Erotica By Helen E. H. Madden

Here's a headline I just couldn't believe:

Banned for life: Gay men still can't donate blood: Gay men remain banned for life from donating blood, the government said, leaving in place _for now_ a 1983 prohibition meant to prevent the spread of HIV through transfusions.

This showed up last week on MSN.com, and I've been considering the implications of it. Rather than go off half-cocked, I decided to do a little research on the subject first. Here's what I've found so far.

According to the Food & Drug Administration website, the FDA is responsible for making sure that any patient who receives a blood transfusion is protected by 'five layers of overlapping safeguards.' These safeguards include:

Donor screening - all donors are required to answer questions regarding the safety of their blood.

Blood testing - all blood donated must be tested to ensure it is free of infections diseases like HIV or BSE (the 'mad cow' disease).

Donor lists - blood collection centers must keep lists to prevent collection of blood from people who have been deferred.

Quarantine - donated blood must be kept in strict quarantine until it has been tested and approved for use.

Problems and deficiencies - blood centers must practice quality control of manufacturing and storage of blood products and must report any problems to the FDA.

All the above is just my rough summation of what you can find on the FDA website. The particular safeguard I'm discussing here is the first one, the donor screening. If you reveal during the screening process that you are a man who has had sex with another man, you will be deferred from donating blood. Note the FDA says 'deferred' and not 'banned,' although you are deferred for life in this case, which to be honest sounds like being banned to me. The FDA also uses the term 'men who have sex with other men' (MSM) as opposed to gay or bisexual. I'm not sure if the language really makes any difference beyond political correctness. The FDA makes the following statement on its policy regarding 'deferring MSMs' from donating blood:

Men who have had sex with other men, at any time since 1977 (the beginning of the AIDS epidemic in the United States) are currently deferred as blood donors. This is because MSM are, as a group, at increased risk for HIV, hepatitis B and certain other infections that can be transmitted by transfusion.

The policy is not unique to the United States. Many European countries have recently reexamined both the science and ethics of the lifetime MSM deferral, and have retained it...

The FDA also states:

In 2005, the largest estimated proportion of HIV/AIDS diagnoses were for men who have sex with men (MSM)...

Of course, being at high risk for HIV isn't the only reason why a person wouldn't be allowed to donate blood. One reason for deferral is spending six months or more in the U.K. The concern over the transmission of Creutzfedlt-Jakob Disease and mad cow disease has put these people of the deferred list indefinitely.

Hepatitis B can also get you deferred for life, as can intravenous drug use and prostitution. According to the FDA, these deferrals have to be made because these individuals are at high risk for carrying HIV and other communicable diseases, much higher than the rest of the population. And while all blood donations are tested for disease, even with improvements in HIV and other disease testing, there is still a chance that a test could be wrong and the donor could be positive for the disease in question. They say:

Blood donor testing using current advanced technologies has greatly reduced the risk of HIV transmission but cannot yet detect all infected donors or prevent all transmission by transfusions. While today's highly sensitive tests fail to detect less than one in a million HIV infected donors, it is important to remember that in the US there are over 20 million transfusions of blood, red cell concentrates, plasma or platelets every year. Therefore, even a failure rate of 1 in a million can be significant if there is an increased risk of undetected HIV in the blood donor population.

Now I have to admit, I am a cautious person. I want to know if I need a blood transfusion that the blood I am receiving is not going to end up killing me in the long run later on. But I also have to wonder if excluding the entire gay population from donating blood doesn't quite make sense. Gay rights activist Peter Tachell discusses how this ban lumps all gay men together in one category (like a class of Typhoid Maries, he says), failing to acknowledge that gay men who practice safe sex and or who have been in long-term monogamous relationships or are even celibate pose little risk as blood donors.

The FDA argues differently, of course. According to their research:

Having had a low number of partners is known to decrease the risk of HIV infection. However, to date, no donor eligibility questions have been shown to reliably identify a subset of MSM (e.g., based on monogamy or safe sexual practices) who do not still have a substantially increased rate of HIV infection compared to the general population or currently accepted blood donors. In the future, improved questionnaires may be helpful to better select safe donors, but this cannot be assumed without evidence.

In other words, the FDA hasn't figured out yet how to identify gay men who don't pose a health risk to the blood supply.

I don't know. To me it makes sense to say that a gay man who either practices safe sex or is in a monogamous relationship poses the same or lower risk to the blood supply than a heterosexual man who sleeps around. Yet if you look at a screening questionnaire for donors, you'll note that while the FDA does want to know if you're a man who's had sex with another man even once, they don't care how many women heterosexual men have slept with. Of course, they also don't ask if women if they've ever had sex with another woman, so that really makes me wonder. Is the FDA ban on gay blood donors really homophobic, or are they looking objectively at the numbers of HIV cases in the various donor populations and making their decision in a sound scientific manner? After all, homophobia is the fear of homosexuals, and aren't lesbians homosexuals? Or does that term only apply to men having sex with other men?

The more I look at it, the more the issue raises questions for me. For instance, the FDA is depending on people to answer the donor questionnaire honestly. But what if they don't? What if a male donor had sex with another man, but decides to lie about it when giving blood? Also, what happens if some other group suddenly shows a higher rate of positive HIV tests than gay men? Like say, black women? If more black women than gay men received positive HIV test results, would we then defer black women from donating blood for life? And if we did, would there be a huge outcry over this, claiming that the deferral is racist? And you better seriously think about this one, because guess what? Black women are one of the fastest growing populations among those infected with HIV and AIDS in the US.

There's much more going on with this debate than I can cover in one blog entry, and even after reading up on the subject all this past week, I still can't make up my mind on where I stand on it. In fact, my head is spinning from all the reading I've done to date. So rather than come down on one side of the fence or the other, I'll just say I'm still reading and still learning. And if you're interested in reading and learning, check out the FDA website and the links in this article to see for yourself. If you're really adventurous, you can look at the statistics the FDA uses to make its decisions. The link is here. If you figure this out, let me know.

Labels: AIDS, HIV, In The News, Sexual Discrimination

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Friday, June 1, 2007

In The News: FDA Continues Deferral Of Gay Blood Donors