Wednesday, February 25, 2009

Bad blood

by Franki Butler

The other night, several of my friends and I were talking about the most recent campus blood drive – specifically, some of the more interesting rules about who can and cannot give blood. Allow me to share with you my personal favorites from the Can Not list :

• You are a man and have had sex with another man, even once
• You have engaged in sex for drugs or money since 1977
• You are, or have been in sexual contact with someone in the above list

It was several years ago when I first heard these rules, and I was fairly confused. The anti-prostitute rule I could almost understand, though given that volunteer blood is tested for disease, I would think that the rule would have a shorter time frame than “since 1977.” Someone who was a hooker 20-30 years ago but is currently clean shouldn’t constantly be coming up against the wall of his/her past. It’s discrimination based on conception, rather than fact.

The other practice that continues to baffle and outrage me is that of banning gay men – and not just gay men, but all males who have had homosexual intercourse and all women who have had sex with men who’ve had homosexual intercourse – from giving blood. And this isn’t simply some archaic law someone forgot to take off the books; the Federal Drug Administration re-stated the policy in 2007. The stated reason for this is that such donors are at a higher risk for HIV, but aside from the fact that “have you tested HIV positive?” is on the blood donor questionnaire, donor blood is tested for HIV. So basically the policy boils down to “Everyone knows The Gays carry HIV, so even though we test donor blood for that specific virus, we’re still going to dismiss all possible gay male donors, and anyone who might have caught their gay cooties, just in case.” Real classy, FDA, real classy.

High-risk behavior by some men should not exclude all gay, bisexual, sexually-open heterosexual men, or women who have been with any of the above from giving blood. It doesn’t make sense. The incidence of HIV transmission from male-to-male intercourse is high, yes, but there are other factors at work. Banning people who have had unprotected sex with a partner whose health status was unknown would make far more sense. Slightly clunkier wording, perhaps, but when trying to end discrimination and allow more people to participate in a practice that could save lives, I think the extra linguistic effort is worth it.

10 Comments:

At February 26, 2009 at 3:27 AM , Blogger Roscoe said...

ah, hyper-sensitivity at its best. When it comes to the lives of every other person who is getting the donated blood are at stake, a little discomfort on the side of the statistical losers should be rationally accepted. Of course, we could also just administer HIV tests to every person who donates blood, but that would be too cost-effective for my tastes. Make sure to test everyone twice, pesky false negatives. Hey, it would be fairer than the current right?

A little discrimination is a heavy price to pay for safe blood, don't get me wrong, it is indeed discriminatory. But it is a price I would pay gladly for the direct safety, or expected safety, pardon my original words, of innocent (AND guilty, in my opinion, but that is only morally praiseworthy, not as morally imposing as innocence) people. I would tend to agree with you on cases that would discriminate at food related areas, or something of the sort, because discrimination can be too high of a cost for the risk involved in those areas. But when it comes to direct blood transfer, my risk aversion is just too much.

It would be a grave tragedy for someone innocent to fall victim to blood infected with HIV or anything else, compared to the mild discomfort of not being able to donate blood because you had sex with another dude. It may sound absurd to some, but that kind of risk aversion is why we have that gem "innocent until proven guilty" which I'm sure you'd agree is a cornerstone of a just system.

 
At February 26, 2009 at 12:07 PM , Blogger Franki said...

You seem to be ignoring the fact that ALL donor blood is tested for HIV (among other illnesses/defects), regardless of who donated it. That way, people who don't know they're carrying can't contaminate the supply.

You're also making the same discriminatory error the FDA is making: assuming that gay automatically equals high-risk for HIV. While the HIV incidence among men engaged in male-to-male sexual contact is high, there are several other factors at work there (one of which is that the men at highest risk are the least likely to admit to having had such intercourse). Male-to-male sexual intercourse is neither a necessary or sufficient condition for infection with HIV. Sexual contact with someone who has had male-to-male sexual intercourse is neither a necessary or sufficient condition for infection with HIV. You know what is? Bodily fluid transfer with someone who has HIV. Gay men who practice safe sex and have tested clean shouldn't be banned from giving blood that may very well save someone's life. Bisexual men who practice safe sex and have tested clean shouldn't be banned from giving blood that may very well save someone's life. Women who have had sex with bisexual men, have practiced safe sex and have tested clean shouldn't be banned from giving blood that may very well save someone's life. You know who should probably be banned? People who knowingly engage in high-risk sexual behaviors, regardless of sexual preference. I'd rather see the wording changed to be more effective than maintain the current standard that treats all gay men are high risk, regardless of whether that's true or not. That is not "innocent until proven guilty."

