US Gay/MSM Blood Donation Ban To Be Eased
December 23, 2014 2:04 PM   Subscribe

 
Via Vox, an additional issue which should not be ignored:

"The ban effects trans women who have sex with men, too. An FDA spokesperson said, "For the purposes of determining donor eligibility, FDA believes that genetic males be considered males even after gender-altering surgery.""
posted by CharlesV42 at 2:09 PM on December 23, 2014 [3 favorites]


I am torn between "small victories are still victories" and "this doesn't affect many gay men - it focuses on, what, bi men who've settled down with a woman, and some smaller groups?"

So, uh, Yayboo?
posted by Lemurrhea at 2:09 PM on December 23, 2014 [3 favorites]


Don't they test every blood donation anyway? This doesn't make any more sense than the initial ban.
posted by Caduceus at 2:17 PM on December 23, 2014 [9 favorites]




This sort of reminds me of a friend that had a job where he toiled for years without a raise. One day his boss came to him and said 'Hey, were giving you a raise!'. 'Great!' he said, 'how much?'. '25 cents an hour'. He quit on the spot.

What I mean to say is that the FDA has long had a homophobic policy that wasn't based on science. So now they've updated that policy, and it's a tiny tiny bit less homophobic (I guess, or maybe not). So they've admitted their past policy wasn't reasonable and now have a new homophobic policy.

Sometimes when you've pissed off both sides (the homophobes and the LGBT friendly folks) you haven't found a 'good compromise', you've just have a new bullshit policy that isn't good in any light.
posted by el io at 2:25 PM on December 23, 2014 [17 favorites]


Yeah, Lemurrhea, I had the same thoughts. Apparently gay men who are monogamous and/or use protection are too risky for them, which is ridiculous. I really don't get why it's not six months, and why use of protection is not taken into account. But I guess the rule change as it is was quite a battle.

I'm looking for a list of all the rules for comparison but haven't found it yet...
posted by pinothefrog at 2:31 PM on December 23, 2014


I jokingly remarked that now the FDA and the LDS Church have something in common - gay men are "OK" so long as they don't have sex.
posted by msbutah at 2:31 PM on December 23, 2014 [8 favorites]


Yeah, I think this is more offensive, actually, than having the previous rules stand. I mean, those were created in the 1980s when (a) there had been much less progress on gay rights and (b) there was much less knowledge about how HIV is transmitted. And while I'm not in any way defending the status quo ante yesterday, I get that policies like this can take a frustratingly long time to change.

But this is just a slap in the face. If they were going to make the effort to change the policy, they should have done so in a fair, effective, scientifically-sound way. This isn't that.

This is the asshole who leaves a five-cent tip because the overworked server didn't wait on them hand and foot. Keep your damn nickel and just walk out, thanks.
posted by tivalasvegas at 2:33 PM on December 23, 2014 [5 favorites]


@Caduceus: they do, but maybe the "logic" is that gay men (in America) are more likely to have undetected blood born pathigeons than heterosexual men. Thus, the rate of postitive test results will be higher. There is some mathematics involved on at what level it is worth accepting dontains given then you are going to discard a certain percentage. Suppose:

"P" is what you can charge per unit of blood. "T" is what it costs to run a test against a unit of blood. "F" is the percentage of units of blood you discard because of testing; this percentage will change depending on the group of people donating.

Then when "F * T > P" it makes no economic sense to accept donations from a group. Yes, you still have to run tests for all donations, but donations from different groups don't all cost the same to test because of the failure rate.

Now, that being said, I think there's enough scientific evidence to say that "F" is low enough where they should accept donations. The cost is not really a concern. The real reason is most likely "Ewwww... gay blood. I don't want that in me!"
posted by sbutler at 2:36 PM on December 23, 2014 [4 favorites]


OK, here it is. Notice that the previous wait period for coming into contact with a random person's open wound was 12 months.
posted by pinothefrog at 2:37 PM on December 23, 2014 [2 favorites]


Well, this means I will be able to donate blood anyway. I've had some male-male sex in my lifetime, but I'm mostly hetero (sexual orientation is a spectrum) and I've been finding myself more and more hetero over the years (sexual orientation is fluid) so it's been about five or six years now since the last time I got it on with a dude.

