It's Time to Let Gay Men Give Blood

If you are in a car crash or have a C-section and need a blood transfusion, will the hospital be able to supply the blood you need? Maybe not. If you are a hemophiliac, have certain genetic diseases or are a child with an immune disease and use treatments made from blood to survive, can you get the life-saving products you need? Don't count on it.
Yet, despite the fact that there is a simple change in public policy that could help solve these problems, old fears about AIDS are standing in the way.
At different times during the year, blood banks and hospitals find themselves unable to meet the demand for blood. And the shortage is growing worse. Demand for blood continues to skyrocket as more Americans undergo bypass operations, organ transplants, C-sections, hip and joint replacements and other treatments that require the use of blood. And as more and more people live with immune disorders or diseases that hamper their ability to make blood, the demand escalates.

We also need blood for other reasons. Sadly, the reality of terrorism and violence has become all too real in American life. This means that the chance of not having enough blood on hand in a particular city on any given day is a risk that each one of us faces.

So what is one simple way to get more blood? Let gay men donate it.

A primary source of blood donation that is currently not being used are men who have had sexual relations with other men. After the AIDS epidemic exploded in 1985, the Food and Drug Administration banned blood donations from any man who had sex with another man even once since 1977.

At one time, that policy made sense. But it no longer does. Testing for HIV and other infectious diseases has improved enormously since 1985. We don’t worry about heterosexuals who engage in risky behavior and might acquire HIV because we know the strict testing of today will screen out their blood if it is infected with the virus. Yet the FDA has not changed its policy about gay men despite the fact that there are people who will die in the United States or have to postpone elective surgery because of periodic shortages of rare blood types and blood products.

Current technology, which screens for the presence of viral DNA, can detect the presence of HIV at the very earliest stages of infection with uncanny accuracy. Admittedly there is a "window period" during which someone can be infected with HIV and not test positive even with the best of tests. But this window can be measured in terms of days not years and certainly not the decades that are currently reflected in the FDA policy.

The policy of forever excluding people who had male-to-male sex at some point during the past 30 years should have been changed a long time ago. The accuracy of the latest technology for screening blood means that there is no reason to exclude anyone as a donor in any risk group for more than a month.

The question now is whether the FDA and Congress will act or simply let old prejudices, biases and fears stand in the way of supplying the nation with more badly needed blood.

The AIDS epidemic has been with us for 25 years. The policy currently governing blood donation in the United States has been with us for 22 years. Given our ability to guarantee an exceedingly safe blood supply, it is time to revisit the policy and accept blood from all Americans willing to donate. Fear and prejudice should not be allowed to kill people.

posted Jun 6, 2006 | link | jump to the comments (14)

comments

The Red Cross tells me that red blood cells can be stored cold for 42 days or frozen for ten years, and plasma can be frozen for a year. Only platelets have a shorter effective storage time (five days). Thus each donation from a gay man could be tested and (if HIV-negative) stored for eight weeks, until his next donation; if he tests negative again the previous donation is OK to use. This level of stringency is NOT necessary, but it should alleviate the fear that drives the continuing ban. After a couple of years of this system, there will be data ready to hand to demonstrate that neither a ban nor donation-to-donation storage is necessary.

- by Bill Hooker on Jun 6, 2006 at 5:06 AM | link

Amen

- by Sheila on Jun 6, 2006 at 12:04 PM | link

Can we let them get married too, while we're at it?

- by Stroll on Jun 6, 2006 at 12:45 PM | link

This policy also excludes women who have partners who may have had sexual relations with a man in the past. What of bisexual couples? What of women who are involved with men who later "come out"? This policy is silly in its discriminatory overtones, but serious in consequence. It is high time to abandon it.

- by Sara on Jun 6, 2006 at 4:39 PM | link

For a disease that can be asymptomatic 10 years or so - and which can go undetected at least 6 months unless the lab is doing PCR (and I don't think most blood banks do this test) - and which attacks the immune response, itself, I want all the screening I can get.
I've had one patient with a false positive HIV, another with a false positive syphillus. The latter was "diagnosed" at routine blood donation. The former had backup with 6 positive antigens. We finally decided someone mixed up the blood tubes, either in the (other) doctor's office or at the lab -- so who got the false negative?
It's not true that risky behavior in heterosexuals is not screened. For the last 2 years, when I donate blood, the questions not only include questions about men having sex with men, but paying someone for sex or having sex with someone who pays for sex. They want to know where I've travelled for 5 years. My daughter was denied for 6 months because she had been to Mexico, where malaria is endemic.

- by Beverly on Jun 7, 2006 at 5:28 AM | link

I can't figure out how to "trackback" and my post here disappeared, earlier. I've commented at http://www.lifeethics.org/www.lifeethics.org/2006/06/way-to-end-vacation.html

- by Beverly on Jun 7, 2006 at 6:41 AM | link

Is there data supporting this claim? What would be the difference in cost of running the HIV tests? How many more units of blood would be gained by allowing gay men to donate?

- by Matt W on Jun 7, 2006 at 2:50 PM | link

Ive looked at the statistics - they are a high-risk group, and there is certinly a strong justification for refusing blood that is even a little more suspect than the usual (there is no zero-risk blood). There have been quite enough scandles over contaminated blood already.
But I also see the reason that its taken personally - its a lifetime ban. A single night of curious experimentation thirty years ago (Or much longer ago under the UK rules) is considered as bad as being an IV drugs user or a prostitute. I have to wonder how many men who havn't had sex with other men in the last ten years just lie on that question.
Im not qualified to judge on the medical side anyway. Its important to prod those who are every few years though, and try to convince them to formally examine the situation to decide if and when the rules can be relaxed a little - perhaps from a lifetime ban to just a three-year ban, or something similar.
Might also be a good way to catch a few more cases - sooner its detected, sooner they can stop spreading it.

- by Suricou Raven on Jun 7, 2006 at 6:03 PM | link

One other factor in the blood supply issue, independent of the gender-preference of the donor, is still the excessive inappropriate use of blood transfusion both in the minor anemia but also as used in patients with known terminal illnesses along with other life-supportive treatments. ..Maurice.

- by Maurice Bernstein, M.D. on Jun 8, 2006 at 3:52 AM | link

As the former chair --four years--of the Advisory Committee on Blood Safety and Availability to HHS I can state that PCR testing is the expected standard of testing, that it is highly accurate to within days of seroconversion, that there is no additional cost involved in changing the policy since all donations have to be tested anyway and that excluding people for behavior engaged in twenty years ago makes no medical sense.

- by art caplan on Jun 8, 2006 at 7:56 PM | link

Okay, first of all this is not accurately described as a restriction on blood from gay men. It is on men who have had sex with other men (MSM).
Next, how about some facts.
About 5% -- 7% of men in the US self-identify as MSM. So relaxing this rule would only increase the blood supply by 2.5% -- 3.5 %.
In the US, 51% of the people living with AIDS self-describe as MSM.
How many cases of HIV transmission via blood transfusion have occurred in the US during the last decade? Whatever the rate is at present, this change in policy would double it. The only benefit would be to increase the available blood supply by about 3%.
If the risk of HIV transmission via blood transfusion really is zero, then I think Caplan may have a good point. Otherwise, this article is very irresponsible.

- by Electrolux on Jun 9, 2006 at 4:47 AM | link

Shame the blood-substitute research hasn't produced anything really usable.

- by Suricou Raven on Jun 9, 2006 at 8:27 AM | link

As the wide number of views expressed here shows, many people are willing to state a position without any qualifications. Only Caplan claims to have any knowledge of the field beyond casual interest.
I know more than most on this, as ive read a bit on it before ("Blood: An Epic History of Medicine and Commerce" - good book, read it). But I admit that I am not sufficiently informed to judge this issue. So I repeat my earlier statement: Feel free to give the blood organisations an occasional prod, but let the experts make the final decision.
That said though... in my non-expert oppionion, a relaxing of the rules to an exclusion period of a few years would do no harm, and would give an extra percent or two in supply.

- by Suricou Raven on Jun 10, 2006 at 11:00 AM | link

"A single night of curious experimentation thirty years ago (Or much longer ago under the UK rules) is considered as bad as being an IV drugs user or a prostitute."
How many nights of curous experimentation does it take to be exposed to HIV? Answer: One, if your partner has it.
Some people sound like they think that wanting gay men not to donate blood is a moral judgement on the homosexual lifestyle. It's not. It's a public health measure and it needs to be viewed from a public health perspective, period. Electrolux's statistics are more compelling, to my way of thinking, that the necessity of letting people donate blood so as not to hurt their feelings.

- by Laura(southernxyl) on Jun 14, 2006 at 5:21 PM | link