BANNED BLOOD: AIDS research pioneers think the lifetime ban that prevents men who have sex with men from donating blood is unscientific and wrong.
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The victim of a car accident can require as many as 100 pints of blood—that's blood from 100 generous donors across the country, meticulously matched for blood type and screened for diseases. More than 38,000 blood donations are needed daily in the U.S., but only 38 percent of Americans are eligible to donate blood, and of those, only 8 percent actually do.
The list of eligibility criteria that a donor must meet is long, ranging from simple characteristics such as age and weight requirements to more complex ones surrounding medical and travel history. Among them is the risk for human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS). Certain factors thought to increase this risk, including illicit intravenous drug use and, if you're a man, having had sex with another male even once since 1977, currently prohibit you from ever donating blood.*
But AIDS research pioneers from the Jewish General Hospital and McGill University in Montreal think the ban is outdated. In their report, published May 25 in the Canadian Medical Association Journal , they call for a change in policy, which was created by the U.S. Food and Drug Administration (FDA) in 1983—before HIV/AIDS screening tests were available. "Today's technology makes it almost impossible for HIV to slip through, and the total ban puts a huge burden on blood agencies and the blood supply," said lead author Mark Wainberg, in a prepared statement. He helped in the discovery of 3TC, one of the first drugs to control HIV. "We constantly have blood shortages that would not occur, perhaps, if we had a more reasonable policy."
History of the ban
In the spring of 1981 cases of an unusually aggressive form of Kaposi's Sarcoma, a benign tumor that normally affects older people, and a rare lung infection called pneumocystis carinii pneumonia (PCP) began to be reported among gay men in New York City and California. To learn more about the transmission of this new, seemingly acquired form of immunodeficiency, the U.S. Centers for Disease Control and Prevention (CDC) formed a Task Force on Kaposi's Sarcoma and Opportunistic Infections. In July task force coordinator James Curran told The New York Times there was no apparent danger to nonhomosexuals. But by December, cases of PCP were also turning up in illicit intravenous drug users.
By the summer of 1982, 452 cases or the new disease in 23 states had been reported to the CDC. Haitians and hemophiliacs also appeared to be vulnerable, resulting in the moniker, the "4-H club" (for homosexuals, heroin addicts, Haitians and hemophiliacs). That December a 20-month old child who received multiple blood transfusions died from AIDS-related infections. The first cases of possible mother to child transmission were also reported.
Evidence that the acquired immunodeficiency syndrome (AIDS, the term for the disease officially adopted by the CDC in September of that year) could spread through blood transfusions caused panic. And in January 1983 a CDC-held public meeting led to a consensus to ban blood donation by men who have sex with men. The rationale: AIDS was a blood-borne disease and the majority of cases had occurred in homosexual men.
"The 1983 ban has hung on so long, unfortunately, because many people became infected by HIV in the early '80s through blood transfusions, and they have mounted continuing pressure on the blood agencies to maintain the ban," Wainberg said in a prepared statement. "While we can sympathize with them, this no longer makes sense in 2010, and with each passing year it makes less sense."
Since 1983 the number of heterosexually transmitted infections has increased dramatically, accounting for about a third of total infections in the U.S. in 2006, according to CDC estimates. But up to 47 percent of all HIV infections (62 percent in men) are still transmitted through male-male sexual contact, according to CDC statistics from 2007. Nevertheless, current blood screening techniques can effectively eliminate the risk of HIV-infected blood, regardless of whether it came from a donor who has had such contact in the past year or the past 33 years.*
Weighing the risks and benefits
After a pint of blood is collected, it is processed into its transfusible components: plasma, platelets and red blood cells. A dozen tests are then performed to establish the donor's blood type and screen for infectious diseases. Since 1985 the American Red Cross has used enzyme immunoassays to test for antibodies to HIV-1 and HIV-2. A positive result is confirmed using at least one additional technique to identify virus-specific antibodies.
Whereas the number of AIDS cases that resulted from transfusions before screening measures were implemented is unknown, CDC-reported mathematical estimates based on HIV-positive donation rates in 1985 suggest that as many as 7,200 transfusion recipients could have received infected blood components. Antibody-based screening measures "virtually eliminated" the risk of transmission by transfusion, which now sits at about one in two million, according to the Red Cross.