In the past that's meant that I couldn't donate blood, which has seemed pretty goddamn ridiculous but that's what the Red Cross people told me and there definitely wasn't any flexibility on the matter. Now, I'll be clear to donate.

So hooray? It's definitely only a step in the right direction, but it frees up at least one potential donor right here and I can't imagine my story is all that unusual. It may not mean much for the gay community (and I hope that with continued agitation we can get some actual science-based policy on this issue) but it means a lot, potentially, for guys who have screwed around with other guys but don't do it on the regular. That's a whole lot of guys, if you believe the statistics.
posted by Anticipation Of A New Lover's Arrival, The at 2:40 PM on December 23, 2014 [5 favorites]


They also won't take blood from anyone who lived in the EU in the 80s and 90s because of mad cow disease for perspective. Ive never been able to donate.

It's much cheaper and easier to exclude huge groups than to do all the work of collection and have to discard.

It's a testimony to how good Americans are about donating that they can afford to do this really.
posted by fshgrl at 2:40 PM on December 23, 2014 [7 favorites]


Wow, pinothefrog, there are some interesting questions in there: "In the past 12 months have you had sexual contact with anyone who has ever used needles to take drugs or steroids?"
posted by smackfu at 2:41 PM on December 23, 2014


Yeah, inferring from the rules a woman can have unprotected anal sex with a man who she knows has HIV, and she has to wait 12 months... which is more than enough time, but just makes the discrimination more obvious.
posted by pinothefrog at 2:47 PM on December 23, 2014


Finally, Marcus Bachman can give blood!

( I give blood every chance I can, everybody has just kind of mumbled over that question really quickly.)
posted by The Whelk at 2:47 PM on December 23, 2014 [1 favorite]


Is it really discrimination to be cautious regarding an infection path that has already been shown to be exploited by a virus in our lifetime?

In my mind, this isn't about HIV, it's about the next blood born virus that exploits the same vulnerabilities.

(I'm speaking as someone who has a lifetime ban on blood donation due to the "time in Africa" questions)
posted by bottlebrushtree at 2:51 PM on December 23, 2014 [1 favorite]


When this subject came up on the green a few years ago, I listed some data on the impacts of this change. At least as of then, switching to a 12 month deferral period doesn't add very many new donors, though it also has a pretty minimal additional risk. So all in all, a good move.

Unfortunately, the blood supply works on averages and excludes large groups of people in the name of efficiency and safety. I would far rather take blood from a monogamous gay couple who always uses condoms and receives regular testing for blood-transmissible diseases than many straight people. However, we don't have the data to know what further changing the policy would do to the safety of the blood system. I think we should collect more of that data certainly, but I don't think it's fair to blame today's policy entirely on bigotry.
posted by zachlipton at 2:59 PM on December 23, 2014


( I give blood every chance I can, everybody has just kind of mumbled over that question really quickly.)
Every time I've given blood, it's been on the written questionnaire?
posted by ArbitraryAndCapricious at 3:00 PM on December 23, 2014


Bottlebrushtree, it might have been sensible when there was less knowledge about the virus and no tests, but we know more now and public health authorities are willing to be less overcautious. Novel infections require their own research, but this is a specific threat that we can react to appropriately.
posted by Small Dollar at 3:02 PM on December 23, 2014 [2 favorites]



I am torn between "small victories are still victories" and "this doesn't affect many gay men - it focuses on, what, bi men who've settled down with a woman, and some smaller groups?


Yeah, there are a bunch of us out there, though. So, still a victory. For whoever gets the blood I donate.

