In 1983, more than 10,000 transfusion recipients were infected with HIV from tainted blood. In response, the FDA instituted a lifelong ban on blood donations from any man who'd had sexual contact with another man ("MSM" for short). There are no exceptions, even for celibate men who have tested negative for HIV.
Last month, U.K. Department of Health, acting on recommendation in a report from the the U.K. Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO), lifted their similar law banning MSM blood donations -- provided the men haven't had sex in at least one year. Restrictions have been relaxed in Australia, Japan, Sweden, South Africa and New Zealand. Some think the US should follow suit, but others believe the ban should remain to protect transfusion recipients.
Why a one-year deferral?
The SaBTO report looked at data regarding HIV and related diseases and "additional infectious agents" in the donor population as well as the UK overall population. What SaBTO found is that these diseases can be reliably screened for at the time of donation -- if the donor is not in an "early window infection" stage. This window is between nine days and 12 months, depending on the disease. During the window, test results could be unreliable -a false negative might appear in donors who'd recently engaged in high-risk behavior, who could then transmit the disease to a recipient.
The SaBTO recommended deferring gay males for either one or five years from their last sexual encounter to ensure the window had been exceeded. The UK chose the one-year deferral.
Should the US follow suit and institute a deferral system rather than an outright ban on donations from gay men?
In favor of maintaining the lifetime ban
In 2009, the Center for Disease Control "estimate[d] MSM represent approximately 2% of the US population, but accounted for more than 50% of all new HIV infections annually from 2006 to 2009." This data is the most heavily cited in ban-lifting opponents, who say this creates an increased risk to recipients.
Dr. Jay P. Brooks, a professor of pathology and the director of blood banking and transfusion medicine at University Hospital in San Antonio, says the risk is too great to lift the ban:
The FDA agrees: a petition put forth from the American Red Cross in 2006 called the ban "medically and scientifically unwarranted," but the FDA maintained that the increased risk of HIV infection in the general population was too great to assume.
In favor of lifting the lifetime ban
The American Red Cross continues to advocate a repeal of the MSM donor ban in favor of a deferral system, as does Dr. James P. AuBuchon, president of the American Association of Blood Banks. "Given the sensitivity of the tests we now have available, there is no detectable increased risk of HIV entering the blood supply by allowing gay and bisexual men to donate. . . [U]nits of blood are typically destroyed quickly if they're identified as unsuitable, and blood collectors have a robust protocols — including computer systems approved by the FDA — to prevent erroneous releases."
What the FDA should focus on, says Joel Ginsberg, head of the Gay and Lesbian Medical Association, are "behavioral risks rather than belonging to a particular group" by reworking the donor questionnaire about sexual activity and lifestyle behaviors, regardless of demographic.
There are opponents to this tactic, though--primarily, SaBTO. They felt that "the introduction of extensive donor health check questionnaires regarding sexual history will lead to a loss of existing donors," when presenting their data to the UK Dept. of Health. So there's the dilemma: do you lose part of your current donor base to admit the (very few) celibate homosexual men who could then donate under the new, fairer screening process? That gamble is not likely to be accepted in the U.S. The most viable option for lifting the ban appears to be the one-year deferral adopted in 12 other industrialized nations.
OK, Neatoramanauts: If it were on a ballot, would you vote to keep the blood donation ban for gay men intact, or vote to implement a deferral system?
Sources:
Pro/Con: Two views of U.S. prohibiting gay men's blood donation
American Red Cross Fights Ban On Gays' Blood
Bloody Personal
Britain Lifts Ban on Gay Men Donating Blood. Could the U.S. Be Far Behind?
SaBTO Donor Criteria Selection Review (April 2011) [PDF]
HIV Incidence Report, CDC 2009
Last month, U.K. Department of Health, acting on recommendation in a report from the the U.K. Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO), lifted their similar law banning MSM blood donations -- provided the men haven't had sex in at least one year. Restrictions have been relaxed in Australia, Japan, Sweden, South Africa and New Zealand. Some think the US should follow suit, but others believe the ban should remain to protect transfusion recipients.
Why a one-year deferral?