In 1999 the Red Cross added another technique to its screening process call nucleic acid testing, which detects the virus's own genetic material using the same gene-amplifying techniques used to test for paternity. The test reduces the amount of time that a person's tested blood could yield a false negative, called the "window period," from three to six months with antibody screening alone (because it takes time for the body to produce antibodies to the virus) to about 12 days. "This "window period" is often the most dangerous time for transmission, because the host may be unaware that he or she is carrying the virus and might unknowingly donate infected blood," Wainberg and colleagues report. But they argue that improvements in screening technology make the current total ban on donors who have had male-male sexual contact pointless, and that the temporary one-year ban implemented for heterosexuals with multiple partners should also be applied to men who have sex with men. Currently, women who have had sex with men banned for life are only prevented from donating for a year.
The major benefit of allowing men who have sex with men to donate blood after a reasonable temporary ban would be a boost in the blood supply, the authors say. "In the United States it has been estimated that a five-year deferral would lead to an increase of 71,400 donors, whereas a one-year deferral would lead to an increase of 139,000 donors," they report. They also say blood clinics would stop losing healthy donors who refuse to donate because they find the current bans offensive. "When a discriminatory policy isn't justified by the science, it leads to controversy," Wainberg said in a prepared statement. "We've seen protests and boycotts of blood drives on Canadian campuses, so I think the blood agencies would be better off if they agreed with us. I suspect, honestly, that many of them already do, in private."
But protecting patients who receive blood is the priority for agencies like the Red Cross. "More important than increasing the donor pool is ensuring the safety of the blood supply," says Red Cross spokesperson Molly Dalton. The agency has tried to get the FDA to reexamine the guidelines as new scientific evidence becomes available, Dalton says. But the latest discussions, which took place in May 2007, did not lead to any changes. "We’re continuing to work with the [American Association of Blood Banks] to ensure that policies are fair and based on scientific evidence," Dalton notes. The policy, she adds, will be reviewed again at a meeting this summer.
*Correction (6/2/10): These sentences were edited after publication to correct an error.
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25 Comments
Add CommentAnyone who understands how safety incidents happen realize that there is not usually 1 event which is the cause. Rather it is usually a chain of events, and if one event in the chain had been prevented, the incident would have been prevented.
Reply | Report Abuse | Link to thisThat's why the rule should not be changed. First, reduce the risk that collected blood is contaminated through reasonable rules, such as those now in place. Second, test for problems. Don't rely only on testing alone because, like anything else, it has a failure rate.
The problem is, these rules AREN'T reasonable. So, by your reasoning, we should ban all blood donation, right? If you read the article, 1/3 of all HIV infections are heterosexuals. How to we make rules to keep them from donating, huh? I think you and everyone else who are for these outdated rules just don't want your precious hetero blood "infected" with gay blood.
Reply | Report Abuse | Link to thisQuote: 1/3 of all HIV infections are heterosexuals
Reply | Report Abuse | Link to thisAnswer: Not being a math whiz even I can see the statement you have made to be .. "since it has been accepted it could be almost ten percent of the population has homosexuality as a 'trait' BUT that one tenth of the population is responsible for two thirds of all HIV infections. That means the homosexual population has about a what .. 70000% - 90000% MORE of a 'chance' of passing HIV than a heterosexual."
Unless my math is off .. ?
27 years ago I lived in London, England for 30 months and I am still banned form donating blood here in the US.
Reply | Report Abuse | Link to thisIs mad cow's diease still that dangerous?
Kathy
I'm no math person either, so let me try this a different way. These rules are like racial profiling and full body scanners at airports. Will they catch a terrorist? Maybe. But, you'll be discriminating against a large number of innocent people. We already have a test that "virtually eliminate[s]" the risk of transmission by transfusion, which now sits at about one in two million, according to the Red Cross. Is it perfect? No, but nothing is and you're still not doing anything to exclude the 13,627 straight people infected with AIDS/HIV in 2007.
Reply | Report Abuse | Link to thisDuffin,
Reply | Report Abuse | Link to thisYour math is all wrong. Whoops - ironjustice has already straightened you out. I have not checked his numbers, but it is irrelevant to the point.
The average male homosexual (likely far less than 10% of the population as commonly claimed and only 1/2 of whom are males) is far far more likely to be infected. And the remainder of the population with AIDS is mostly drug addicts (also excluded from donation) and women who have had sex with a homosexual (or bisexual) or drug abusing man (these women are also excluded under the current rules). So, the rules take out nearly anyone who has likely been exposed to HIV.
Sorry, but this movement is based on politics, not science. They want to increase risk for patients (I'll admit, probably a small increase) to be politically correct. Our culture generally does not tolerate an increase in risk.
Soccerdad, I'd like to know where you're getting your "facts." Last I checked, HIV can be passed from female to male and a woman with HIV can also pass it to her child during pregnancy. This means that there are plenty of people out there with HIV contracted from straight sex. We can argue all we want about the origins of the disease and whether or not it originated amongst or was only passed between gay men in its beginnings, but even if that were the case it is certainly not the case now and HIV is not magically created when two men have sex. While 2/3 of HIV infections are homosexual, it's unfair and wildly presumptuous to say that the remaining 1/3 are having sex with men that have had sex with other men, are having sex with drug users or are drug users themselves.
Reply | Report Abuse | Link to thisYes, your math is way off. The US has a population of approximately 320 million people with approximately 1.2 million with AIDS. Assuming (for the sake of the argument), a 10% homosexuality rate, that gives us 32 million homosexuals, 288 million straights. Again, for simplicity's sake, we'll say 50% are male or 16 million gay, 144 million straight. 1/3 of those affected are straight (400,000), 2/3 gay males(800,000).
Reply | Report Abuse | Link to thisThis means 800k/32m = 2.5% chance you'd get an HIV positive sample from a gay male. 400k/144m = .28% chance from a straight. That's a 9X increase, not 900x.
But, that too is irrelevant since the tests can screen out all but one in two million of those, and it doesn't care if the donor was gay or straight....say, a woman who didn't know her husband was cheating on her by participating in oral sex in a public restroom because their puritanical upbringing won't allow them to actually come out of the (water) closet. Or didn't know her husband was a drug user. Or, to be fair, a man who didn't know the man his wife cheated with was bisexual and infected, or an amateur porn star or...a myriad of choices that a self-reporting test won't catch.
The margin for error on the rules you're so insitent on keeping are much, much higher than the scientific tests that are performed on the blood itself. The blood tests are the safety net to catch the infected samples that slip through the rules, not the other way around. Also, as someone who has a bisexual, drug-using friend who regularly donates blood, I reiterate that self-reporting tests are practically meaningless.
Yes, it's for political reasons. We're discriminating against a group of people because a few of their number have an issue. Perhaps we should exclude Catholics as they're not likely to report their gay encounters with their priests?
I am a British Citizen and I know the rules over here are a bit different but even so. If you are banned from giving blood for life if you have sex with a man once a long time ago (which is true in England) then I think that needs to change. The average period of time it takes for symptoms of HIV to show is 10 years. Therefore why not put a limit on it - if you're male and not had sex with another male for more than 10/15 years then you can give blood. That would allow more people to give blood. It reduces the risk of undetected HIV transmission. Why wouldn't something like that work?
Reply | Report Abuse | Link to thisIt doesn't even seem to mention that plenty of people who *are* gay or who *do* use intravenous drugs simply lie and donate blood - so without any way of testing the veracity of the ticks on the forms, what use is the rule and the questions?
Reply | Report Abuse | Link to thisMaybe they don't want to publish their drug use or sexuality, maybe they don't care, maybe they realise that since the blood is tested anyway, if there's anything wrong with it it will be discarded otherwise it will be of use.
Wow, You've got pretty bulletproof Gaydar their IronJustice. Have you offered you're amazing 'undesirables' spotting skills to the airports? I bet you could totally pick the terrorists out of a group of non-caucasians.