But yeah, they test all the blood, so it still seems unneccessary.
posted by Cookiebastard at 3:04 PM on December 23, 2014 [2 favorites]


sbutler: "pathigeons"

I'm just going to quote that, because it's way too good a misspelling to let it just pass unnoticed. So, infected people are carrier pathigeons, I assume?
posted by Joakim Ziegler at 3:04 PM on December 23, 2014 [15 favorites]


It can certainly add to stigmatization, but I don't see how even a total ban on men who have sex with men infringes anyone's rights. It's not a right to donate blood. And I say that as someone who's not allowed to donate.
posted by Joakim Ziegler at 3:06 PM on December 23, 2014


Watch out for those homing pathigeons :) Also, I think I missed a term in my formula: "F * T > (1-F) * P". Anyway, it's still bullshit.
posted by sbutler at 3:12 PM on December 23, 2014 [1 favorite]


bottlebrushtree, I'm not sure there's that much difference in the vulnerabilities exploited in the heterosexual infection paths that previously had fixed wait periods of one year or so vs. the vulnerabilities exploited in the infection paths of men who have sex with men. Given how quickly HIV spread through heterosexual populations, I imagine a new pathogen will have little trouble being spread by heterosexual contact.

Just out of curiosity, what part of Africa and time period? I understand where you're coming from, given that the Africa portion goes on to explain their reasoning—but even then, if you are donating at a facility that can test for the "rare strains" of HIV then that question is eliminated. So they're not looking out for new pathogens, the rule is based on specific pathogens that they know they can't test for.
posted by pinothefrog at 3:14 PM on December 23, 2014


"P" is what you can charge per unit of blood. "T" is what it costs to run a test against a unit of blood. "F" is the percentage of units of blood you discard because of testing; this percentage will change depending on the group of people donating.

Then when "F * T > P" it makes no economic sense to accept donations from a group. Yes, you still have to run tests for all donations, but donations from different groups don't all cost the same to test because of the failure rate.


Point taken, however there are certainly ways to screen for what they're actually looking for, which is donors who have an uneconomically high likelihood of giving blood which contains HIV.

For instance, they could create a safe haven like "Have you been tested for HIV and if so, have you engaged in (insert high-risk activities) since that date? (And these activities should not include engaging in sexual activity within a monogamous relationship.) I can't imagine that the set of persons who have tested negative for HIV and have subsequently not engaged in high-risk activities is going to be higher than that of the general population.
posted by tivalasvegas at 3:16 PM on December 23, 2014 [3 favorites]


In my mind, this isn't about HIV, it's about the next blood born virus that exploits the same vulnerabilities.

I feel like the odds that a similar virus that exploits the same vulnerabilities will come along are significantly lower than the odds that a dissimilar virus that exploits some other vulnerability will come along, but we're not defending against that dissimilar virus, because that would be kind of insane.

This was always based on homophobia, or whatever you want to call the belief that men who have sex with men are incapable of protecting themselves from known public health risks with known, simple methods of amelioration.
posted by Etrigan at 3:17 PM on December 23, 2014 [4 favorites]


Sorry, Cookiebastard/Anticipation of A New Lover's Arrival, The, I totally didn't mean to minimize your situation! I do get that it's a relatively large category, just it's still weirdly discriminatory.
posted by Lemurrhea at 3:19 PM on December 23, 2014 [1 favorite]


Meh.

This is progress, but it's anti-science progress, and it's still discriminatory based on nothing other than sexual orientation.
posted by roomthreeseventeen at 3:22 PM on December 23, 2014 [1 favorite]


men who have sex with men are incapable of protecting themselves from known public health risks with known, simple methods of amelioration

Precisely. There is absolutely no reason for MSM to be categorically disallowed from donating blood even if we have been tested, know our status and have not engaged in risky behavior since.

I can't give blood even though I am as certain as one can be that I am not HIV-positive. Because bigotry.
posted by tivalasvegas at 3:23 PM on December 23, 2014 [4 favorites]


No offense taken, Lemurrhea. It is still weirdly and unnecessarily discriminatory. For real, because I'm in a long-term heteronormative marriage, this is about the only sexual-orientation thing that's had any effect on me in decades. Many of my LGBT brothers and sisters face much more varied, and much worse discrimination every day.
posted by Cookiebastard at 3:29 PM on December 23, 2014


In my mind, this isn't about HIV, it's about the next blood born virus that exploits the same vulnerabilities.

There are more heterosexuals then gay men. We can argue about promiscuity rates and number of partners, but I think thanks to Tindr and the ongoing sexual revolution, heterosexuals are catching up to homosexuals in that regard (and as society starts to accept and value homosexual relationships, I think promiscuity is/will fall). By sheer force of numbers there is much more heterosexual sex occurring than homosexual sex.

