine months in 1980. I usually check up with a donation station once a year to see whether they've lifted the ban. I do donate when I'm back in Australia, where this silly restriction isn't applied.

In a sense, though, I'm kind of glad about it, because I hate the process of giving blood.
posted by Coventry at 7:16 AM on November 12, 2012 [2 favorites]


The ban is completely ridiculous. As a Red Cross blood center worker once told me when I was trying to find out if I was disqualified or not, "even if you once gave a guy a handjob you're disqualified, because you could've like, had a hangnail or something and that could have done it."

It's homophobia in the most literal sense of the word and it sucks, and the FDA should be ashamed, not that they have any shame.
posted by Scientist at 7:17 AM on November 12, 2012 [31 favorites]


Would switching the ban from life-time to one year after having sex with a MSM affect things that much? What percentage of gay non-virgins haven't had sex in over a year?
posted by 23skidoo at 7:26 AM on November 12, 2012 [7 favorites]


It's homophobia in the most literal sense of the word and it sucks, and the FDA should be ashamed, not that they have any shame.

The FDA should be ashamed -- well, actually, the responsibility for reviewing, continuing, or lifting the FDA ban lies with the Advisory Committee on Blood Safety and Availability. If you want someone to blame, here's their roster as of June 2012. Some big names from some big research centers on there. Which makes the persistence of the ban even more ludicrous.
posted by blucevalo at 7:29 AM on November 12, 2012 [3 favorites]


I'm banned for life because I lived in the UK during the mad-cow years (early-mid-nineties). It's a shame because I'm O-.
posted by oneironaut at 7:30 AM on November 12, 2012 [8 favorites]


The FDA is just protecting their consumer; what red blooded American would want faggot blood in their veins? They might catch The Gay, better dead than that.

I will give blood drives credit though, they have a way a man can go through the whole public ritual of donating blood, then quietly and privately telling the attendant that his blood is homotainted and they should destroy it. So at least they don't force people to out themselves at the work / school / church blood drive.

Seriously, my very blood is considered unacceptable, despite any evidence I have a blood borne disease and a lifetime of meticulously avoiding catching blood borne diseases. Even if they lift the ban I will never donate, because fuck 'em.

(Obligatory meanwhile, in China.)
posted by Nelson at 7:30 AM on November 12, 2012 [11 favorites]


"...the Red Cross believes there should only be a 12 month deferral [on MSM].
I don't see this as a step forwards at all. I'm in a 10-year, committed, monogamous relationship, and still would be barred from donating. That makes no sense.
posted by CrayDrygu at 7:30 AM on November 12, 2012 [20 favorites]


Well, it would certainly allow *me* to donate. Not every MSM is gay or has sex primarily with men. There's a whole continuum of sexual identity and activity, doncha know. And contrary to stereotype, not all gay men are promiscuous. Periods of abstinence of a year or more are quite common among all kinds of people for all kinds of reasons.
posted by Scientist at 7:31 AM on November 12, 2012 [5 favorites]


Would switching the ban from life-time to one year after having sex with a MSM affect things that much?

Guys who "experimented in college," for one.
posted by modernserf at 7:32 AM on November 12, 2012 [3 favorites]


Even if they lift the ban I will never donate, because fuck 'em.

Yes, fuck people who just got hit by cars because the FDA had a dumb law once. You know the Red Cross wants them to change it, right?
posted by theodolite at 7:32 AM on November 12, 2012 [30 favorites]


23skidoo, I think changing it to one year after having sex with a new partner would make more of a difference, similar to what appears to be the case in Italy.
posted by Karmeliet at 7:34 AM on November 12, 2012 [2 favorites]


What percentage of gay non-virgins haven't had sex in over a year?

I'm female. I've dated bisexual men that, in the course of our extended monogamous relationship, would have become eligible to donate after a year.

The rules right now insist on a lifetime ban for people I have been with, yet only defer me for a year. That is some silly nonsense.
posted by almostmanda at 7:34 AM on November 12, 2012 [5 favorites]


This is a topic that enrages me. Shit like this normalizes the othering of gay men and does actual harm.
posted by Sternmeyer at 7:36 AM on November 12, 2012


Yes, fuck people who just got hit by cars because the FDA had a dumb law once.

Oh I realize my reaction isn't rational, even petty. I take it as one of the rare privileges of being a homosexual in America; I have broad access to a blood bank of lovely heteroblood and I don't ever have to contribute myself. Ha ha! Seriously, I'm confessing my irrational decision to never donate blood to convey how emotionally angry the ban makes me. I normally strive to be a reasoned, rational, cool headed guy. But this ban is just so personally offensive, I can't.

(PS: the self-screening ban for behavior is largely useless because people lie. Particularly that guy who "experimented in college" and keeps "experimenting" in airport restrooms and has never practiced safe sex because hey, he's not a homo, he's not going to catch that gay disease.)
posted by Nelson at 7:39 AM on November 12, 2012 [6 favorites]


Just throwing this out there, but can't you just lie (or "forget") and donate anyway? What's wrong with breaking an unjust law? Have they ever really tried to punish anyone for this?

I mean, especially if you've been tested regularly and you know you're clean. And it's not like they don't test the blood anyway before using it.

BTW I agree the one-year ban is almost as offensive as the lifetime one.
posted by pete_22 at 7:41 AM on November 12, 2012 [2 favorites]


Yeah, I understand that it would make MORE people be able to donate. I was just wondering how MANY people would be able to donate if the ban were at one year.
posted by 23skidoo at 7:42 AM on November 12, 2012


Just throwing this out there, but can't you just lie? Or "forget"?

You can, and a lot of us do. But that's a whole 'nother can of fucked-up.
posted by nebulawindphone at 7:43 AM on November 12, 2012 [12 favorites]


The part that makes me a little hysterical is this idea that there needs to be any delay at all. It has been basically MY ENTIRE LIFETIME since AIDS became a known thing. If we do not currently have testing in place that will catch HIV in the blood supply, that will catch any blood-borne pathogen in the blood supply, before it reaches the person who is receiving said blood? That's a problem with the process, not with the donors, wheter they be gay men, people who have at some point visited Africa, whatever.

I mean, there might be some people who're at such high risk of needing to trash it that you don't want them to donate. People who actually HAVE a known STD infection. Drug users. Fine. Otherwise, if gay men telling the truth about that fact when donating blood is allegedly the thing keeping our blood supply safe, the system is massively broken. Or else the system is fine and we don't need any of this nonsense. There is no reasonable problem that is solved by restricting donations on the basis of the gender of people you have sex with (or your travel habits, or your tattoos, etc), no matter when.

Given the lack of FOX news anchors shrieking about people getting HIV from blood transfusions, my bet right now is on the system being fine and the rules just being pointless and hysterical, but it always makes me wonder.
posted by gracedissolved at 7:50 AM on November 12, 2012 [4 favorites]


They should make it the same questions as for people who have heterosex: have you been tested for HIV? Have you have unprotected sex with someone other than a longterm monogamous partner, who has also been tested for HIV? The emphasis should be on whether you had protected sex or not, not with whom.

That said, this isn't the only ban: I am also banned from giving blood in Canada or the US because I lived in the UK after BSE was discovered to be a major problem. The irony is that by the time I did live in the UK, their beef was safer than Canadian or American beef - I was more likely exposed to BSE in North America than in the UK.
posted by jb at 7:51 AM on November 12, 2012 [2 favorites]


Elsewhere it's 12 months since you last had sex with a new partner:

Many countries including the United Kingdom and Brazil have a one-year deferral period, allowing MSMs to donate blood if they have not had intercourse with a new partner within that time.