The SaBTO report looked at data regarding HIV and related diseases and "additional infectious agents" in the donor population as well as the UK overall population. What SaBTO found is that these diseases can be reliably screened for at the time of donation -- if the donor is not in an "early window infection" stage. This window is between nine days and 12 months, depending on the disease. During the window, test results could be unreliable -a false negative might appear in donors who'd recently engaged in high-risk behavior, who could then transmit the disease to a recipient.
The SaBTO recommended deferring gay males for either one or five years from their last sexual encounter to ensure the window had been exceeded. The UK chose the one-year deferral.
Should the US follow suit and institute a deferral system rather than an outright ban on donations from gay men?
In favor of maintaining the lifetime ban
In 2009, the Center for Disease Control "estimate[d] MSM represent approximately 2% of the US population, but accounted for more than 50% of all new HIV infections annually from 2006 to 2009." This data is the most heavily cited in ban-lifting opponents, who say this creates an increased risk to recipients.
Dr. Jay P. Brooks, a professor of pathology and the director of blood banking and transfusion medicine at University Hospital in San Antonio, says the risk is too great to lift the ban:
"If the current policy is changed or eliminated, we just don't know what the increased risk to the blood supply will be. We could have one additional HIV-positive unit released every 10 years, every 20 years — or one per year. . . But if the policy is changed to relieve the stigma, you have a risk that has been transferred to a completely different group — the recipients — and I think that is an unfair situation."
The FDA agrees: a petition put forth from the American Red Cross in 2006 called the ban "medically and scientifically unwarranted," but the FDA maintained that the increased risk of HIV infection in the general population was too great to assume.
In favor of lifting the lifetime ban
The American Red Cross continues to advocate a repeal of the MSM donor ban in favor of a deferral system, as does Dr. James P. AuBuchon, president of the American Association of Blood Banks. "Given the sensitivity of the tests we now have available, there is no detectable increased risk of HIV entering the blood supply by allowing gay and bisexual men to donate. . . [U]nits of blood are typically destroyed quickly if they're identified as unsuitable, and blood collectors have a robust protocols — including computer systems approved by the FDA — to prevent erroneous releases."
What the FDA should focus on, says Joel Ginsberg, head of the Gay and Lesbian Medical Association, are "behavioral risks rather than belonging to a particular group" by reworking the donor questionnaire about sexual activity and lifestyle behaviors, regardless of demographic.
There are opponents to this tactic, though--primarily, SaBTO. They felt that "the introduction of extensive donor health check questionnaires regarding sexual history will lead to a loss of existing donors," when presenting their data to the UK Dept. of Health. So there's the dilemma: do you lose part of your current donor base to admit the (very few) celibate homosexual men who could then donate under the new, fairer screening process? That gamble is not likely to be accepted in the U.S. The most viable option for lifting the ban appears to be the one-year deferral adopted in 12 other industrialized nations.
OK, Neatoramanauts: If it were on a ballot, would you vote to keep the blood donation ban for gay men intact, or vote to implement a deferral system?
Sources:
Pro/Con: Two views of U.S. prohibiting gay men's blood donation
American Red Cross Fights Ban On Gays' Blood
Bloody Personal
Britain Lifts Ban on Gay Men Donating Blood. Could the U.S. Be Far Behind?
SaBTO Donor Criteria Selection Review (April 2011) [PDF]
HIV Incidence Report, CDC 2009
I support lifting the ban and testing all the blood. Back then the blood banks were fighting tooth and nail against testing because it was expensive and time consuming; they had only ELISA and Western Blot tests at the time. Now the tests are fast, more accurate, and much less expensive. Let gay people donate.
So, if historically, we have deduced that many terrorists are (INSERT HIGH-RISK GROUP HERE), it would be scientific to discriminate against all (INSERT HIGH-RISK GROUP HERE)s, and keep them off of airplanes altogether. But the only screening done is to ask a person if they're (INSERT HIGH-RISK GROUP HERE) before they board the plane. We won't even screen their luggage, or anyone else's luggage, for that matter. After all, they're not (INSERT HIGH RISK GROUP HERE)s. Because people never lie. That wouldn't be very scientific of them to lie.
The ban is discriminatory because it presumes that ANY male-to-male homosexual contact is inherently more dangerous than SOME TYPES of heterosexual contact.
Taking someone's word for it is like asking your casual sex partner, while you're undressing, "You don't have anything, do you?" or trusting that man who says, "We don't need a condom, baby. I've had a vasectome."
Laughable.