So I couldn’t find any recent posts relating to this issue, and I thought it would be a good way to start off my blogging of issues related to Feministing-type questions (since I think that most of my friends on LiveJournal are starting to get tired of my ZomgFeministRants! posts. Hah.)
Yesterday the American Red Cross was holding a blood drive at my college, and I decided to step up to the plate and do my part in “making a difference.” Donating blood is actually something that I’ve been meaning to do regularly for quite a while (uh, since I turned 18 and became eligible?) but let’s just say, I haven’t exactly been proactive in seeking out opportunities. That, and I do have a few piercings and tattoos, which all have their own various deferral periods. (Because you know piercing my ears is a risk activity, ya’ll!)
But I did it! Huzzah! I did my first blood donation and got through the post-event dizziness and doctored myself up real good at home making sure I got lots of fluids like a good little patient. Hurray for me! Where’s my cookie..?
But something was bothering me. While I read through all of the required paperwork and pre-screening that they do to make sure that I am healthy enough to give blood– both to protect myself, and whoever will eventually get my blood from possible blood-transmitted infections. And I did very dutifully read all of the restrictions and make sure that I didn’t meet any of their qualifiers for “people who should not donate.” And it should not come as a surprise that they screen for anyone that would be considered “at risk” for HIV, because uh…okay I don’t even feel like this requires an explanation.
But among their qualifiers for who would be considered “at risk” were, “Any male who has had sexual contact with another male since 1977.” (They also included “Anyone who has had sexual contact” with the above.) – *screeching-sound-of-tires-squealing-to-a-stop* Say what?
Okay, okay, I admit I’m a little slow on the draw on this particular issue. I had to do some research to even find out if I was alone in finding this policy to be viscerally disturbing, and to figure out where the policy stems from. Turns out, the FDA sets the rules on blood safety, and the policy has been up for review several times, only it’s been rejected every time.
Anyway; Let my outrage not somehow imply to someone that I don’t think avoiding the spread of HIV by way of blood transfusions (or by ANY means) is extremely important. It completely is. I am all for complete and scientifically informed policies to keep the public up to date on how to prevent the spread of infectious diseases. (The whole abstinence-only vs. safer-sex education is a whole different debate, I’ll cover that another time.) This is a dangerous, ultimately life-threatening infection if it turns to full-blown AIDS. And nobody should have to be infected with a deadly disease because someone was trying to save their life. Yeah.
But that is not (the only thing) that this policy is protecting against. What this policy means (as if you couldn’t figure it out), is all you gay, bisexual, bicurious, experimental, heteroflexible or whatever dudes out there? Yeah, don’t have sex with another dude, or else you will be barred from blood donation for life. Also, all you gay-men-that-occasionally-sleep-with-women (by the way, I love you), bisexual, bicurious, experimental, heteroflexible, or whatever dudes out there? Don’t sleep with any other women if you’ve slept with a man (since 1977), because all of your female partners will ALSO be barred for life because you once, slept with a dude. Regardless of your HIV-testing status. Regardless of your partner(s)’ HIV-testing status. Regardless of whether since then, you have been in a committed and monogamous relationship for 2, 5, 10, 15, 20+ years. Ya’ll still can’t donate. Nor can your previous partners. Oh, and forget that part about how you were careful to use protection every time– the FDA doesn’t give a hoot.
I am all for safety being more than just “politically correct” (I’m not entirely sure I jive with the “PC” movement to begin with– I chose my morals a little differently than that), but it still jars me that there is something fundamentally wrong with saying that by virtue of being being male and having had Male-Male sex ONCE, you are now categorically disqualified from helping people because you are determined to be statistically “at risk.” Not all gay men are manwhores. (There is a misconception that being a gay man means you’re automatically promiscuous—and in the “straight” community, that this accounts for the higher rate of infections among the gay male population—or should be.) Not all gay men have unprotected sex. Not all gay men have HIV. And more to the point, even if a man DID have unprotected sex with another man, years ago, and has since been tested repeatedly for HIV and come up negative, I can’t believe that he ought to still be considered at a HIGHER risk than any average heterosexual person — for whom the rate of using condoms every time isn’t all that great either…!