Most people commenting would be able to give.
posted by dd42 at 8:07 AM on November 12, 2012 [4 favorites]


If we do not currently have testing in place that will catch HIV in the blood supply, that will catch any blood-borne pathogen in the blood supply, before it reaches the person who is receiving said blood? That's a problem with the process, not with the donors, wheter they be gay men, people who have at some point visited Africa, whatever.

The current policy is all about redundant precautions. Getting HIV in the blood supply (again) would be a catastrophe, so it's worth being very, very cautious and conservative about whose blood we'll accept.

That's the FDA's position here — and honestly, I agree with it as a general principle. I am very glad that the Red Cross has multiple, layered safeguards in place.

I just don't agree with the way they've implemented this one particular safeguard.
posted by nebulawindphone at 8:09 AM on November 12, 2012 [1 favorite]


Googling "are gay men more likely to have aids?"gave answers that included

yes, 2 times more likely
yes, 18 times more likely
yes, 44 times more likely
yes, 50 times more likely


None of these seemed to come from reliable sources. Is there any formal, respectable research on this?
posted by Tarumba at 8:11 AM on November 12, 2012


I'm banned for life because I lived in the UK during the mad-cow years (early-mid-nineties).

Me too, though I was there in the late 80s.
posted by shoesietart at 8:11 AM on November 12, 2012


I'm banned for life because I lived in the UK during the mad-cow years (early-mid-nineties)

That's hilarious, and not just because BSE was hugely underreported or curiously untested for in many other countries, fearful of the impact on their meat and livestock exports. Especially the US, which still sees beef bans because of BSE cases from this year.

It would never occur to anyone in the UK that they were now at any kind of elevated risk of vCJD so long after the 1996 BSE crisis and more than 10 years since peak vCJD diagnoses.
posted by MuffinMan at 8:12 AM on November 12, 2012 [1 favorite]


gracedissolved: I think the reasoning behind the 1-year delay is that tests for HIV are less reliable if you've been infected only recently.
posted by RobotHero at 8:13 AM on November 12, 2012


I'm banned for life because I lived in the UK during the mad-cow years .

It's been interesting watching the blood donor requirements shift over time. Under the current rules I'm perma-banned because of the mad cow thing (and, I suppose, for some "experimenting" with a friend in about fourth or fifth grade, though that seems exceptionally silly); I used to be banned under some of the other categories (eg travel, tattoos, etc) but the timelines on those are shorter than they used to be or I am misremembering.

Honestly I suspect greater safety comes from constant improvements on the testing side of things than it does on the hoping people answer screening questions honestly side; redundancy is good but it needs to be reality-based.
posted by Forktine at 8:14 AM on November 12, 2012


Yeah, the FDA's position has historically been that allowing any MSM to donate blood would increase the overall rate of HIV+ donors and thus with a constant failure rate of screening the overall effect would be more blood-transfusion-caused HIV infections. But this, from one of the above articles, is particularly telling:
...said Dr. Bauer, “The existing theoretical models show that if we shorten the deferral period from lifetime to one or five years, we would see a small increase in HIV-infected blood collected, and the real risk to the blood supply would be the erroneous releases of HIV-positive units from quarantine as a result of human error.” That quarantine release risk is based on the assumption that there would be more HIV-infected units collected but the empirical data from Australia show that there was no such increase. “This speaks to our inability to predict these things using theoretical models,” Dr. Bauer observed.
(my emphasis)

(The FDA has also said that it has been unable to stratify MSM by any questionnare questions such that the overall HIV rate in that pool matches the pool of existing donors but I haven't seen any of the questions they tried so I don't know if they also tried to identify people who, e.g., abstain entirely from anal sex, or are in a long-term monogamous relationship and always use protection, etc.)
posted by en forme de poire at 8:14 AM on November 12, 2012 [2 favorites]


Yeah, I'm another BSE life-ban, which strikes me as hilarious. My bone marrow is still a hot commodity, apparently.
posted by elizardbits at 8:17 AM on November 12, 2012


Can I Donate My Gay Blood? AskMe from 2010.
posted by purpleclover at 8:20 AM on November 12, 2012 [1 favorite]


O- here.

Was well on my way to becoming a galloner when I met my first boyfriend.
posted by jefficator at 8:23 AM on November 12, 2012 [4 favorites]


Tarumba, CDC data give the rate of HIV among all MSM at around 20%. It is lower for younger men.
posted by en forme de poire at 8:27 AM on November 12, 2012 [1 favorite]


Here's the Red Cross blood testing regimen. They do an antibody test, not a direct virus test, but believe that they can catch HIV 4-7 days after infection.

Here's some basic stats on HIV infection in the US. Unfortunately it doesn't have a measure of prevalence of HIV by population, so we can't easily play amateur medical statistician.

But one glaringly obvious stat is that African Americans are much more likely to have HIV than white Americans. They have a higher incidence of new infections and they have a higher cumulative rate of infection (a random African American is something like 6x likely to have AIDS compared to a white American.) So clearly if we're playing the odds of HIV+ blood slipping into the blood supply, the FDA should ban blacks from giving blood. Easy policy to enforce; no need for people to self identify, the blood screener could just compare the donor's skin color to an FDA-calibrated paper bag. And keeping negro blood out of the US blood supply would please the same people who don't want faggot blood. It's a win-win all around!
posted by Nelson at 8:35 AM on November 12, 2012 [9 favorites]


I'm BSE banned too, but I checked at a blood drive a couple of months ago and they said that they should have a test for it in 2 years or so (this was in Canada). I hope so, giving blood ranks alongside voting as something relatively painless that I can do that has a direct positive impact on my community. The MSM ban is ridiculous and should be done away with ASAP.
posted by arcticseal at 8:37 AM on November 12, 2012 [1 favorite]


pete_22: "Just throwing this out there, but can't you just lie (or "forget") and donate anyway? "

Some folks do. When a friend who had cancer asked for blood donations from people she knew prior to her surgery, a couple of mutual friends lied so they could do so.

I posted the "previously" link two and a half years ago. It is beyond my comprehension that so much time has passed, yet this is still an issue and the US hasn't removed the ban / shortened waiting time.

Donated blood is already tested for HIV. The ban is discriminatory. :(
posted by zarq at 8:37 AM on November 12, 2012 [2 favorites]


I'm also under the UK BSE ban, which is particularly pointless since I was a vegetarian the entire time I lived there.
posted by gingerbeer at 8:37 AM on November 12, 2012 [5 favorites]


I agree that the ban should be amended. The rules were made in reaction to earlier times in which the blood supply as well as plasma products were contaminated with HIV (as well as Hepatitis C). The results of that contamination were overwhelming, cataclysmic. (And in the case of some plasma products, preventable.) Perhaps some of the people now in charge of the rules lived through those grim times -- if so, it might be hard for those policy makers to give up the rules (psychologically).

There should be a way for MSM to give blood, given the other procedures that now protect the blood supply.
posted by ClaudiaCenter at 8:41 AM on November 12, 2012


Don't forget that it also outlaws women who have had sex with men who have had sex with men, too. I forgot to ask if that includes women who have sat on the same toilet seat as men who have had sex with men, I'll be sure to ask next time.
posted by corb at 8:41 AM on November 12, 2012 [1 favorite]


"Would switching the ban from life-time to one year after having sex with a MSM affect things that much?"

My large easy to draw from cyclist veins would suddenly be eligable.
posted by Blasdelb at 8:44 AM on November 12, 2012


I agree that the ban should be amended. The rules were made in reaction to earlier times in which the blood supply as well as plasma products were contaminated with HIV (as well as Hepatitis C). The results of that contamination were overwhelming, cataclysmic.

