Thursday, August 30, 2007

The gay male blood donation issue: a revisit

Very often, major media outlets in most cities report shortages in donated blood, especially plasma, and issue appeals for blood donation, particularly after local disasters.

Since around 1982, blood donation is one area where there is mandatory “asking.” Men who admit that they have had sexual relations with other men since 1977 are deferred from donating blood. I remember learning about this at an AIDS information forum put on by the Dallas Gay Alliance as early as late 1982 at the local Metropolitan Community Church.

In the years before the rather sudden appearance of AIDS (originally called GRID), community efforts even then had encouraged blood donation from everyone, including being a “super donor” of platelets or for bone marrow transplants, which then were more experimental. Some gay men donated large volumes of plasma in the development of a Hepatitis B vaccine, which in those days was a big deal and the largest health threat faced by gay men before AIDS appeared.

As far as I can tell, the absolute ban on gay men as blood donations continues today. It applies only to men. Lesbians are not affected, as they were not particularly at risk of acquiring HIV or any blood-borne agents. (Lesbians, as a whole, have few sexually transmitted diseases.)

I was particularly embarrassed about this issue at work in the early 1990s when working for a company that sells life insurance for the military when a male coworker approached me about participating in a company blood drive and as inquisitive as to my self-deferral.

Socially, the “ban” can be perceived as defamatory. Like the military gay ban, it can imply that gay men cannot “pay their dues” and carry their fare share of community obligations. At, worse, unlike the military ban, it is gender specific.

Since about 2000 there have been increasing calls that the ban should be lifted, and that blood donation centers should become comfortable with relying on blood tests for HIV, which are mostly antibody tests (Elisa, Western Blot) but which could include antigen tests. The tests have improved as to specificity and sensitivity. There is some mathematical concern, however, on relying on a test where most results will be negative when applied to the general population. Of course, there are other bloodborne diseases tested (Hepatitis B, Hepatitis C) and there may exist the speculative concern that some new virus could suddenly appear and be amplified by certain chain-linked behaviors before tests could detect it.

There are other categories of self-deferral, such as for prostitution, or for women who have had sex with “gay men” but these are not as permanent.

Reportedly, the Red Cross is open to changing the rules and letting gay men who have been abstinent for long periods donate. Here is a reference at "Defending the Truth."

Here is a 2006 writeup on the issue from The Stanford Daily, "Banned from the Blood Bank: Restrictions on Blood Donation Cause Controversy," by Marie-Jo Mont-Reynaud.

Here is an original 1986 paper from the Centers for Disease Control.

Here is my 1999 article on the subject. I personally believe it is time to revisit this issue and consider allowing donations for men who have been abstinent for some length of time greater than any window period undetectable by tests.

Update: Sept 17, 2007

NBC Nightly News presented a "pay it forward" plan on kidney donations, and it's important to note that a ban on organ donations (usually posthumous) would also apply in a manner similar to the blood donation ban.

Update: Nov. 14, 2007

There are media reports that four people became infected with HIV after organ donations from someone who did not test positive and who may have been infected too soon before death. The New York Times story is by Denise Grady, Nov. 13, 2007, "Four Transplant Recipients Contract H.I.V.", here.

Update: Feb. 1, 2008

ABC WJLA news at noon reports that about 37% of adults are eligible to donate in the United States, but only 5% of adults actually give blood.

No comments: