Post a Comment On: Vigilance

AIDS was first identified in a group of five gay men in Los Angeles in 1981, and the CDC initially called the disease GRID, or Gay-related immune deficiency. The disease was soon found to infect not only homosexuals but Haitians, hemophiliacs, and heroin users, and so was called "the 4H disease." By September 1982 the CDC began calling the syndrome AIDS, as it was not limited to any particular community.

President Ronald Reagan famously refused to address the topic as the disease became epidemic, he would not even say the word "AIDS" publicly, until near the end of his second term, in May, 1987, though more than 16,000 Americans had died of the disease by then.

It became apparent during those years that some people were getting the disease from blood transfusions. In 1985 the first AIDS antibody test was approved and blood products began to be tested. Also in 1985, the FDA prohibited blood donations by gay men. They didn't just prohibit gay men, they prohibited any man who had had sex with another man since 1977. And that's the way it stands now, any guy who has had sex with another guy at any time since 1977 cannot donate blood. On the other hand a straight person who has sex with an HIV-positive partner or with a prostitute is required to wait twelve months before they can donate blood.

The disease had not spread to the heterosexual community in those days, the disease was poorly understood and testing was not very good, and the gay-donor ban might have been a reasonable judgment, made in the chaos of an epidemic. But it's not 1985any more. We have a President who is not afraid to say the word, the HIV virus is found throughout the population, and there are good tests for its presence in blood. While it is sensible to eliminate HIV-positive blood donors, it just doesn't make sense to reduce the pool of potential blood donors just because a man has had sex with another man at some time in the past.

The Department of Health and Human Services has hearings scheduled today and tomorrow on the topic.

MSNBC:
Should gay men be allowed to donate blood? A government health committee is re-examining that question today.

A regulation created at the height of the 1980s' AIDS epidemic banned men who have had sex with another man since 1977 from ever giving blood.

Advocacy groups, blood-collection organizations and some members of Congress are calling for the Food and Drug Administration to revise the lifetime ban, which has been reviewed twice in the past 10 years, but left unchanged.

Groups advocating lifting the ban point to frequent shortages in the blood supply. A new study by the Williams Institute at the UCLA School of Law estimated that if the ban on gay men ended, 219,000 additional pints of blood would be donated annually.

Gay rights organizations say the regulation discriminates against gay and bisexual men. They point out that heterosexual men who have had sex with an HIV-positive partner or a prostitute are barred from donating blood for only 12 months after that contact. Ban on gay blood donors revisited

It will be interesting to see what happens. Of course the policy is dumb. The problem is HIV, not sexual orientation. If your life is on the line, you don't care who donated the blood that saves you, but you want to know that it is not contaminated.

The current method relies on people telling the truth. The policy is casual about heterosexuals in risky situations. It assumes that gay men have HIV and that straight ones don't. It just doesn't make sense on a lot of levels.

The Red Cross and other blood-collection organizations recommend a one-year ”deferral,” or waiting period, on donations after male-to-male sex, saying the current lifetime ban, established in 1985, is scientifically unwarranted. The policies “should be applied fairly and consistently among donors who engage in similar risk activities,” the Red Cross says.

A one-year deferral period on blood donation by a man who has had sex with another man would produce an estimated 89,000 additional pints, according to the Williams Institute study.

And that's a lot of blood.

The FDA will decide. They have a reason for keeping the policy:
The FDA, explaining the current policy, points out that men who have had sex with men since 1977 have an HIV prevalence that’s 60 times higher than the general population. The agency contends its first obligation is to ensure the safety of the blood supply.

Look, the question isn't "have you had sex with another man?" The question is "Are you infected with HIV?" And the fact is, every pint of donated blood is tested, regardless of the donor's self report of sexual behavior or infection. If someone says they do have HIV, then don't bother sticking them, that's easy enough. If they say they don't have it, there is still a chance they have it and don't know, or are lying about it -- whether they have ever had sex with a man or not. That's why they test it all.

The FDA will gather evidence today and tomorrow and go back and study it. Here's what you don't want to see: you don't want to see politicians who are afraid to make the obviously correct decision because it might cost them votes. Here's what you do want to see: discussion and study among people who understand the implications of the statistics, who can accurately calculate any possible increase in the number of people who will get HIV from blood, compared to the number of people whose lives will be saved because of the increase in donors. Those researchers can adjust the waiting-period, it doesn't have to be a year, maybe six months gives the same result, or two months, or two years, or five. It's all probability and statistics, you adjust a parameter to the model and see what the result is. It doesn't matter whether your religion tells you that some kinds of sexual behavior are immoral, the risks and benefits are objectively calculable.

More blood donors means more blood, which means more sick and injured people can be saved. If the inclusion of gay donors drives the risk upward beyond a reasonable threshold (it won't), then it makes sense to keep their blood out of the supply. The researchers should come to a consensus definition of "acceptable risk" at the beginning of their discussion, and stick to it. Most likely, it will turn out that gay blood donors who report they are HIV-negative will increase the supply of blood significantly.