That's it exactly. An over abundance of caution.

I don't know whether this is part of the decision matrix, but I would imagine that the worry isn't so much that HIV or other known diseases could slip through the tests, but that there could be some other yet-unknown disease lurking out there.
posted by gjc at 8:48 AM on November 12, 2012


The whole list of deferrals for HIV makes me cringe. I work in HIV and public health, and it's just a list of stigmatizing stereotypes. It's honestly the sex work one that's the most pointless, although the drug use one irritates me, too.

"You are at risk for getting infected if you:
have ever used needles to take drugs, steroids, or anything not prescribed by your doctor
are a male who has had sexual contact with another male, even once, since 1977
have ever taken money, drugs or other payment for sex since 1977
have had sexual contact in the past 12 months with anyone described above"
posted by gingerbeer at 8:51 AM on November 12, 2012


And I say that as not only a public health advocate, but as someone who lost a family member to transfusion-acquired HIV.
posted by gingerbeer at 8:52 AM on November 12, 2012


But one glaringly obvious stat is that African Americans are much more likely to have HIV than white Americans. They have a higher incidence of new infections and they have a higher cumulative rate of infection (a random African American is something like 6x likely to have AIDS compared to a white American.) So clearly if we're playing the odds of HIV+ blood slipping into the blood supply, the FDA should ban blacks from giving blood. Easy policy to enforce; no need for people to self identify, the blood screener could just compare the donor's skin color to an FDA-calibrated paper bag. And keeping negro blood out of the US blood supply would please the same people who don't want faggot blood. It's a win-win all around!

Blood donors aren't random, they are self-selected. I would not be surprised that if you run the stats on the "likely blood donor" population, the odds of an unknown HIV infection level out between the races.
posted by gjc at 8:54 AM on November 12, 2012


One of my brothers is in rather dire need for a bone marrow transplant. Another brother can't even get active because he is a) gay and b) sexually active. I was talking with my ill brother's doctor and asked:

"Without a transplant, he's only got a couple of years."
"Yes."
"And my other brother can't donate because he is gay."
"Yes."
"Now, let's assume that my other brother isn't careful and is HIV positive. Even if the transplant infects my ill brother, won't he live longer than he will without a transplant?"
"..."
"I mean, he could survive for a decade without HIV manifesting, and then he'll have a while after that, right? I realize his immune system is already a bit of a mess, but it's not like he has anything to lose. So why not test my other brother?"
"We don't do that."
"But what is the logic?"
"..."
"Um, OK."

Yeesh.
posted by GenjiandProust at 9:00 AM on November 12, 2012 [35 favorites]


> the FDA's position has historically been that allowing any MSM to donate blood would increase the overall rate of HIV+ donors and thus with a constant failure rate of screening the overall effect would be more blood-transfusion-caused HIV infections.

Even without the data from Australia, I'm more than a little unconvinced by that argument, given that HIV tests are among the most accurate diagnostic tests around (in both terms of sensitivity and specificity). The tests themselves skew towards more false positives* than false negatives and this doesn't even address the redundant tests that most blood banks perform.

There are sufficiently accurate tests and more than adequate procedures to ensure any false negative blood never makes it into the system. The standard NAT testing is, by the FDA's own assessment, basically foolproof outside of a few day "window period." So why not simply ask if the donor has engaged in any possible "high-risk" behavior in that window, which could include any unprotected sex, not just that of MSM?

*Fun fact: When you do get a false positive, the Red Cross retests the blood using more specific test, then sends you a 2-page letter with the results. The first page basically says "You tested positive for HIV." If you survive that heart attack, you can then flip to the second page that says, "But then we double-checked, and you're fine." Still can't donate after that though.
posted by Panjandrum at 9:00 AM on November 12, 2012


oneironaut, that's me, too. Because of the time I spent in Europe & the U.K. in the 80s and 90s, I went from donating whole blood every two months (and platelets every two weeks!) to...nothing. :7(
posted by wenestvedt at 9:02 AM on November 12, 2012


have ever taken money, drugs or other payment for sex since 1977

wow so all those times me and my ex got each other ice cream cones after hot sex, i guess we're both hookers now, just hookin each other.
posted by elizardbits at 9:03 AM on November 12, 2012 [6 favorites]


Tarumba, CDC data give the rate of HIV among all MSM at around 20%. It is lower for younger men.

That seemed really high - when I read your link I couldn't find this information, maybe you meant to give a different link? It talks about the proportion of HIV diagnoses that are diagnosed in MSM, but not about the proportion of HIV+ MSM.

The closest thing I could find was their statement saying "At the end of 2009, an estimated 441,669 (56%) persons living with an HIV diagnosis in the US were MSM" which combined with their estimation that 2% of the US population is MSM, would mean approximately 441k/6.2 million are diagnosed, which is about 7% overall. If I'm missing something or mathing wrong, could you clarify?
posted by randomnity at 9:04 AM on November 12, 2012


Also, Nelson, would you mind toning down the language? I know you are understandably angry, but I'm not a big fan of slurs being tossed around, even in an ironic and sarcastically biting manner.
posted by Panjandrum at 9:04 AM on November 12, 2012 [4 favorites]


I'm also under the BSE ban. Lived there for two and a half years in the early 80s and I can't donate for life. I'm not sure I physically could donate due to my phobia of needles, and sometimes it's a relief to answer "I'm banned" when asked, but sometimes I wish I could try.
posted by immlass at 9:04 AM on November 12, 2012


So far looking at this recent CDC study I am not super impressed with the data collection:
In each city, a team of staff members familiar with the local community conducted formative research to establish a list of venues frequented by MSM (9). ... Venues on the list were categorized as a bar, dance club, fitness club or gymnasium, Gay Pride event, park or beach, large dance party (e.g., rave or circuit party), café or restaurant, retail business, sex establishment or sex environment, social organization, street location, or another venue type, such as an event hosted by the local house ball community.
They did exclude gay clinics, for obvious reasons. However, this data collection strategy seems like it could easily be dominated by cruisier environments (for example, circuit parties are really big and draw a lot of sexual tourism, so you would be sampling lots of people who are explicitly looking for sex; political organizations tend to be smaller because they are tied to a particular community) and thus lead to a somewhat inflated and inaccurate estimate of HIV among MSM. To be clear, this is absolutely not a slam on cruising or promiscuity, which after all, do not have to involve unsafe sex. And of course it is totally possible that this is an unbiased sample - it's hard to tell for sure. But it did seem to me like this type of sampling could result in an inflated estimate of HIV risk.

(Bizarrely, they do make the point that it's hard to establish a "reference" MSM population, but actually argue that cruisier environments may be underrepresented in their sample which seems kind of baffling to me.)
posted by en forme de poire at 9:04 AM on November 12, 2012


I don't know whether this is part of the decision matrix, but I would imagine that the worry isn't so much that HIV or other known diseases could slip through the tests, but that there could be some other yet-unknown disease lurking out there.