What really hammered in this point for me, was in talking to one of my girlfriends-since-high-school buddies about it, and she goes, “Uh yeah. I’m not allowed to donate.” And it took me a full minute to retrace back and remember who in the hells she was referring to (a longtime exboyfriend who happened to be bisexual.)
Of course, not everybody gets tested regularly so you can’t rely just one people opting themselves out, because they may not know they’re infected (which is why they test all donated blood before giving it to anyone.) And, according to the CDC:
Gay, Bisexual, and Other Men Who Have Sex with Men (MSM): By risk group, gay, bisexual, and other MSM of all races remain the population most severely affected by HIV.
- MSM account for more than half (53%) of all new HIV infections in the U.S. each year, as well as nearly half (48%) of people living with HIV.
- While CDC estimates that MSM account for just 4% of the US male population aged 13 and older, the rate of new HIV diagnoses among MSM in the United States is more than 44 times that of other men and more than 40 times that of women.
- White MSM account for the largest number of annual new HIV infections of any group in the United States, followed closely by black MSM.
- MSM is the only risk group in the U.S. in which new HIV infections have been increasing since the early 1990s
Statistics taken from: http://www.cdc.gov/hiv/resources/factsheets/us.htm
Also, according to the CDC, “Gay and bisexual males of all races and black heterosexuals account for the greatest number of new HIV infections in the United States.” (http://www.cdc.gov/nchhstp/newsroom/docs/FastFacts-MSM-FINAL508COMP.pdf)
…If this policy were based solely upon risk factors, clearly black heterosexuals should ALSO be deferred from donating. (But of course, then where would we be? I guess technically gay or bisexual women of any race, and straight men or women of any race OTHER than black, would be the only available donors left?)
What this amounts to isn’t scientifically-based appropriate screening of higher-than-average at-risk donors who pose a serious threat to the safety of the American blood supply. But, let us be fair and see what the FDA has to say about their own policy. The FDA even has a handy-dandy little Blood Donations from Men Who Have Sex with Other Men Questions and Answers worksheet, just in case you have this insane idea that—oh, I don’t know, unfairly discriminating against gay men is actually, *gasp* “discrimination”, here’s how they justify their stance:
“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…” ..Okay. But, Why doesn’t FDA allow men who have had sex with men to donate blood?
“A history of male-to-male sex is associated with an increased risk for the presence of and transmission of certain infectious diseases, including HIV, the virus that causes AIDS. FDA’s policy is intended to protect all people who receive blood transfusions from an increased risk of exposure to potentially infected blood and blood products.
The deferral for men who have had sex with men is based on the following considerations regarding risk of HIV:
- Men who have had sex with men since 1977 have an HIV prevalence (the total number of cases of a disease that are present in a population at a specific point in time) 60 times higher than the general population, 800 times higher than first time blood donors and 8000 times higher than repeat blood donors (American Red Cross). Even taking into account that 75% of HIV infected men who have sex with men already know they are HIV positive and would be unlikely to donate blood, the HIV prevalence in potential donors with history of male sex with males is 200 times higher than first time blood donors and 2000 times higher than repeat blood donors.
What in the bloody hell is this statistic supposed to tell me? (paraphrasing) “MSM donors since 1977 have an HIV prevalence 800 times higher than first time blood donors” – No fucking shit (pardon my French.) You screen them all out (that is unless they lie), so why wouldn’t they be higher than first time blood donors? This doesn’t tell me anything.
- Men who have had sex with men account for the largest single group of blood donors who are found HIV positive by blood donor testing.
If blood donor testing is effective in screening out HIV positive blood, what, exactly, is the problem? Okay, another argument from them:
- 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.
- Detection of HIV infection is particularly challenging when very low levels of virus are present in the blood for example during the so-called “window period”. The “window period” is the time between being infected with HIV and the ability of an HIV test to detect HIV in an infected person.
