Gay male blood donor controversy
|Parts of this article (those related to policies and events) are outdated. (March 2012)|
The gay male blood donor controversy refers to the dispute over prohibitions on donations of blood or tissue for organ transplants from men who have sex with men (MSM), a classification of men who engage (or have engaged in the past) in sex with other men, regardless of whether they identify themselves as gay, bisexual, or otherwise. Opposition to the prohibition is most frequently addressed in terms of gay men. The MSM group is considered to be at high risk for HIV/AIDS and the AIDS pandemic was first identified in gay communities. MSM are also at high risk for some types of hepatitis and syphilis. These pathogens can be transmitted in blood transfusions. Restrictions on donors are sometimes called "deferrals" since blood donors who are found ineligible may be accepted at a later date. The restrictions vary from country to country, and in many cases men are deferred who have not had sex with men for many years. The restrictions affect these men and any female sex partners. They do not otherwise affect women, including women who have sex with women. Critics of many of the deferrals claim these policies are not supported by medical science.
Many LGBT organizations view the restrictions on donation as based on homophobia and not based on valid medical concern since donations are rigorously tested to rule out donors that are infected. They state the deferrals are based on stereotypes. Proponents of the lifetime restriction defend it because of the risk of false negative test results and because the MSM population in developed countries tends to have a relatively high prevalence of HIV/AIDS infection. Studies have found, to varying extents, that the potential risk of transfusion of HIV infected blood would increase if MSM were allowed to donate blood. Opponents of prohibitions against MSM point out that screening of donors should focus on sexual behavior as well as safe sex practices, and any use of needles regardless of why they are used. Some groups in favor of lifting the restrictions support a waiting period after the blood is donated when the donor is considered to have had behavior considered higher risk, and before it is used, to match the blood bank's window of testing methods. Depending on the testing method used, the window to detect HIV can be as short as three weeks (NAT testing method), or as long as three months (serology testing method).
- 1 MSM and HIV/AIDS
- 2 Current situation
- 3 Reasoning for the restrictions
- 4 Criticism of the restrictions
- 5 Protests and boycotts
- 6 See also
- 7 References
- 8 External links
MSM and HIV/AIDS
In many developed countries HIV is more prevalent among MSM than among the general population. In the United States, MSM accounted for 49 percent of new HIV diagnoses reported in 2005. Estimates of the percentage of men in the US who have had sex with men vary from 0.5% to 13.95%. The US Census does not ask about sexual practices. African Americans, who are also at high risk but are not banned from donating blood, accounted for 49 percent of new HIV diagnoses reported in 2007 and 12% of the population.
List of countries with their stand on MSM blood donors
|Country||Deferral for MSM||Deferral for female
sex partners of MSM
|Australia||1 year||1 year|||
|Canada||5 years||1 year|
|Czech Republic||1 year||1 year|||
|New Zealand||5 years||1 year|||
|Poland||No deferral A|||
|South Africa||6 months|||
|United Kingdom||1 year|||
|United States||Indefinite B||1 year|||
|Venezuela||Indefinite C||No deferral|
- ^A People of any sexual orientation involved in any kind of sexual activity are welcome to donate blood, if they are confident that their sexual behaviour is safe and does not expose them to sexually transmitted diseases by e.g. unprotected sex with non-trusted partners, regardless of sexual orientation.
- ^B No restriction if last MSM activity was before 1977.
- ^C Individuals are requested to fill a "Yes/No" questionnaire about his/her sexual life. Direct questions like "Have you ever had any sexual intercourse with someone from your same sex?" may appear.
In the US, the current guidance from the U.S. Food and Drug Administration (FDA) is to indefinitely defer any male donor who has had sex with another man, in the period from 1977 to the present day. In early 2012 the Department of Health in the United Kingdom asked for comments on a pilot study to "assess alternative policies that would allow some gay and bisexual men to donate blood."
Female sexual partners of MSM are deferred for one year since the last exposure. This is the same policy used for any sexual partner of someone in a high risk group. The argument used to follow these policies is that blood should be collected from a population that is at low risk for disease, since the tests are not perfect and human error may lead to infected units not being properly discarded, and these population groups would be considered a high risk. The policy was first put in place in 1985.
Donors of what the FDA calls "HCT/P's", a category that includes transplants (other than organs) and some reproductive tissue, notably anonymous semen donations, are ineligible for five years after the most recent contact. UNOS policies for Organ donation require the hospital receiving the organ to be notified if the donor was an MSM within the past 5 years. The organs are generally used unless there is a clear positive test for a disease.