The FDA makes it pretty clear that their concern is in fact mainly HIV, though they are also concerned about Hep B/C and HHV-8. Also, I would imagine that there are now enough public health professionals specializing in gay sexual health (not really a thing pre-HIV as I understand it) that if gay people were suddenly getting sick and/or dying of something bizarre we would be hearing about it.
posted by en forme de poire at 9:11 AM on November 12, 2012 [1 favorite]


Despite several attempts, I have given blood successfully exactly once, thanks to exceptionally deep stubborn veins. If the nurses at City of Hope's donation center can't make it happen, I don't have much confidence in the mobile wagons knowwhatImean?
I was, however, rejected for bone marrow matching for my mom, due to my weight which was pretty frustrating and I don't quite understand.
posted by ApathyGirl at 9:13 AM on November 12, 2012


The paper linked to by the Maclean article is an interesting read. Australia switched from a total ban to a 1-year exclusion, around which time their donation rates went up: from 4,025,571 over five years before the change, to 4,964,628 over the five years after. But, interestingly, the number of detected HIV+ donations stayed the same: 24 in each 5-year period. The number of these cases who were MSM basically didn't change: 2 before the change and 5 after, a difference which is not statistically significant. Further, the 5 HIV+ MSM all later admitted that they'd had sex within the 12 months before donating, and so should have been kept out by the screening process anyway.

Now, I know for sure that there are guys might go years at a time between sexual encounters with other guys, and therefore be added to the donation pool by this rule change. But I can't imagine that it's a huge proportion of the population: most of the people excluded by a lifetime ban are also going to be excluded by the 12-month ban. We can't know this for sure, as the study only reported data from people who turned out to be HIV+, but it seems like a safe guess.

So, for me, this study has basically demonstrated that the number of HIV+ MSM who're willing to lie about their sexual history in order to donate blood has stayed about the same pre- and post-change. The data as they present them do not provide evidence that more MSM are actually donating. So this change in rules seems to be safe for the people receiving blood, but might not actually achieve anything much in terms of allowing more people to donate.

gingerbeer - Do you happen to know the false positive/negative rates for the HIV screening tests currently used to monitor blood stocks? Googling gives me all sorts of numbers, none of which look particularly well sourced.

I feel like I can't have an opinion on the addition of high-risk populations to the donation pool without an understanding of what it will do to the proportion of infected units that would be expected to make it through screening.

(For anyone curious, I once wrote an AskMe comment that explains why you need to know the expected prevalence in a population and the false positive and negative rates, before you can interpret the results of many medical tests.)

GenjiandProust - "And my other brother can't donate because he is gay."

That's really surprising. My understanding is that here in the UK, the bone marrow registers will accept MSM, recently tattoo'd people, etc. I always assumed that it's because sufficiently few people get called to donate that they can really go nuts with the testing, as compared with the millions/year that the blood service has to deal with.
posted by metaBugs at 9:20 AM on November 12, 2012 [1 favorite]


I am a bisexual male. I'm also an O-neg, and outrageously healthy. I also live at high altitude, which means I have more hemoglobin than your average donor.

I'm ineligible to donate until 2099.

Hey FDA, fuck you too, a'rite?
posted by endotoxin at 9:20 AM on November 12, 2012 [2 favorites]


Randomnity: I was going off "Results of HIV testing conducted in 21 cities indicated that 19% of MSM tested in 2008 were HIV-positive" under "Prevention challenges."
posted by en forme de poire at 9:20 AM on November 12, 2012 [1 favorite]


Can we do something like a banned-for-life swap, similar to the carbon credits? That way, you can donate blood for me, and I'll take over your lifetime ban?
posted by Old'n'Busted at 9:21 AM on November 12, 2012 [1 favorite]


nebulawindphone: "The current policy is all about redundant precautions. "

This is it. Redundant precautions to help prevent a catastrophe not to mention huge lawsuits.

The world is filled with laws/regulations that are unfair, illogical, prejudicial, and over the top.

However the litigious nature of the public makes them necessary - at least for now.
posted by 2manyusernames at 9:22 AM on November 12, 2012


That's really surprising. My understanding is that here in the UK, the bone marrow registers will accept MSM, recently tattoo'd people, etc. I always assumed that it's because sufficiently few people get called to donate that they can really go nuts with the testing, as compared with the millions/year that the blood service has to deal with.

Well, we are not in the UK, so there is that. My impression of the situation is that, if my brother was not sexually active, they would test him. But, no matter what his sex life is like, any sexual activity is a deal-breaker. At least at the moment. They seem to be wavering as other options are exhausted. (It is, however, notoriously hard to get medical information out of my brothers, and the doctors don't really have any reason to get into a dialogue with me about this, so something may have changed recently.) If anything, I am more perplexed than you. It's pretty crazy in my book.
posted by GenjiandProust at 9:29 AM on November 12, 2012


I would imagine that the worry isn't so much that HIV or other known diseases could slip through the tests, but that there could be some other yet-unknown disease lurking out there.

For that argument to make any sense, you'd have to believe that gay people are more likely to get this mysterious new disease. I guess if you believe the whole "AIDS is god's punishment" narrative that would make sense, but it doesn't make sense here in the evidence-based world.

If you read the women's magazines anal sex has become a whole lot more common in the heterosexual world in the past 20 years. And rectal transmission is a higher risk than vaginal. So why don't we ban all heterosexuals who've had anal sex, too? After the African Americans, of course, for their statistical profile.
posted by Nelson at 9:37 AM on November 12, 2012 [1 favorite]


Well, and the CDC just came out with a recommendation that all baby boomers should be screened for hep C, because of their higher likelihood of being infected. Why aren't they banning blood donations from all boomers?

(Not that I think that's a good idea, just that the CDC and the FDA are not being logically consistent on any of this.)
posted by gingerbeer at 9:41 AM on November 12, 2012


It mildly frustrates me that in the US the Red Cross won't take my blood because I lived in Nigeria for nine months in 1980.

...

I'm banned for life because I lived in the UK during the mad-cow years (early-mid-nineties). It's a shame because I'm O-.

Not only am I covered by both of these, but I frequently travel to areas where malaria is endemic. There is literally no place in the world that will take my blood.
posted by atrazine at 9:56 AM on November 12, 2012


metaBugs: "gingerbeer - Do you happen to know the false positive/negative rates for the HIV screening tests currently used to monitor blood stocks? Googling gives me all sorts of numbers, none of which look particularly well sourced.

I feel like I can't have an opinion on the addition of high-risk populations to the donation pool without an understanding of what it will do to the proportion of infected units that would be expected to make it through screening.
"

Here's the specifics of the tests the Red Cross is using. The testing technology is vastly improved from where it was in the mid-80s.

The screening criteria have not kept up with the actual technology, nor the movement of HIV through other populations, nor the public health messages and technologies. Nor the improved availability of HIV treatments, for that matter. HIV is a different world, both demographically, clinically, and technologically, than it was when these criteria were developed.

These descriptions of "high-risk populations" are unhelpful, stigmatizing, and inaccurate. It's not actually describing the behaviors that put people at risk of HIV or hepatitis, and I think leads to people feeling not at risk, if they aren't, say, taking cash for sex.
posted by gingerbeer at 9:58 AM on November 12, 2012 [6 favorites]


Also, sorry to post so much here but this review is interesting and relates to the points metaBugs and gingerbeer have brought up. Probably paywalled, but here's one quotation I thought was particularly relevant:
Taken together the UK and US data indicate that prevalence type risks are relatively small compared to incident risks and that they could be effectively managed by improving overall systems used to manage testing and distribution of blood supplies [e.g.., taking more steps to prevent "quarantine release errors"]. They also both clearly identified that improvements in compliance with deferrals would result in an overall improvement in safety levels significantly greater than the current risk associated with prevalence type risks.
posted by en forme de poire at 10:06 AM on November 12, 2012


A one year limit would allow the Canadian Red Cross to once again get my O- blood. They used to act like I had molten gold in my vains. But I had a brief relationship with a bisexual man 4 years ago so now they cannot accept my blood (if I'm honest about that) for the rest of my life.

Since I understand they test every sample anyway, I don't see the benefit in banning anyone based solely on their demographic.
posted by Kurichina at 10:20 AM on November 12, 2012 [1 favorite]


dd42: Elsewhere it's 12 months since you last had sex with a new partner:

Many countries including the United Kingdom and Brazil have a one-year deferral period, allowing MSMs to donate blood if they have not had intercourse with a new partner within that time.

Sadly that's not correct in the UK (I realise you are quoting the article). The National Blood Service say:
Previously, men who had ever had oral or anal sex with another man, even if a condom was used, were permanently excluded from blood donation in the UK. The change means that only men who have had anal or oral sex with another man in the past 12 months, with or without a condom, are asked not to donate blood. Men whose last sexual contact with another man was more than 12 months ago are eligible to donate, subject to meeting the other donor selection criteria.
(Typical British phrasing there, too: 'asked not to donate blood'?)
posted by smcg at 10:28 AM on November 12, 2012


I'm now curious about what the FDA thinks about trans women who have sex with (heterosexual) men or about trans men who have sex with (gay) men. If the FDA thinks about them at all.
posted by nicebookrack at 10:33 AM on November 12, 2012 [7 favorites]


I'm another perma-ban due to spending all of the period from 1980-96 in the UK. That strikes me as ridiculous, as ridiculous as not allowing men who have had any kind of sexual contact with other men since 1977 to give blood, the difference being that whilst both seem completely paranoid, it's hard not to see the second as paranoid and prejudiced.
posted by ob at 10:44 AM on November 12, 2012


nicebookrack: "I'm now curious about what the FDA thinks about trans women who have sex with (heterosexual) men or about trans men who have sex with (gay) men. If the FDA thinks about them at all."

Last I'd heard, we're banned, too. But the Red Cross website doesn't say anything about trans folks that I could see. It may still be on the questionnaire, though.
posted by jiawen at 11:03 AM on November 12, 2012


The different US bans for MSM and their female partners are weird. Say John is an MSM and Jane is his girlfriend. They are both ineligible to donate blood.

Then they break up and both start dating women. After a year, Jane is eligible to donate again, but John is not. What is the reasoning?
posted by feets at 11:17 AM on November 12, 2012 [1 favorite]


I helped set up one of those nucleic acid testing labs when it was brand new, cutting-edge technology... in 1999. It's a pretty sweet system that could test 96 samples (in pools of 16) within hours. If one pool tested positive, those 16 samples would get retested to narrow down the problem one(s) while the other 80 could be released for patient use. Probably the technology has got even better/faster since then, but at the time we could go through easily 5-6 if not more of those 96-sample trays in a 24-hour day.

Ironically, the exact same type of test is used to screen for hepatitis C, and no one has suggested a lifetime ban on donors who have ever in their life done anything that might increase their risk for hepatitis.
posted by Flannery Culp at 11:20 AM on November 12, 2012 [2 favorites]


I work for the Red Cross and am gay. Before I took the job I read up on this policy because I don't want to work for homophobes. Now at parties I will have to at least once explain to a well-meaning fellow sodomite that my employer has no control over it.

I'm now curious about what the FDA thinks about trans women who have sex with (heterosexual) men or about trans men who have sex with (gay) men. If the FDA thinks about them at all.

I believe this is a new emerging policy. I can't say for certain since my job has almost nothing to do with eligibility criteria. But a trans woman who has sex with a heterosexual man is allowed to donate. Trans men who have sex with gay men are out as that is (awesome) man on man sex.

The FDA may be dicks about MSM but they are doing pretty good on trans issues.
posted by munchingzombie at 11:33 AM on November 12, 2012 [4 favorites]


I was just discussing this the other day. I've been donanting for about a decade (just received a gallon pin from Bonfis) and I find the questionnaire particularly offensive. It reads like a very blurry blueprint for a national socialist blood purity law. It doesn't just disqualify gays. You also can't give blood if you've ever (yes I realise many of you know this, but in case you don't): Never mind that they perform three separate blood tests with every donation. Never mind that you may have been a junkie or a prostitute 20 years ago and have been clean in every test you've ever had. Never mind that the continent of Africa is not, as some might have you believe, one giant concentration refugee camp of AIDS-riddled bushmen.

I bring these up with each phlebotomist that screens me to see what they think. Some agree that they're prejudiced and outdated. Some are noncommittal. Some reveal their ugly prejudice. If it were a consumer product I'd boycott it and tell others to do the same. But in the end patients need blood, and I have blood to give. It's as simple as that.

I cannot wait for the FDA to give up on an ethos of hygiene that reads like a 1950s eugenics manual. A sincere apology would be nice too, but we won't get that.
posted by clarknova at 11:35 AM on November 12, 2012 [3 favorites]


I'm banned for life because I lived in the UK during the mad-cow years (early-mid-nineties).

Me too, though I was there in the late 80s.


You don't even have to have lived there, it just has to add up to 6 months.

I'm disqualified for spending a couple of weeks or so every summer in the UK when I was a kid.
posted by madajb at 11:46 AM on November 12, 2012


As a complete derail, I just want to say that, if no one had snapped up "well-meaning fellow sodomite" as a user name, I just don't know what's wrong with MetaFilter.
posted by GenjiandProust at 11:49 AM on November 12, 2012 [4 favorites]


GaP, I saw that turn of phrase and was never more disappointed to be a straight girl.
posted by Flannery Culp at 11:57 AM on November 12, 2012 [1 favorite]


Tarumba: Gay men are certainly more likely to be HIV positive and thus to develop AIDS, though estimates may vary. This study suggests men who have sex with men are 10 times as likely to have undiagnosed HIV than the rest of the population: Diagnosing HIV in men who have sex with men: an emergency department's experience.
posted by reren at 12:00 PM on November 12, 2012


I can't give blood because I lived in England for nine months in the '80s. They have a rule that if you've lived there for more than six months between 1980 and 86 or something, you likely ate too much mad cow. Awesome.
posted by asfuller at 12:37 PM on November 12, 2012


gingerbeer: Thanks, I'd seen that link before but it doesn't give the figures that I'm interested in. It says that "The current risk of transfusion-transmission of HIV is approximately 1 in 2,000,000", which is great but doesn't let us calculate how that figure would change if we increased the number of HIV+ people in the donor pool. The data must be floating around somewhere, but I can't find it. I'm inclined to trust the Red Cross' judgement, but I'd still be interested to see the numbers myself.

These descriptions of "high-risk populations" are unhelpful, stigmatizing, and inaccurate.
My apologies. I was using the phrase to describe an identifiable group who have a higher incidence of the disease than the general population. And, indeed, all the figures that I've seen indicate that if you take 500 MSM at random and 500 non-MSM, you'll find more HIV+ people in the MSM group.

IANAEpidemiologist, but my understanding is that you need some way to identify that "people who engage in [risky activity] are [x%] more likely to be HIV+ than the rest of the population". And, knowing that information, you'd be crazy not to factor it into your screening/transmission models.

So is there a better phrase that I should have used, or is your complaint more along the lines that the "high-risk populations" currently defined in policies are overly broad and/or not based on current evidence? For example, that men having sex with men should not be regarded as a risk factor, but that some subset of that engaged in a more specific risky behaviour should be?


kurichina (and clarknova, and others) - Since I understand they test every sample anyway, I don't see the benefit in banning anyone based solely on their demographic.

That only works if the test catches 100% of cases and/or every HIV+ person will refrain from donating. Unfortunately, no test is perfect, and not everyone who has HIV knows that they're infected. So if you accept donations from a demographic with a higher rate of undiagnosed HIV, you have a larger number of HIV+ people donating, and an increased chance that one or more HIV+ donations will slip through the test undetected.