So what is it in your mind that makes homosexuals a particular risk for the next big, blood born disease?

BTW: don't ignore that HIV first made inroads into human populations through heterosexual sex in Africa. That HIV is predominately a "gay disease" in America is a regional phenomena.
posted by sbutler at 3:29 PM on December 23, 2014 [8 favorites]


I am torn between "small victories are still victories" and "this doesn't affect many gay men - it focuses on, what, bi men who've settled down with a woman, and some smaller groups?"

It affects any gay man who has sex more than once every twelve months. It's still ridiculous and discriminatory; the questionnaires should focus on actual behaviour. "Which of the following have you done in the past 6 months / when was your last HIV test / etc."

Don't they test every blood donation anyway? This doesn't make any more sense than the initial ban.

Yes but that costs money, especially since they need, as I understand it, to test directly for the virus and not for antibodies. The direct test is more expensive.
posted by feckless fecal fear mongering at 3:31 PM on December 23, 2014


To be clear, though, the issue isn't really promiscuity or even unprotected sex. Being the receptor of unprotected anal sex has the highest rate of transmission.
posted by roomthreeseventeen at 3:31 PM on December 23, 2014


( Have the vCJD rules changed? I seem to recall that I'd spent too much time in Europe to donate, but now I seem to be under the five year line - but not by much.)
posted by wotsac at 3:40 PM on December 23, 2014


What I never understood about these bans is - how do they verify people's answers? Don't they test ALL blood anyway, in case people lie? So - what's the point in the bans, if they assume people will lie and do the tests anyway?
posted by FritoKAL at 3:42 PM on December 23, 2014 [2 favorites]


Even incremental improvements are still improvements, but this change sure does seem like it has a "fuck you" embedded in it. I wish I had confidence that these decisions were made purely on science, rather than on grounds of "ew, icky!"

They also won't take blood from anyone who lived in the EU in the 80s and 90s because of mad cow disease for perspective. Ive never been able to donate.

If I'm reading the rules correctly, I've aged out of all the other restrictions (such as time in Africa, tattoos, etc) except for the mad cow issue. As of right now, I've never actually been eligible to give blood in my adult life; I wonder if the rules will ever change such that I have the option.
posted by Dip Flash at 3:44 PM on December 23, 2014 [1 favorite]


They do test blood but it's also about exposing their employees and about the enormous class action lawsuits brought by groups exposed to AIDS via the blood supply in the 80s.

I'm surprised by the tone of this thread. Normally metafilter does complex situations a bit better than this.
posted by fshgrl at 3:48 PM on December 23, 2014 [3 favorites]


Written questionnaire?

Huh, I always got a little interview from the person who sticks you as they run down a checklist?
posted by The Whelk at 3:52 PM on December 23, 2014


Don't they test every blood donation anyway? This doesn't make any more sense than the initial ban.

No screening test is 100% effective. If the test is 99.9% sensitive, one tainted donation in a thousand slips through, which they'd consider an unacceptable risk. Over half of HIV carriers in the USA are MSM, and about 9 percent of men in the USA* (so, about 4.5% of the total population) have had a male sexual partner in their lifetime. If you can cut your "risky donation pool" by 50% by reducing your total donor pool by 4.5%, that's a win in terms of statistics, if not ethics.

I recently got an online survey from Canadian Blood Services asking their donors for opinions on a new MSM donation policy (CBS's current policy is like the new FDA one, but with a 5-year celibacy period rather than 12 months). One of the options is that MSM who have been in a committed relationship *or* been celibate for at least a year would be allowed to donate. I don't understand the thinking behind the FDA not choosing that option; heck, you could make an argument that donors of any and all genders should have to have to follow that rule.

What I never understood about these bans is - how do they verify people's answers? Don't they test ALL blood anyway, in case people lie? So - what's the point in the bans, if they assume people will lie and do the tests anyway?

It's interesting, actually -- at Canadian Blood Services at least, they have a system for people who are motivated to go through the donation process although they know they shouldn't, and lie on their screening as a result. (Examples would be people donating out of peer pressure, or wanting to get free HIV or hep C test results). As part of the donation process, the staff leave you alone in a room for a minute with two anonymized barcode stickers, one for YES and one for NO; you put one on your form and throw the other one away. If you choose the NO, the staff will never know you put it there, but the scanner that processes your forms will know that you nixed your donation and will flag it for removal from the system. The blood will still get tested for HIV / hep C and you will be notified if there's a positive test. I thought it was pretty clever.