Right, which is why you would screen to avoid this “window period” rather than defer for life willing and healthy donors. They clearly have no problem deferring for a set period anyone who has taken certain medications (the time period is dependent on the medication in question) that are known to cause birth defects until it has a chance to be cleared from the body, as well as anyone who has had a new tattoo or piercing in the last 12 months. The most up-to-date blood tests claim to be able to detect HIV infections within 9 – 11 days. 9 – 11 days, is a hell of a lot shorter than “never.”
Hell, how hard could it be to get a verification certificate from Planned Parenthood (or any other STD/STI testing facility) stating that the patient has been tested every 2 to 3 weeks for the past two months and can be safely assumed to be HIV- (and other STDs) free? ZOMG HOW HARD IS THAT? That took me all of 2 minutes to think up.
So look, FDA– and for that matter the CDC whose published statistics the FDA is using, but yet do not appear to cross-reference other demographic and behavioral risk factors to actually provide a nuanced picture of total risk for infection– get off your homophobic high-horse and stop hiding behind statistics that could blatantly be avoided by asking more than one lousy question that basically amounts to: “Are you gay?”
(Disclaimer: I realize that that is not actually what the question is asking, and there are a great many people who may fit the Male-Having-Sex-with-Male or Sex-with-Male-Having-Sex-with-Male category, and yet for a variety of reasons may choose not call themselves “gay,” which is a question very much intertwined with questions of self-identity, the fluidness of sexual identity/orientation and the vastness of variety in human sexual behaviors. I’m just using it to illustrate the point.)
The FDA’s website implies the last review was done in 2006, but I see other references going all the way up to June of this year, when “The HHS Advisory Committee on Blood Safety and Availability held a two-day meeting to reconsider the FDA ban on blood donations from MSM.”Currently, “The American Red Cross, America’s Blood Centers, American Association of Blood Banks, American Medical Association, and a coalition of nearly fifty other organizations all support a revision of the ban.” Sadly the most recent review was still rejected on June 11th (making the change.org petition my link leads to somewhat superfluous at this point.)
Here’s to hoping that in the near future, it won’t be. Preferably before, you know, too many more incidents of blood shortages.
13 Comments
I went to college at a very small liberal arts (and primarily performing arts) school in new york city where the VAST majority of the male student body was gay. For reasons unknown to me, the red cross decided to come to our school for blood donations, and of course wasn’t willing to take most of the blood. Yeah. Everyone was pissed. You make important arguments and I agree with you 100%. I actually didn’t know this was a thing until I asked why everyone at my school was so pissed about the red cross being there. And then I got pissed too. There’s really no excuse.
Don’t forget that hetero trans women are considered ‘gay men’ for the vast majority of blood donations.
Yeah, and so are their male partners. Of course, post-Gender Recognition Act, the treatment of trans women for blood donation purposes over here in the UK is now truely, mind-warpingly bizarre…
What’s interesting is that the FDA goes on about how European states have similar rules on blood donations, but as I understand it many European states have aligned their rules on blood donation with the FDA’s so that they can make money from selling excess donated blood products to the US. In other words, it’s not an independent decision at all, but one influenced by financial pressure to follow the FDA’s discriminatory stance!
Vexing, oh yes that’s true as well.
makomk, I didn’t know that, but that only makes it more infuriating! Agh!
Note to Feministing editors: I just went to hit “reply” and accidentally hit “report comment.” I did not mean to report this comment, and I apologize for doing so makomk, but editors, perhaps this is something to think about? I love the redesign but the “Reply Report comment” buttons look like one single button, so maybe this could be clearer? I’m sure I am not the only one who’s made this mistake and it will save you time if there aren’t a million accidental reports! Just a friendly suggestion from a fan (who really does love the redesign very much!).