From epidemiological studies, we can say that e.g. MSM, injected drug users and people from certain parts of Africa as populations have higher proportions of undiagnosed HIV cases than the rest of the population. You can see why people designing the screening protocols would want to avoid such groups: for a relatively small drop in the donation pool, you can get a relatively big drop in the HIV+ donations that your screening protocol might miss.

Now, you can argue that the populations described are too vague or based on old data, which I think is (part of?) gingerbeer's point. Certainly a gay guy who's been safe in his youth and then monogamous for ten years is going to be a much lower risk than a straight guy who's been sleeping around for years and not using condoms properly. But until you can work out what those sub-populations are and a reliable way to identify them (safe sex practices is something that basically everyone lies about, even to themselves), the broad-brush approach is the only way to minimise the risk.

All that said, the Red Cross seem to think that the test is so good that screening by population like this is unnecessary. I'm inclined to trust their judgement, but I'd really like to see the data underlying their claim and the FDA's claim, to understand why they've come to such different conclusions. Possibly I'm naive, but my money would be on a subtle difference in the model or a different tolerance for risk, rather than an institutionalised policy that "these people are just dirty".
posted by metaBugs at 12:54 PM on November 12, 2012 [4 favorites]


Never mind that the continent of Africa is not, as some might have you believe, one giant concentration refugee camp of AIDS-riddled bushmen.

I think (based on the Red Cross website and on my own experiences filling out a donor questionnaire - I have slept with a South African and was allowed to donate) that the restriction against having had sex with an African actually only applies if you've had sex with someone from Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, or Nigeria.

But in general I agree with you.
posted by naoko at 1:01 PM on November 12, 2012


Never mind that they perform three separate blood tests with every donation.

It's important to note, though, that blood tests are not really binary: even though tests have very low false-negative rates, they are not zero, and the number of transfusions per year is huge (~20 million). So if you double the risk of getting an HIV+-blood donation by allowing MSM to donate (that's about what you get if the risk in the MSM population is 25-50x that of the general population and you assume that MSM are 2.5-5% of the general population) even if the absolute risk is still a pretty small percentage, it is still likely to cause new HIV infections just because of the sheer number of blood transfusions.

Having said that (and this is probably relevant to metaBugs's post, on preview), there are also indications that this is a pretty major overestimate (my emphasis throughout):
In the current issue of TRANSFUSION, Anderson and colleagues revise some overly conservative assumptions made in earlier models of the risk of accepting MSM who have abstained for 12 months as donors. These assumptions are no longer plausible after the introduction of nucleic acid testing of donors for HIV infection and the process and quality improvements implemented by blood establishments in the past 10 years (Fig. 1). Anderson and colleagues also substantiate the probability used in their model for the erroneous release of HIV-positive units from quarantine by an analysis of nationwide Biological Product Deviation Reports. The probability at which they arrive based on 2003 through 2005 data is similar to that employed previously by Germain and colleagues and approximately 10 times lower than the probability derived from pre-1994 New York State data. Thus, following refinement and substantiation of many of the assumptions used in the earlier models, Anderson and colleagues calculate that, if the MSM deferral were reduced to 12 months, on average 1 additional HIV-infectious unit would be released for transfusion in the United States every 5.55 years—a risk 5 times lower than that projected previously by Germain and colleagues.
...
Despite the elegance of the current analysis, the reported risk is probably still a significant overestimate of the true risk. The crux of the issue remains the fact that there are no data on the actual prevalence of undiagnosed HIV infection in MSM who have abstained for 12 months. What is certain is that blood donors are not a random subset of individuals eligible to donate, but a highly self-selected subgroup cognizant of risk factors for transfusion-transmitted infections. Germain and colleagues considered that the prevalence of undiagnosed HIV infection in actual MSM donors made eligible to donate by a reduction of the MSM deferral to 12 months would be 0.6%. This estimate was based on the assumption that the prevalence in actual MSM donors would be less than the 1.45% prevalence of HIV seropositivity, observed in the Omega cohort of sexually active, young, Montreal gay men—that is, men who had not abstained for 12 months and had not self-selected to donate—specifically among those who thought that they were not infected (unpublished data from the Omega cohort used by Germain and colleagues). ...

If the self-selection factors that determine the behavior of actual donors are the same in the United States as in Canada or the United Kingdom, the assumption of so high a prevalence of infection in actual MSM donors is unwarranted. Thus, a plausible, yet still very conservative, estimate of the actual increase in risk if the MSM deferral were reduced to 12 months might be that 1 additional HIV-infectious unit would be released for transfusion in the United States every 18.5 years—the figure arrived at if the prevalence of undiagnosed HIV infection among actual MSM donors were 0.6%.
And probably the biggest "wow" moment I had reading this review was this statement from the conclusion (again, my emphasis):
In conclusion, in the United States today, the risk from pooled whole blood–derived PLTs [i.e., platelets] is greater than the risk from reducing the MSM deferral to 1 or 5 years. Although exclusive reliance on single-donor PLTs is feasible and would have had a greater impact on safety than reducing the MSM deferral, such a measure has not been implemented because the increased HIV risk associated with pooled whole blood–derived PLTs is too small to be detected by our current surveillance systems and is thus regarded as “tolerable.” Similarly, although 5 years elapse between the emergence of a novel pathogen and the introduction of measures to protect transfusion recipients (Table 2), policy-makers have not extended from 1 to 5 years the deferral for activities through heterosexual contacts that are similar in risk to MSM activity.
I think this is probably one of the most persuasive arguments I've read so far in favor of lifting the lifetime ban (combined of course with the empirical evidence that other countries have moved to a 12-month window, so far with no significant differences).
posted by en forme de poire at 1:24 PM on November 12, 2012 [3 favorites]


munchingzombie: "But a trans woman who has sex with a heterosexual man is allowed to donate."

Can you provide a cite for that? Everything I've seen shows that trans women are still effectively barred from donating blood, and nothing I could find on the FDA website showed any reversal of that policy. I'd love to see evidence that it's been changed.
posted by jiawen at 1:33 PM on November 12, 2012


I'm also under the UK BSE ban, which is particularly pointless since I was a vegetarian the entire time

Me too. Evidently the FDA must think British people are surreptitiously slipping the beef to visitors.
posted by tangerine at 1:41 PM on November 12, 2012 [1 favorite]


jiawen: " Can you provide a cite for that? Everything I've seen shows that trans women are still effectively barred from donating blood, and nothing I could find on the FDA website showed any reversal of that policy. I'd love to see evidence that it's been changed "

There's nothing in the eligibility requirements for blood donation that bars trans women from giving blood, unless they had sex with a man before transitioning, or unless they had sex (as a woman) with a man who'd had sex with another man.

While I'm quite sure that doesn't stop doctors from barring trans women out of homophobia, my understanding is the FDA doesn't have any other official policy about trans women.
posted by zarq at 1:54 PM on November 12, 2012


Blood donors aren't random, they are self-selected. I would not be surprised that if you run the stats on the "likely blood donor" population, the odds of an unknown HIV infection level out between the races.

In response to this, and anyone else offerings statistics, I think Nelson's point with that gay/black comparison -- or at least the way I would put it -- is that the FDA would be unlikely to ban donors based on race, whatever the numbers said -- and appropriately so. and sexuality in this case should be accorded the same status.

In other words, homophobia is the only reason the statistical arguments are even on the table. Just by having them, to some extent you're going along with it.
posted by pete_22 at 2:59 PM on November 12, 2012 [3 favorites]


I'm permanently banned because of the BSE thing too--lived in the UK 1989-1990.