* Lots more good statistical info in this FiveThirtyEight link.
posted by saturday_morning at 3:57 PM on December 23, 2014 [12 favorites]


Here is what the FDA has to say about (MSM) blood donations.

Here are laws in the rest of the world. The US is far from unique.

Normally metafilter does complex situations a bit better than this.

Depends on how buzzy the subject is, alas.
posted by IndigoJones at 3:57 PM on December 23, 2014 [1 favorite]


Normally metafilter does complex situations a bit better than this.

MetaFilter isn't the entity that's mishandling this complex situation by reducing it to an overly simplistic binary choice.
posted by Etrigan at 4:12 PM on December 23, 2014 [12 favorites]


It's interesting, actually -- at Canadian Blood Services at least, they have a system for people who are motivated to go through the donation process although they know they shouldn't, and lie on their screening as a result. (Examples would be people donating out of peer pressure, or wanting to get free HIV or hep C test results). As part of the donation process, the staff leave you alone in a room for a minute with two anonymized barcode stickers, one for YES and one for NO; you put one on your form and throw the other one away. If you choose the NO, the staff will never know you put it there, but the scanner that processes your forms will know that you nixed your donation and will flag it for removal from the system. The blood will still get tested for HIV / hep C and you will be notified if there's a positive test. I thought it was pretty clever.

The Red Cross in the US has a similar mechanic. Since blood drives here are often at work I think it's a good idea; it helps avoid outing people.
posted by winna at 4:19 PM on December 23, 2014 [8 favorites]




For what it's worth, the ban has been part of my personal motivation to donate as often as I can. I figure that since so many people I know can't do it, it's up to me do my part.
posted by octothorpe at 5:54 PM on December 23, 2014 [6 favorites]


People who would otherwise not support an apparently-discriminatory policy often change their mind if they're given a scientific basis for it, even if the reason is really weak. In this case it's obviously desirable that blood products be safe; gay blood donors are reportedly somewhat more risky than heterosexual donors; therefore the older policy seems reasonable. But it isn't! We know that the added risks are small - Wikipedia reports an estimate of one added HIV infection every 32.8 years. The cost of excluding gay donors is real: for one thing, it reduces the supply of blood products (which is a problem, especially for rare blood types). For another, any instance of discrimination, even rational discrimination, places a burden on people.

That Wikipedia article reports that from 2006 "the AABB, American Red Cross, and America's Blood Centers all supported a change from the current US policy of a lifetime deferral of MSM to one year since most recent contact". That's a pretty substantial body of opinion, over a long period of time. So why did it take this long for the policy to change? I suppose it might be due to a bias against risk, combined with a deference to (earlier) authority. That's no defence of the older policy: those arguments are a-scientific, irrational. I think our policy-makers need to be more active in asking whether their positions are reasonable, or whether they are just masks for unexpressed or unconscious prejudice.
posted by Joe in Australia at 6:13 PM on December 23, 2014 [2 favorites]


I'm not going to donate again. I have a fear of needles and I sweated the two times I tried to donate. I thought the first time was a mistake; she threw my blood sample into the trash without looking at me. The second time, the nurse was very clear: we will not accept your blood. And she threw my blood sample into the trash.

Yes, I'm bitter about this. They could have at least put up a sign, "Gays and Bi's go away!" Instead, I sat through 45 minutes of terror, twice, trying to be a good citizen, only to be told my blood is worthless.