–
Anyway, what I wanted to say is that it’s not just Europe and the States. Canada has this law too. I’ve donated blood twice, and when I was filling out my form, something struck me one day as really illogical about this system:
Let’s say there’s a woman, Jill, who has never had an STD test in her life. She has had numerous one-night-stands. One-night-stands where she’s hooked up with some dude at a bar and they go home and have sex. She never sees him again. She knows nothing about his sexual history. And Jill’s done this, oh I don’t know, let’s say six or seven times.
Let’s say there’s another woman, Jane, who has never had a one-night-stand in her life. She’s only ever slept with one man, her husband, who she’s been involved with monogamously for ten years. Jane’s husband is bisexual, and he’s only ever slept with two people: Jane, and a previous boyfriend. All three (Jane, her husband, and his ex-boyfriend), none of whom are promiscuous people, have had STD tests that have come back clean.
Which of these women is more at-risk for HIV? Now, I’m not slut-shaming Jill; I don’t think there’s anything wrong with her promiscuity. I’ve certainly had my share of one-night-stands, and they were fine, I have no regrets, and neither does Jill. But Jill is statistically more likely to have come into contact with HIV, isn’t she? However, Jane is the one who wouldn’t be allowed to donate. (Neither would her husband or his ex, for that matter.) Even though for all Jill knows, one of her one-time lovers could be a bisexual man who’s had dozens of male partners. She can’t say with certainty what her former partners’ pasts are, but since since she hasn’t knowingly had sex with a man who’s had sex with a man, she’s allowed to donate. Jane – who can say with certainty what her only partner’s past is, and can also clarify that this partner has been tested for STD’s – is the one who’s barred from donating. Doesn’t this represent a highly ineffective system, since it’s keeping out a donor that is almost guaranteed to be STD-free and allowing in a donor who can’t meet those odds? What if Jane is type O, a universal donor, making her blood extrememly valuable? Where is the logic in keeping her out of the system?
Again, I’m not saying there’s anything right or wrong about either woman’s lifestyle, I’m just pointing out the flaw in this logic. The blood will be tested anyway. And since the rules (at least in Canada) don’t prevent people from donating if they’ve ever had sex with someone whose sexual history is unknown to them, the whole point of the rule is void. What is the social benefit in keeping a large portion of the population from donating, especially considering hospitals are constantly suffering from blood shortages?
I was taken aback by this exclusion as well when I donated blood.
No matter what questions the screening process asks, it still fundamentally comes down to someone donating blood to honestly answer questions and not cover-up any relevant risks. The FDA would do well to enhance the rate of honesty with its survey by asking relevant questions that directly address the risks — asking appropriate questions increases the likelihood that those who want to donate will take the questions seriously rather than tell themselves “I know I’m fine, so I’ll just give them the answers they want to hear.”
That’s a good point. I mean, donating blood is a charitbale act. And many people want to participate in that. I’m sure lying on the forms/to the questioner is quite common. And how is that helpful?
They can test for it. They test all blood anyway. This system saves neither lives nor money.And THAT’S what bugs me about ALL risk factors (except IV drug use, which spreads other bloodborne disease, not all of which can be tested for, and also which is the most likely to actually result in transmission).
“If blood donor testing is effective in screening out HIV positive blood, what, exactly, is the problem? ”
You’re missing an important piece of information here. It doesn’t cost much to accept a blood donation, so we assume that there’s no real loss when HIV-positive blood is donated and then detected and tossed. Testing blood is NOT cheap – it costs about $250 to test a unit of blood. Remember, they have to test all donated blood for a bunch of bloodborne diseases. About 5% of MSM have HIV, which means you’re going to have to throw out 5% of the donated blood from MSM after paying to test it. This means you’re paying about 13$ extra per blood donation from MSM. This is a big part of why these rules are in place.
Yes, 13$ isn’t too much, but 13$ per donation adds up. You could be spending that money trying to get more eligible donors – so if it costs less than $13 per person to convince eligible donors who otherwise wouldn’t donate blood to do so, it gets you more blood in the end.
By the way, only about 35% of people are eligible to donate blood – it’s not like this is unprecedented.