History of calls to change the policy
- In 2006, the AABB, American Red Cross, and America's Blood Centers all supported a change from the current US policy of a lifetime deferral of MSM to one year since most recent contact. One model suggested that this change would result in one additional case of HIV transmitted by transfusion every 32.8 years. The AABB has suggested making this change since 1997. The FDA did not accept the proposal and had concerns about the data used to produce the model, citing that additional risk to recipients was not justified.
- On August 19, 2009, the Assembly Judiciary Committee in California passed AJR13, the U.S. Blood Donor Nondiscrimination Resolution, calling upon the FDA to end the MSM blood ban.
- In April 2010, the New York City Council passed a resolution calling on the U.S. Food and Drug Administration (FDA) to eliminate the ban stating "This ban was based on prejudice, a knee-jerk reaction, and misunderstandings about the HIV/AIDS disease. Given the constant need for blood, it does not make common sense to prohibit donations from an entire population."
- On June 1, 2010, the Washington, DC City Council passed a resolution calling on the FDA to "reverse the lifetime deferment of blood donations by men who have had sex with men since 1977 in favor of a policy that protects the safety and integrity of the blood supply that is based on an up-to-date scientific criteria."
- In June 2013, the American Medical Association issued a statement calling on the FDA to change the policy, stating that "[o]ur technology has advanced to the point where . . . it is antiquated to keep this policy in place and to keep those units of blood from entering the blood supply."
- In July 2013, the American Osteopathic Association approved a policy calling on the FDA to "end the indefinite deferment period for Men who have sex with Men (MSM)", and to "modify the exclusion criteria for MSM to be consistent with deferrals for those judged to be at an increased risk of infection."
The UK lifted its lifetime ban on MSM blood donation in September 2011, and changed the policy to simply restrict men who have had sex with another man within the previous 12 months. The Advisory Committee on the Safety of Blood, Tissues and Organs recommended the policy change after a study concluded that a total ban may breach equality legislation and that the risk of HIV reaching the blood supply would only increase by approximately 2%.
A similar policy exists in the rest of the European Union and is the prevailing interpretation of the European Union Directive 2004/33/EC article 2.1 on donor deferrals. The policy, however, is not very specific and refers to "high risk sexual contact."
In Finland, the parliamentary ombudsman launched an investigation on the possible unconstitutionality of the lifetime ban in January 2006. In June 2008, it was concluded that the ban was not unlawful in Finland as it is based on "appropriately reasoned epidemiological information" and because it is related to sexual behaviour rather than sexual orientation. The ombudsman added that people over the age of 65 and people who lived in Britain during the bovine spongiform encephalopathy (mad cow disease) outbreak are also screened out during blood donor interviews.
Australia's individual states and territories each had their own policies on blood donations by MSM. Most previously had some form of the indefinite deferral, and they all changed to a 12-month deferral at different times between 1996 (SA) and 2000 (ACT, NSW).
A comparison of confirmed HIV positive blood donations before and after the change did not see a statistically significant difference, though the number of HIV positive blood donations during the period with a 12-month deferral was greater. In all of the cases of HIV positive donations associated with MSM after the 12-month deferral, the donors had lied about their medical history and would not have been eligible under either criterion.
Since 2009, the New Zealand Blood Service (NZBS) have deferred males who have had oral or anal intercourse, with or without protection, with another male for five years. From the formation of the NZBS in 1998 to 2009, the deferral period was ten years, but reduced to five years following an independent review of blood donation criteria in 2007-8 which found no significant difference in risk to the blood supply for deferral periods of five years compared to ten years.
The five year deferral period for MSM is on par with the five year deferral period for persons engaging in prostitution outside of New Zealand and people who have resided in a country which has a high (1% or more) HIV prevalence. Females who engage in sexual intercourse with a male who has had sex with another male are deferred for twelve months.
Reasoning for the restrictions
Blood services first and foremost must ensure that all blood received for donation is safe for transfusion purposes. This is achieved by screening potential donors for high risk behaviors through questionnaires and interviews before blood is taken, and subsequent laboratory testing on samples of donated blood.
Blood services commonly justify their bans against MSM using the statistically high prevalence of HIV and hepatitis of MSM in population studies.
In the earliest years of the AIDS epidemic, there were no reliable tests for the virus, which justified blanket bans on blood donations from groups at high risk of acquiring or having HIV, including MSM. These restrictions are similar to current restrictions in most countries on people residing in the United Kingdom between 1980 and 1996, due to the absence of a test to screen for variant Creutzfeldt–Jakob disease (vCJD).