 
At February 26, 2009 at 1:57 PM , Anonymous Dan said...

Franki,

Testing for HIV does not remove all the risk:

The window period is the time from infection until a test can detect any change. The average window period with HIV-1 antibody tests is 22 days for subtype B. Antigen testing cuts the window period to approximately 16 days and NAT (Nucleic Acid Testing) further reduces this period to 12 days.

I took the above from here:
http://en.wikipedia.org/wiki/HIV_test

I realize Wikipedia is not the final authority, but this should give you some idea why we should not place too much trust in a test for HIV.

I do agree with you that it would be a good idea to exclude those who knowingly engage in high-risk behaviours. But we would still be depending on them to exclude themselves.

There are no easy answers...

 
At February 26, 2009 at 9:46 PM , Anonymous Samantha H. said...

If the main concern is making sure that people who are infected with HIV/AIDS aren't incorporated into the donor pool, why isn't there a question about engaging in unprotected sexual activity? As far as I know, those engaging in such practices are at far greater risk than men who have sex with men. I agree with Franki.

 
At February 27, 2009 at 6:20 PM , Anonymous Dan said...

Samantha,

It depends what you mean by "unprotected". A couple who are HIV negative and faithful to each other don't need any protection. On the other hand, when a man has sex with another man who is infected with HIV, a condom is insufficient protection.

See for example:

Eric Vitinghoff, John Douglas, Frank Judon, David McKiman, Kate MacQueen, and Susan P. Buchinder
"Per-Contact Risk of Human Immunodificiency Virus Tramnsmision between Male Sexual Partners"
Am. J. Epidemiol. 1999 150: 306-311.

Quoting for this paper:

The analysis shows that while condoms provide considerable protection when used correctly, condom failure poses substantial risk for the receptive partner in
anal sex... Thus, it is important to communicate clearly that these practices are not without risk.

 
At February 28, 2009 at 8:14 PM , Anonymous AC said...

"As far as I know, those engaging in such practices are at far greater risk than men who have sex with men. I agree with Franki."

That is simply untrue, though ideologically convenient. The fact is, gay men are both much more promiscuous than heterosexuals, and gay sex is inherently more unsafe when it comes to HIV transmission.

"According to the CDC, through 2005 (not 2003), 55% of diagnosed cases were attributed in whole or part to "male-to-male sexual contact." So of these 1,112,000 cases, approximately 611,600 of them are attributed to men who had sex with other men.

An Alan Guttmacher Institute study found that only 2.3% of men aged 20-39 experienced same-sex sexual activity in the last ten years. But based on 6,736 respondents in the General Social Survey, 4.5% of men who reported having sexual activity during the last five years reported doing it with men, 3.1% exclusively.

If we go with the 2.3% figure, there were 2,656,000 gay men at the end of 2003. Using a higher 4% figure we would find that there were 4,620,000 gay men at the end of 2003. Thus between 13% and 23% of gay men had HIV/AIDS at the end of 2003.

This figure understates the percent of gay men who will become infected with HIV/AIDS, because many gay men who don't currently have it will become infected if they continue their lifestyle. I think it would be fair to approximate that a third of men who lead a gay lifestyle will become infected with HIV/AIDS.

To contrast the very high percentage of gay men with HIV/AIDS, using the same analysis, only 0.08% of the non-gay-male U.S. population (in other words women and men who are not gay) at the end of 2003 acquired HIV/AIDS from heterosexual sexual contact. Thankfully, in the United States, HIV/AIDS has been rare for people who are not gay and who don't use intravenous drugs.
........
[G]ay sex is 160 to 290 times as likely to lead to HIV/AIDS as heterosexual sex. So yes, gay sex is risky and straight sex is relatively safe. That's what the numbers tell us. I'm not trying to justify any "revulsion towards gay sex," I'm just explaining the truth of the numbers."

http://www.halfsigma.com/2007/06/gay_sex_inheren.html

 
At March 1, 2009 at 1:15 AM , Blogger LSG said...

Dan,
In your first comment, you made a good point that wasn't really related to Franki's point but that I think should be emphasized: there IS a window after exposure before HIV antibodies start showing up. Everyone should know to get tested three months after a possible exposure, and again three months after that. A negative test a week after possible exposure doesn't always mean you don't have the virus.

