"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.*Wikipedia - Gay male blood donor controversy
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?"
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."
"...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.
...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)
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.
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
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'?)
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.And probably the biggest "wow" moment I had reading this review was this statement from the conclusion (again, my emphasis):
...
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%.
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).
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.posted by grouse at 5:35 PM on November 19, 2012 [4 favorites]
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.
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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]