But I didn't get a letter telling me this until after I'd donated for years after moving back to the US in 1990. Late 90s, it had to be, or maybe even early 2000s. Presumably, many sombodies got my mad cow blood.
posted by ImproviseOrDie at 3:10 PM on November 12, 2012


Are men who have sex with transwomen not categorized as MSM?
posted by modernserf at 3:11 PM on November 12, 2012


The last (and only) time I tried to give blood here in Korea, years ago, they told me I couldn't. Naturally, I asked why.

They said, without the slightest hesitation, that it was because I'm not Korean.

So, yeah. Dunno if that's changed since, but it certainly was an eye-opener.
posted by stavrosthewonderchicken at 3:14 PM on November 12, 2012 [2 favorites]


Can you provide a cite for that? Everything I've seen shows that trans women are still effectively barred from donating blood, and nothing I could find on the FDA website showed any reversal of that policy. I'd love to see evidence that it's been changed.

I wish I could. Though the link Zarq provided looks pretty comprehensive.

I will say that the link you provided is an instance at a privately owned blood bank. Maybe they are a pack of transphobic jerks, maybe the phlebotomist was the only transphobic jerk. I just can't say what goes on in that organization.
posted by munchingzombie at 3:41 PM on November 12, 2012


Why not change from blacklist to whitelist? By which I mean, preemptively ban everyone, and then selectively unban after showing one or more clearing criteria. For example, a pre-existing history of blood donation where that blood has been tested, without positive result, or a set of recent tests of you for the various things they screen the blood for. They could charge some nominal fee to perform the tests, which are useful anyway to at-risk people, including people who have had sex with at-risk people, and give you the result - if you're clear, you can donate blood, but if you go for two years without, then you need to be re-tested.

Also the testing could be "first one free" or "free with a student ID" or otherwise set up to encourage young, healthy donors.
posted by aeschenkarnos at 3:49 PM on November 12, 2012


I don't know that I'd say the FDA policy on trans people is good, but it does treat people as indeed being whatever sex is listed on their ID. I donated blood 4 times a year for twenty years. Then I transitioned from legal female status to legal male status (I'm intersex by birth). I haven't been able to donate blood since then, although I have tried twice. I pointed out each time that I had given blood for many years without a problem and that the only thing that had changed about me was that my license went from reading "F" to "M." No dice.

So, thanks, FDA, for treating me just as you would any other man. And fie, FDA, on your treatment of men who've had sex with men.
posted by DrMew at 5:16 PM on November 12, 2012 [1 favorite]


Seems like it'd be good for the FDA to make their policy clear, instead of leaving it up to the interpretation of transphobic jerks and uninformed professionals. DrMew's experience provides good evidence that the FDA itself isn't being actively transphobic, which is at least something.
posted by jiawen at 5:51 PM on November 12, 2012


One obvious point that I'm sure the FDA et al. realize but I'm pointing out anyway: accepting the potentially-uncleeeean blood of MSM would have a significant impact on for HIV testing and infection-awareness rates for those MSM. IIRC blood donation centers notify you by letter if your blood tests positive for HIV (and for hepatitis, etc?). Many people, gay or straight, who would never even think to get "tested" for STDs will happily give blood and help.
posted by nicebookrack at 9:36 PM on November 12, 2012


nicebookrack, that's possible but blood donors tend to be a self-selected group, and the ones who are most at risk are unlikely to be outside of the 12 month "window" so they would still be prohibited anyway. We also don't want to encourage people who feel even a little unsure of their serostatus to donate blood until they get tested independently: the more negative results you have, the more likely they are to be "real," so when at all possible you don't want someone's first HIV test to be from trying to give blood.

But I do agree that being unaware of HIV status is a big problem that needs to be addressed and that the incentive to donate blood might be something that drives an increase in testing, since it's a really good reason to know. (From what little I've read mostly people don't get tested because they don't think they're at risk or they're nervous/ashamed about testing, as opposed to for structural reasons like not being able to afford it.)
posted by en forme de poire at 10:13 PM on November 12, 2012


Well I was going to call someone here out, but now two of you are making a case for discrimination, then immediately linking to actual science that discredits your own argument. Breaking apart both of your posts would just be tedious.

Why not change from blacklist to whitelist? By which I mean, preemptively ban everyone,

The population of the United States is not lining up to fight for the privilege of giving blood. There's usually a shortage.

Here's a strategy I advocate that no one wants to listen to: Universal single-payer health insurance, with compulsory blood donation and periodic medical screening, or you don't get the coverage. After you've done enough tests on an individual to satisfactorily rule out false negatives, and estabilsh a baseline disease-free status, that person donates once every three months. If a disease turns up in the linked screening, they're exempt from donation and treated immediately. Our chronic blood shortages are over. We catch blood borne diseases in the general pop much sooner, saving both money and lives. We have extra blood products to sell to nations that don't have the same regime. That extra income helps fund our health service. That's at least three birds with one stone.
posted by clarknova at 11:27 PM on November 12, 2012


> Would switching the ban from life-time to one year after having sex with a MSM affect things that much? What percentage of gay non-virgins haven't had sex in over a year?

Imagine all the people you have ever known in the whole world who are currently over 18. Friends, relatives, everyone. How many reasons can you think of for any of them to perhaps gone one year without sex? Too young to really be ready to pursue a vigorous sex life, lack of interested partners, moral objections, shyness, unpleasantness, physical or mental illness, side-effects from medication, sex-drive mismatch, complacency, children-related exhaustion, reduced libido in elder years, etc.

All applicable to gay men.
posted by desuetude at 11:44 PM on November 12, 2012 [2 favorites]


clarknova - Well I was going to call someone here out, but now two of you are making a case for discrimination, then immediately linking to actual science that discredits your own argument. Breaking apart both of your posts would just be tedious.
Well, if you can't be bothered to argue your point but still feel the need to make it clear that you disagree, could you at least be clear about who you're calling out? I assume that I'm one of them?

I agreed in my second comment that the Red Cross' evaluation is probably correct (and en forme de poire's subsequent comment has strengthened that opinion). To be clear: the demographic exclusions are a stop-gap, intended to shore up an imperfect test. As such, if the test really is good enough that we can rely on it completely and scrap demographic exclusions without unduly increasing the risk of transmission, then that's exactly what we should do.

I was trying to explain that the exclusion of certain populations from donating can make sense from an epidemiological perspective: there are (or probably "were", looking at the data linked in this thread) good reasons for such exclusions beyond "eew, gay blood". I agree that it sucks to have discriminatory policies like that, but epidemiologists necessarily work in terms of populations and risk factors. These will always be crude tools that catch people unnecessarily (I am excluded despite having enough negative screens to be extremely confident that I'd be fine as a donor; the same is true for friends of mine), but sometimes a crude tool to save lives is the only one that's available.

Again, if that's no longer the case for HIV in blood donations, then that's awesome and policy shuold be updated accordingly. But not all demographic screening is necessarily evil, is the point I'm trying to make.
posted by metaBugs at 5:31 AM on November 13, 2012 [2 favorites]


Here's a strategy I advocate that no one wants to listen to: Universal single-payer health insurance, with compulsory blood donation and periodic medical screening, or you don't get the coverage.

I would be very, very nervous about compulsive blood donation for health insurance in a country where it is now effectively illegal to not have health insurance.
posted by corb at 6:08 AM on November 13, 2012 [1 favorite]


"compulsory blood donation"

Really? ... Really?