In your response to Samantha, you also say something that's almost true: I would emphasize that a heterosexual OR homosexual couple who are faithful to each other and HIV negative have no need for protection. Similarly, as you quote from the paper, condoms give "considerable protection" but there's a high risk of infection if they fail during anal sex between a positive and negative man. I want to emphasize that the same holds for vaginal intercourse, or anal intercourse between a man and a woman: condoms provide considerable protection but it's bad news when they fail. (Incidentally, there's little risk of HIV infection when performing oral sex on a man, so the gay men really have the advantage on that one!*)

Finally, Dan, I appreciate your willingness to see the lack of easy answers in this situation, and your appreciation of the genuine dilemma facing the Red Cross.


AC,
I strongly urge you to spend some serious time considering a couple of things:
1. The validity of your sources. The article you sited deliberately twists statistics, writes with a overtly anti-gay agenda, and the the previous two articles on the blog were about his revulsion at the "sodomy and suggestion of sodomy" in some TV shows and his hatred for liberals who suggested that poor people might have been victimized in some way and don't bear full responsibility for their poverty. Just because someone includes numbers in their posts doesn't mean they are communicating truth.

2. Your own motivations. While you write that you're NOT trying to justify a revulsion to gay sex, the mere fact that you bring up the phrase speaks volumes, as do your references to a "gay lifestyle." Please, AC, consider carefully why it matters so much to you that you "prove" gay sex is inherently unsafe.

3. Your attitudes about safe sexual practices. I know that you were focused on the dangers of gay sex, but unprotected sex of all kinds should scare the bejeesus out of you: unprotected sex between a man and a woman is not "relatively safe."

Everyone who found themselves nodding along with Dan's post: think carefully about your sources, your motives, and what "the truth of the numbers" actually amounts to.



*HOWEVER I do not endorse unprotected non-monogamous oral sex...even though the chance of transmitting HIV is not high, other scary diseases like syphilis and gonorrhea are easily passed through oral sex with/between men.

 
At March 1, 2009 at 1:33 AM , Blogger LSG said...

I'm making this a separate comment because I wanted to address Franki's original point:

I think having a questionnaire about lifestyle is a good idea as another layer of security. I think what happened, though, is that the questionnaire was written up several years ago when HIV/AIDS was largely confined to the gay community in America, and nobody ever bothered to revise it. May I suggest the following revisions: take out the sex-with-dudes questions, and put in questions about unprotected sexual activity (right on, Samantha). For instance, with approximately how many partners have you engaged in unprotected sexual contact? When taking part in a sexual encounter or relationship, how much do you ask about your partners' sexual history? Do you use condoms or dental dams during oral sex? vaginal sex? anal sex?

These questions apply to men and women and transgendered persons, and to the whole spectrum of sexual orientations: and more importantly, they target the actual activities that spread HIV -- the exchange of bodily fluids. For the people out there who are oh-so-worried that gay men are uniformly promiscuous, well, these questions would weed em out. For the people who realize that there are huge ranges of sexual activity in those of every orientation, these types of questions make VASTLY more sense, and will allow (for instance) a gay man who's been in a monogamous relationship for the past ten years with a negative partner will be able to donate his DESPERATELY needed blood.

 
At March 1, 2009 at 5:55 PM , Anonymous Dan said...

LSG,

My comment about faithful couples indeed applies to both heterosexual and homosexual couples. That was my intent, and I thought it was obvious enough that it didn't need to be stated explicity.

I was really commenting on Samantha's use of the term "unprotected" so I grabbed a couple of examples to illustrate that "protection" is not really the issue here. If you look at the numbers in the paper I quoted, and figure out the corresponding probabilities of failure over a period of time (say a year) you will see that condoms are shockingly ineffective. Perhaps similar data exists for heterosexuals, but I haven't gone looking for it (yet).

Regarding my comment about window periods, that was in direct reply to Franki's reply to Roscoe above, in which she states: "You seem to be ignoring the fact that ALL donor blood is tested for HIV (among other illnesses/defects), regardless of who donated it. That way, people who don't know they're carrying can't contaminate the supply." I was just showing her why I disagree with her statement.
People who don't know they're carrying HIV can in fact contaminate the supply.

 
At March 4, 2009 at 1:55 PM , Blogger LSG said...

Dan,
I assumed/was hoping you were referring to both heterosexual and homosexual couples, but in light of AC's ranting about the "gay lifestyle" I thought it could use some emphasis. You're also right on about the window period, which is why they have the questionnaire and why I don't think it should be eliminated...just modified. In short, I was actually supportive of your comments and thought they were very reasonable -- I'm sorry if some of my irritation at AC's arguments spilled over into my response to you.

 

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