In 1985, early tests using the ELISA method looked for antibodies, which are the immune system's response to the virus. However, there is a window period when using this method in which a person who has been infected with HIV is able to spread the disease but may test negative for the virus. This window period can be as long as three to six months, with an average of 22 days. Tests using the ELISA methods are often still used in developed countries because they are highly sensitive. In developing countries, these tests are often the only method used to screen donated blood for HIV. To cover the window period resultant from the use of these tests, donors are also screened for high risk behaviors, one of which is a history of same-sex sexual activity among male potential donors. Other groups with similar restrictions include commercial sex workers, injecting drug users, and people resident in countries with a high HIV prevalence (such as sub-Saharan Africa). Newer tests look for the virus itself, such as the p24 antigen test, which looks for a part on the surface of the virus, and Nucleic acid tests (NAT), which look for the genetic material of the virus. With these tests, the window period is shorter, with an average duration of 12 days.
Risks are also associated with a regular donor testing positive for HIV, which can have major implications as the donor's last donation could have been given within the window period for testing and could have entered the blood supply, potentially infecting blood product recipients. An incident in 2003 in New Zealand saw a regular donor testing positive for HIV and subsequently all blood products made with the donor's last blood donation had to be recalled. This included NZ$4 million worth of Factor VIII, a blood clotting factor used to treat haemophiliacs which is manufactured from large pools of donated plasma, and subsequently led to a natiowide shortage of Factor VIII and the deferral of non-emergency surgery on haemophiliac patients, costing the health sector millions of dollars more. Screening out those at high risk of bloodborne diseases, including MSM, reduces the potential frequency and impact of such incidents.
Criticism of the restrictions
Objections to the restrictions are generally based on the idea that improvements in testing and other safeguards have reduced the risk from transfusion transmitted HIV to an acceptable level. Blood shortages are common, and critics of the policies point out that excluding healthy donors only makes the problem worse. "Ideal" inventories are at least a three day supply, but many blood centers struggle to meet this demand.
Other criticism stems from the fact that the ban is a blanket ban encompassing all men who have had sex with another man, even once during their lifetime. Critics claim that a promiscuous heterosexual male is a higher-risk donor than a gay or bisexual man in a monogamous relationship, for example a civil partnership in the United Kingdom, but the former will usually be allowed to donate blood. Furthermore, other high-risk activities such as having sexual contact with anyone who has used needles to take drugs not prescribed by their doctor have a set deferral period before the donor is allowed to donate blood, whereas MSM donors are deferred indefinitely. Female donors who have sexual contact with MSM are deferred for only twelve months.
Protests and boycotts
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- The students association at Carleton University in Ottawa, Ontario voted in 2012 to maintain a ban on blood clinics on campus.
- Throughout the 2000s, several boycotts have been held on college campuses across the United States against blood drives. For example, in 2003, a blood drive at the University of Vermont was cancelled to protest the MSM donor policy. In 2007, an Iowa State University student group sparked controversy when they pulled their support for a blood drive. In 2008, a faculty member at Sonoma State University proposed a ban on blood drives on campus, and at San Jose State University President Don Kassing suspended all blood drives on campus. In 2010, students from Keene State College protested blood drives on their campus. On April 14, 2011, The Queens College Academic Senate of The City University of New York recommended that all blood drives on campus should cease. The recommendation was adopted by Queens College President James Muyskens but reversed in June 2011 when the CUNY chancellory expressed its disapproval. http://www.qc.cuny.edu/Academics/AcademicSenate/Documents/Minutes/110414.pdf In March of that same year (CCNY) The City College of New York, of The City University of New York also ceased all blood drives on their campus
- On June 10, 2010, a group of bloggers led by Adam Bink of OpenLeft.com created a blog swarm asking people to submit a public comment to Dr. Jerry Holmberg of the Advisory Committee on Blood Safety and Availability, asking the committee to revise the ban. On June 11, 2010, the Committee voted 9-6 against lifting the ban. In a follow-up vote, the Committee voted 14-0 to declare the policy "sub-optimal" because "some potentially high-risk donations[clarification needed] while preventing some potentially low-risk donations".
- As of March 2011[update], an online petition promoted along with the forthcoming documentary movie Save A Life, has 2,383 signatures.
- As of May 2012[update], an online petition started by a graduate student at the University of Oklahoma has 11,850 signatures.
- The National Union of Students LGBT Campaign runs a "Donation Not Discrimination" campaign to have the blood ban revised, while also advocating for those who are not banned from donating.
- Schoettes, Scott (December 2012). "Blood Donations Questions". Adelante Magazine.
- Stier, Jeff (2007-06-13). "Blood for Sale". HuffingtonPost.com, Inc. Retrieved 2008-04-05.
- UNAIDS 2006 report on the global AIDS epidemic, Chapter 05, June 2006
- "Homosexual men allowed to give blood but sex banned for decade". Telegraph. Retrieved 2013-08-01.