Reply | Report Abuse | Link to thisIf there actually was any point in a self reporting based exclusions (and I'm frankly dubious) - surely it would make more sense to exclude parties who have had unsafe sex in the last 6 months outside of a monogamous relationship.
Gender or sexual preference doesn't determine your exposure risk. Your actions do. 6 months would exclude (with a significant safety margin) the detection window issues and making the rule based on sexual practices rather then sexual preferences would apply fairly to all donors.
I'm fine with this if there is truth in labeling. Allow the recipient to specify which categories they are willing to accept donated blood from. Let the market determine the rules and which questions are asked.
Reply | Report Abuse | Link to thisIt is pretty much "just plain stupid" to think that questionnaires are some worthwhile form of screening.
Reply | Report Abuse | Link to thisSometimes the willful naivete of bureaucrats amuses me.. other times it makes me mad-as-hell.
The questionnaire method is so some lazy imbeciles looking to keep conning a paycheck they don't deserve can pretend they "did something" while doing nothing of any value.
The only "safe" method is to test the blood/blood product for dangers. Even safer is to donate your own in advance of surgery... or maybe we start a system where we routinely have a few pints of our own donated on the off chance we get in a car wreck/whatever and have it ready.
How obvious is that?
The insane naivete of thinking questionnaires actually represent reality is what is amazing.
Reply | Report Abuse | Link to thisA questionnaire provides us information on "questionnaire answering behaviors" and little else.
All the commentary and hand-wringing on this issue is based upon the ridiculous notion that the answers on a questionnaire are a reflection of factual reality.
Nope... we have selective memory being tested.. we have the "straight guy" who just 'kinda forgets' some party-adventure... we have people who have obviously not got a clue how statistics work trying like mad to use a tool they do not understand.
What we really see in questionnaires is just plain nosiness on the part of people who simply want to busybody in other people's private lives... it is the National Enquirer mentality.. and it is irrational int he extreme.
Ever been around medical people with access to "confidential information"... it is a damn hen party of gossip.. every damn time.. to claim otherwise is just a plain lie.
You test the blood for infectious diseases... you ask the person to return after the window-for-infection-to-show passes and retest, perhaps.
I'm an Italian guy who moved to the US in 2008. When I was in Italy I was an active blood donor, and I donated blood 8 times in two years (over there you have to wait a three-months period between each donation). Then I came to the US and when I went to make my first donation, I was told I was not eligible because I had lived in Europe during the mad-cow disease period. But that happen almost 20 years ago, and I've been a donor already. So I really think those rules are outdated and should be reviewed :) At least let donate people who were donors in their Country.
Reply | Report Abuse | Link to thisOoooh, Soccerdad-- you are wrong, so very, very wrong.
Reply | Report Abuse | Link to thisYour statement "I have not checked his numbers, but it is irrelevant to the point" pretty well summarizes your post entirely.
YOU are the one ignoring science in favor of what you call "politics".
The process of blood donation is not a right but a privilege to provide a life sustaining product to someone who requires it. Lest be clear - ALL the risk is of the recipient. The incremental risks to the recipients does not warrant the relaxing of these rules. Indeed there are often shortages of blood in the US as well as Canada, however, this is as the result of only a small percentage of the population stepping up to make a gift of life. If more Americans and Canadians donated blood even just once per year there would be significantly more blood available.
Reply | Report Abuse | Link to thisDr. Wainberg fueling this argument is problematic as he is focused on the issues of HIV and the resulting media push is not reflective of what this policy truly mitigates. The issue is NOT if there are effective methods for screening HIV, but rather that Epidemiology predicates that the MSM population is of higher risk for transmission of sexually transmitted viruses.
New pathogens appear regularly in the blood system and can move quickly and undetected with potentially long latency periods where those infected would not be presenting symptoms. Testing for an unknown virus would not be occurring, it could be years where this virus would be identified, testing would be developed and implemented all while the recipients of blood would be infected. The exact situation which occurred with HIV and HCV and likely VCJD (the reason why individuals who visited or lived in Europe are excluded)
MSM are a very high-risk donor population based on epidemiology. Exclusion of high-risk groups is a scientific decision, not a moral or political one.