In order for blood donation to be safe for either the donor or the recipient, donors need to be really really comfortable not donating. Whether their breakfast just isn't sitting right that day, or they didn't get to their breakfast, or its so hot outside as to be dehydrating, or the libations the night be for were dehydrating, or maybe they're feeling a little under the weather from the flu that is about to hit them, or there was that condom break a couple weeks ago that they were meaning to check out with their fiddly-bits-doctor, or that other risky thing they are only really able to acknowledge as risky sub-consciously for whatever reason, donors need to be totally cool with not donating for their own safety as well as others.
posted by Blasdelb at 6:36 AM on November 13, 2012 [2 favorites]


compulsory blood donation

This is a bad idea. I wish I could donate blood, but realistically even if I weren't under the British beef ban, I'd be a bad candidate. I have a phobia of needles and need anti-anxiety meds to have an IV for any length of time. I don't want to panic and start attacking a nurse (which is what I did before the therapy I had for it) who is just doing their job. And there are a lot of other people who have equally good reasons not to donate that have nothing to do with discriminatory bans.
posted by immlass at 7:12 AM on November 13, 2012 [1 favorite]


Well I was going to call someone here out, but now two of you are making a case for discrimination, then immediately linking to actual science that discredits your own argument. Breaking apart both of your posts would just be tedious.

I'm sorry if I was confusing above. My post was arguing that in order to know whether the policy is in fact discriminatory, we need to know 1) whether allowing MSM donation would result in a higher risk of getting HIV from a blood transfusion (and how much higher that risk would be), and also 2) whether the FDA is being consistent in its assessment of what level of risk is allowable. I then linked to a review which presents some evidence that the increased risk from moving to a 1-year deferral is probably at least ten times lower than previously suspected, and that the FDA already tolerates a much greater level of risk by allowing the pooling of platelet units. This suggests, together with empirical data that shows no increase in HIV+ blood released after moving to a 1-year deferral, that the blanket ban is overly cautious and possibly discriminatory.

Since you brought it up, there are a few problems with relying only on testing. One is that every test has a false negative rate, and even a small false negative rate multiplied by millions can have real consequences, as mentioned above. Another is that tests have window periods: typically HIV tests cannot detect recent (in the last few months) infections because the immune response is not yet detectable at that stage. PCR-based tests can shorten this window period to on average around 20 days but will still fail to detect infections within that time frame, and are less reliable outside of but close to the window. A third problem is related to Bayes' rule: the probability that you actually have a disease depends not only on your test result, but also on how much baseline risk you have. If you have spent your entire life in Vermont but you think you may have a rare tropical disease, getting tested for that disease is basically a waste of resources because even if you test positive, it is still overwhelmingly likely that you do not really have it. However, if you just returned from Malaysia plus you have symptoms that match (including a couple of uncommon ones), but you test negative, it might actually be worth running the test again. So the interpretation of testing results has to differ depending on what your risk was going into the test. This means that even with state of the art tests we are unlikely to be able to stop using risk factors to make public health decisions entirely.
posted by en forme de poire at 9:47 AM on November 13, 2012 [1 favorite]


Imagine all the people you have ever known in the whole world who are currently over 18. Friends, relatives, everyone. How many reasons can you think of for any of them to perhaps gone one year without sex?

Tons of reasons, but I don't think that being able to think of a ton of reasons implies that a ton of people (at any given time) have gone a year without having had sex.
posted by 23skidoo at 9:51 AM on November 13, 2012


23skidoo, I think in the paper I linked, they estimate that number at around 30% of MSM.
posted by en forme de poire at 10:01 AM on November 13, 2012


I've been in a monogamous relationship with a man (gasp) for 10 years (clutches pearls) and I've had more HIV tests in that period than the vast majority of the straight people I know. All negative, thankfully. My partner has been tested several times since we met and he has also always come out negative. I can't donate because I regularly touch another guy (one singular guy, who also only touches me) like some guys touch girls (even if that guy is touching a new random girl hourly). That's plainly ridiculous.

Also, speaking of being ashamed or unable to afford a test, when I went to the doctor for a physical a year or two ago (since I hadn't actually seen a doctor for maybe 8 years previously) I decided I might as well have them do an HIV test since they were already drawing blood. When I got the call telling me that everything had come back fine, the doctor's office told me that, in order to get my insurance to pay for the HIV test, they had to claim that it was in response to a possible exposure. I can imagine that there are many at-risk individuals who don't want "possible HIV exposure" coming up on their health history, for whatever reason.
posted by This Guy at 10:33 AM on November 13, 2012 [2 favorites]


A friend of mine is a blood bank physician, and gave me permission to post her thoughts in response to the Atlantic article:
Obviously, I’m an [evidence-based medicine] person, all the way. Isn’t that what [mutual science professor]’s mission in life was – to educate us into being evidenced-based for basically all decisions? Also, the guidelines for EVERYTHING pertaining to transfusion medicine in Europe are better/more evidence based than what we do here in the U.S. I have no idea what the U.S.’s problem is, but if I was told I had to adhere to all Europe’s regulations for blood bank, I would jump for joy. Much better patient care there.

In short, I absolutely agree that there should only be a one-year deferral for people who engage in high-risk activities.

I feel like a lot of this push-back has to do with the history of blood banking in the 80’s. The emergence of HIV hit the transfusion community hard. Many people were sued, lost their jobs and reputations – over something no one saw coming and we had no way of testing for at the time. Almost every hemophiliac over the age of 60 today has HIV/AIDS because of the epidemic. I met a hemophiliac with HIV, whose brother (also a hemophiliac) committed suicide when he was diagnosed with “the gay disease”. It was horrible, and people are still scarred. I think they’re scarred so badly they can’t accept the data. Babies and kids with an untreatable disease is a hard thing to get over.

In my program we are big on limiting unnessecary transfusions as much as possible. Not only does receipt of more blood spell a worse outcome for a trauma patient (not because it means you are more injured or sick, but because of tissue changes arising from the transfusion itself), but we are very aware that there will be a newly emerging disease we cannot identify, coming from the blood supply. Right now we are great at identifying pathogens in the blood that we are aware of, but as soon as something new comes along, we’re fucked. So the daily goal is to make sure you only get blood if it’s truly life or death. (The surgeons DO NOT agree with us).

What a great idea – a sponsor drive! How creative and helpful to overcome the protests! Genius.

I very much feel like donors are there because of altruism and would never want to hurt someone. So education about their donation would be the most powerful deterrent. The blood bank should let them know even if they have a minor bacterial infection or URI, much less a long-term communicable illness with potential severe sequelae, that they shouldn’t donate. It’s like each unit of blood should be treated as if it’s going to the sickest neonate, and we have to be that careful all the time. Sure, the blood could go to an 89 year old grandma who would die or natural causes before HIV/whatever causes harm, but people would be more conscientious if they knew they were giving to a 1 lb new born who might have decades of life left.

An interesting aside to this is that not only are women more likely to donate blood, but we actually need more donations from nulliparious women and men. Almost all blood banks separate out red cells and platelets from the plasma for storage (and some other reasons). The patient’s antibodies are contained in the plasma bag. So, female donor’s red cells are great, but if the woman has had kids, she may have made alloantibodies that may cause acute lung injury in plasma recepients. We sequester all “female plasma” and use “male plasma” first, because it has such a lower chance of causing pulmonary complications.

The author of that article talked about discrimination and legality – fuck that shit. That’s great if you’re talking about everything other than the right to donate, but if someone has a higher likelihood of transferring illness via a tissue donation, then they can take the constitution and shove it where the sun don’t shine. I’m only talking about people who really are more likely to taint the blood/tissue supply, which is not the case with MSM, but I don’t give a fuck about parity amongst donor groups when it comes to patient care. I will only give blood that I truly think is safe because that’s on me for the rest of my life.
posted by grouse at 5:35 PM on November 19, 2012 [4 favorites]


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