So, screw it. Bleed to death, for all I care.
posted by SPrintF at 6:25 PM on December 23, 2014 [6 favorites]


Yeah, nobody has a right to donate blood, but the FDA is a Federal organization that is actively practicing (and prescribing) discrimination against MSM.
posted by xedrik at 6:50 PM on December 23, 2014


This was always based on homophobia, or whatever you want to call the belief that men who have sex with men are incapable of protecting themselves from known public health risks with known, simple methods of amelioration

This does not seem to be borne out by STD rates which is probably a prety good indicator of overall safe sex practices.
posted by rr at 8:03 PM on December 23, 2014


I recently got an online survey from Canadian Blood Services asking their donors for opinions on a new MSM donation policy

Maybe if you don't want people accurately pointing out that your donation criteria are based more on old bigotry than current science, don't do things like this? I can't imagine that my queer-ass blood would be all that popular in an online survey, so I have no idea what great wisdom they were after with that.
posted by Corinth at 1:12 AM on December 24, 2014 [4 favorites]


I'm not too thrilled with this change, either. I'm in a committed monogamous relationship and still can't give blood. The FDA needs to recognize that the single question "have you had sex with another man in the last year" still doesn't provide them sufficient information to assess risk, particularly in light of how short the window period is for modern HIV tests.

And on the subject of this thread's tone, I'm sad to say this is the first thread in a while where I feel hurt and unwelcome. Ouch, y'all.
posted by spitefulcrow at 5:26 PM on December 24, 2014 [3 favorites]


So, from pinothefrog's link, check out page 17:

"In the past 12 months have you had sexual contact with anyone who has HIV/AIDS or has had a positive test for the HIV/AIDS virus?"

Yes: defer donor
No: accept donor

So yeah, until yesterday the FDA considered men who had had sex with a man EVEN ONCE since 1977 more of a risk -- infinitely more of a risk, to be precise -- than some hypothetical guy who'd had sex with (say) a thousand women each of whom he knew to be HIV-positive, so long as he'd had sex with all of them more than 365 days ago.

Now we have achieved the dizzying heights of being reclassified as being at exactly the same level of risk as this hypothetical person.

I continue to be unimpressed with this great leap forward.
posted by tivalasvegas at 9:57 PM on December 24, 2014 [3 favorites]


As a House fan, I feel the need to point out that just because someone thinks they're in a monogamous relationship, doesn't mean that their partner is actually being faithful to them (this was a frequent theme on the show, accounting for various "impossible" STDs and genetic diseases via mistaken parentage). Not saying that's a large fraction of the people who would say they were in a monogamous relationship, but it is some fraction, anyway.
posted by OnceUponATime at 3:26 PM on December 25, 2014


I feel the need to point out that just because someone thinks they're in a monogamous relationship, doesn't mean that their partner is actually being faithful to them...

In my admittedly limited experience, that is also the case for heterosexual relationships, but no one is using it as a reason to keep MSWs or WSMs from donating blood.

Not that I'm saying you're advocating it as a reason to keep MSMs from donating blood, but bringing it up in this case can easily be interpreted as such.
posted by Etrigan at 5:01 PM on December 25, 2014 [2 favorites]


Right, I thought about including a disclaimer saying "applies to heterosexual couples too", but maybe too optimistically thought it wasn't necessary.

I probably should've quoted a couple of previous comments for context:
Then when "F * T > (1-F) * P" it makes no economic sense to accept donations from a group. Yes, you still have to run tests for all donations, but donations from different groups don't all cost the same to test because of the failure rate.
Point taken, however there are certainly ways to screen for what they're actually looking for, which is donors who have an uneconomically high likelihood of giving blood which contains HIV.

For instance, they could create a safe haven like "Have you been tested for HIV and if so, have you engaged in (insert high-risk activities) since that date? (And these activities should not include engaging in sexual activity within a monogamous relationship.)


It seems to me that whether this is an unreasonable restriction or a reasonable one depends on the outcome of that calculation. However, I agree that more specific questions could probably reduce the risk/cost while excluding fewer people. Only I'm not sure that "are you monogamous" is going to reduce it by as much as one would wish. That's what I was getting at.
posted by OnceUponATime at 6:43 PM on December 25, 2014


Right, I thought about including a disclaimer saying "applies to heterosexual couples too", but maybe too optimistically thought it wasn't necessary.

Yeah… just for reference, in this sort of thread, with my pissed-off-and-defensive hat already on, this read as the shitty old meme that we gays are just sluts who can’t help but bend over for anyone with a stiffy. So, if you mean well, then make sure we know you mean well.
posted by spitefulcrow at 7:20 PM on December 29, 2014


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