The gay rights groups and their lobbiests should take a step back and see if they are serving their members appropriately. Do they which to further risk their population when they are in need of a blood transfusion - a transfusion that could result in an infection that would create significant complications or death?
I donated blood regularly for many years because it was the right thing to do. Then I was eliminated as a possible donor because I was stationed in Germany in the US Army during the 70's & 80's. That was 30 years ago and the ban is still in place. I wonder how many lives my blood donations might have saved over these 30 years.
Reply | Report Abuse | Link to thishow about people who weigh less than 110 lb? I lost a few pounds and now I cannot donate anymore, it's pretty upsetting. I understand that maybe it's expensive to be flexible about accepting 0.75 pint donations, but I wish it were possible.
Reply | Report Abuse | Link to thisA simple 'opt out' method could work.
Reply | Report Abuse | Link to thisAll people who don't care whether they receive the blood of a homosexual should be given blood from a homosexual.
BUT a RECORD of who receives this blood MUST be kept and those who DO receive a homosexuals blood NOW becomes one of those who receive homosexual blood in the future PLUS they are deferred to DONATE only to the homosexual blood 'pool'.
THAT way they would be doing what they ARGUE is the REASON for acceptance of blood from a homosexual.
They say "it would input badly needed blood to our blood banks if we agreed to accept homosexual blood."
If one uses logic then the use of homosexual blood BY them would FREE UP blood which would be otherwise wasted on them .
Give them the homosexual blood which they want .
Everyone should be happy then.
Simple logic.
I'm sure nurses wouldn't have any problem with taking a homosexuals' blood.
In fact they shouldn't be given a choice when it comes to homosexual blood.
ALL people in the medical field should be given homosexual blood EXCLUSIVELY.
Imho ..
= i have donated my blood 60 times before age 60. TWICE on a day april 1974 Vietnam when we were shelled.=now what EVERYONE DODGES is: if a person comes to donate blood today and he had exposed to Positive juice vagina yesterday , and we know it may take 6 - 8 weeks or more for the anti-bodies to show a positive blood HIV,and today this person shows rapid test negative naturally, what is the procedure? even PCR needs 24 hrs, and beyond reach........what do we do?
Reply | Report Abuse | Link to thiswith 40% maybe infected???? THE ANSWER IS TO GET AN INSTANT AFFORDABLE viral PCR like test.Tell us if it is round the corner,Will the commercial marketers withhold such tests to suit their market profit convenience????
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=what logic?
Reply | Report Abuse | Link to thisIf you are in desperate need of blood and the chances are one in 1000 that you will acquire a disease in the process of the transfusion, chances are you'll risk it. If you need eight pints, the chances are 1:1000 each time so really they are only 8 in 1000 (I think?) over the course of replacing the blood in an adult body.
Reply | Report Abuse | Link to thisI was seriously ill long ago and received, over the course of the ailment, more than 30 pints of blood. When I had recovered, I felt a debt to all the blood donors and considered it my duty to give blood whenever I could. And I did so for years.
Then, while I was in the UK, their regulations changed. The cure for the ailment I had makes it more difficult for my body to absorb water; in my normal life, this just means I am never without drinking water wherever I go, but it is nothing more than a quirk of my life activities. I have played tennis in 90 degree heat for hours & as long as I keep re-hydrating, I've never suffered any problems. The new regulations prevented me from giving blood for this reason.
When I returned to the States, I tried to give blood, but they wouldn't take mine any more because I had lived in England during the whole initial mad cow scare. That was twenty years ago now & I haven't developed, nor do I show any signs of developing, Creuzfelt-Jakob disease or the mad cow equivalent.
Still no one wants the blood I would willingly donate.
If hospitals want to decrease accidental treatment deaths, they should pay & train their cleaners more, wash their hands more frequently and prevent all the nasty hospital-borne infections. Meanwhile, blood donors could get on with helping to prevent shortages.
Me, too, Kathy. See below.
Reply | Report Abuse | Link to this"40%" infected? Where did this statistic come from? Can anyone cite the source? It seems far-fetched to me.
Reply | Report Abuse | Link to this