All that said, it might (or might not) be a good idea (good idea being in terms of “what gets us more blood for less cost”) to change to “males who have had sex with other males in the last X amount of time.” Or it might be a good idea, instead, to stop taking blood donations from black people. On which note, your comparison here is somewhat flawed – the rate of new infections are comparable between black people and MSM, but the percentage of black people with HIV is a lot lower – about 1.25%. So it’s not inherently unreasonable to say that 3$ extra per donor is worth it, but 13$ extra per donor isn’t. The only real way to tell this, though, is to do some trials where you start accepting blood from different groups of currently ineligible people, see how much extra you’re paying, and compare it to spending that money on blood drives.
I understand the problem/question of costs for testing and comparing it to how often donated blood has to be disposed off because it comes up positive. Even though a large part of me cringes at having to draw the line at “it’s more cost effective to discriminate out X people”, I do understand this concept.
Although, how do you get the $13 more for MSM donations? Is that accounting for the (as you stated) 95% of MSM blood that would test negative and is therefore useable? I’m not sure I follow, and it’s easier to ask than give myself a headache with a calculator.
But I guess my real argument is not based on taking extra safety measures for supposedly higher risk groups. My argument is that this policy of “deferred for life” doesn’t seem to me, to be the most efficient way to really do that.
If I, for example, want to donate blood, and have myself tested for HIV, shouldn’t that be proof enough– BETTER, proof, in fact, than the supposed gender of my previous partners? (I mean that’s assuming that I’m telling the truth about not having had any new partners since being tested that would invalidate the results, and also that the test was done after the appropriate “waiting period” since the most recent new partner, and also that none of my current partners have any untested OTHER partners.)
Hell, I might argue that my being polyamorous would be better grounds for deferring me from donating, than the possibility of a previous partner having once had male-male sex.
95% of MSM test negative, 5% test positive. A small percentage of both MSM and eligible donors will also, of course, test positive for other stuff (the proportion of non-MSM that will test positive for HIV is only about 1/300 which is fairly insignificant) but this won’t skew it much since its roughly equally likely in both groups and not nearly as much as 5%.
What this means is that for every 100 donations of blood from eligible donors, you’ll get 100 units of blood and pay 25,000$ to have it tested, for every 100 donations of blood from MSM, you’ll get 95 units of blood but still pay 25,000$ to have it tested. 25,000/100 is 250$ per unit of blood, 25,000/95 is 263.15$ per unit of blood.
For the rest of your post: I honestly don’t know whether “deferred for life” is sensible or not. You’d be surprised at how often what seems to make sense about human behavior is actually completely wrong – Courtney’s post: http://feministing.com/2010/08/06/the-poverty-lab/ has a pretty good discussion of this.
In theory, the FDA should have compared the value of an “X time period” deferral versus a lifetime deferral. In practice, maybe they haven’t done it properly. The only real way to tell whether it would work or not would be some randomized trials, and I am not familiar enough with this area to know whether they’ve been done and what the results were.
I should also point out that the lifetime deferral for MSM is not unique among the FDA guidelines. They are very, very cautious in general. For example, having lived in the UK for 6 or more months anytime between 1980 and 1996 is a lifetime deferral (this one is why I can’t donate blood, despite definitely not having mad cow disease). Getting an inconclusive HIV test and then getting a negative test is also a lifetime deferral.
We had similar restrictions in New Zealand until very recently. It was a ten year waiting period for any MSM. It is now five with or without a condom. If you are a woman you are required to wait a year before if you have had sex with a man who has had sex with another man.
My other big issue is the year long waiting period required if you have been a sex worker in New Zealand. Sex work is decriminalised here and it is law to use condoms for all sexual activity. Clients can be fined as a result. Every single sex worker I’ve ever met (as a sex worker myself) strictly use condoms in work and their personal life. There is no stipulation when donating blood you must have had safe sex or face a waiting period. In fact the words state, “After engaging in sex work (prostitution) or accepting payment in exchange for sex in New Zealand”, which to me screams discrimination.
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