- CDC HIV/AIDS Surveillance Report: HIV Infection and AIDS in the United States and Dependent Areas, 2005.
- "HIV and AIDS in America". avert.org.
- Clive R. Seed, Philip Kiely, Mathew Law, and Anthony J. Keller (December 2010). "No evidence of a significantly increased risk of transfusion-transmitted human immunodeficiency virus infection in Australia subsequent to implementing a 12-month deferral for men who have had sex with men". Transfusion (AABB) 50: 2722–2730. doi:10.1111/j.1537-2995.2010.02793.x.
- "Mclaughlin Report on Risk Management for Canadian Blood Services" (PDF). McLaughlin Center for Population Health Risk Assessment, University of Ottawa. 2007-01-31. p. 28. Retrieved 2008-05-25.
- "FAQs - Who can give". Australian Red Cross Blood Service. 18 April 2012. Retrieved 7 June 2012.
- "Rotes Kreuz: Wer darf Blutspenden?". Roteskreuz.at. Retrieved 2012-07-20.
- "Avis du CSH relatif a` la sécurisation maximale de la collecte et de la transfusion sanguine (CSH 8094)." (PDF) (in French). Brussels: FPS Health Belgium. 2005-02-18. Archived from the original on 2011-04-20. Retrieved 2009-09-24.
- D Andreatta (2013-05-22). "Ban lifted on gay men giving blood, but tough restrictions remain". The Globe and Mail. Retrieved 2013-05-22.
- "Gays and lesbians in Chile now allowed to donate blood". Santiago Times. Retrieved 2013-04-28.
- Ministry of Health (Croatia) (1998-12-16). "Pravilnik o krvi i krvnim sastojcima" [Bylaw for blood and its contents] (in Croatian). Narodne novine. Retrieved 2011-07-18. "E`lanak 16. Trajno se iskljue`uju kao davatelji krvi: [...] osobe sa homoseksualnim ponašanjem [...]"
- "Doporučení Společnosti pro transfuzní lékařství ČLS JEP č. STL2007_03 ze dne 12. 4. 2007 verze 6 (2012_04)" (DOC) (in Czech). Společnost pro transfuzní lékařství ČLS JEP. p. 8. Retrieved 2013-02-07.
- "Richtlinien zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten (Hämotherapie)" [Guidelines for the collection of blood and blood components and the use of blood products (haemotherapy)]. German Medical Association. 2010. Retrieved 2013-10-28.
- "What should you know about the Health history Enquiry in Blood Donation?" (PDF) (in Traditional Chinese & English). Hong Kong: Hong Kong Red Cross Blood Transfusion Service. 2008. Retrieved 2011-08-14.
- "Blood Donation". Magen David Adom.
- Roberts, Scott. "Mexico lifts ban on gay men donating blood". PinkNews.co.uk. Retrieved 2013-03-02.
- TFE, tfe.nl (2011-12-23). "Bloed geven - Risicofactoren hiv mannen" [Giving Blood - Risk Factors of HIV for men]. Sanquin.nl. Retrieved 2012-07-20.
- "Safe Blood Starts with You". New Zealand Blood Service. Retrieved 20 July 2012.
- "Internetowy System Aktów Prawnych" [Internet System of Legal Acts]. Isap.sejm.gov.pl. Retrieved 2012-07-20.
- "Narodowe Centrum Krwi: Nie będziemy dyskryminować homoseksualistów" [National Blood Center: We will not discriminate against homosexuals]. Wiadomosci.gazeta.pl. Retrieved 2012-07-20.
- "Honorowe krwiodawstwo mężczyzn homo- i biseksualnych. Fakty i mity" [Honorable blood donation by gay and bisexual men. Facts and Myths]. Kph.org.pl. Retrieved 2012-07-20.
- "Приказ Минздравсоцразвития России от 16.04.2008 N 175н". Российская газета. 2008-05-24. Retrieved 2013-11-13. Unknown parameter
- "Россиянам вольют "голубую кровь"" (in Russian). Полит.ру. 2008-05-23. Retrieved 2013-11-13.
- "The Republic of Slovenia Institute for Transfusion: Who cannot donate blood". Ztm.si. Retrieved 2012-07-20.
- "Gay men blood donor ban to be lifted". BBC News Online. 2011-09-08.
- "Thailand joins gay blood ban". Pink News. 2 April 2008. Retrieved 23 July 2013.
- "Donor selection criteria review". Department of Health and SaBTO, Blood Donor Selection Steering Group. Retrieved 8 September 2011.
- Consumer Affairs Branch (CBER). "Blood Donations from Men Who Have Sex with Other Men Questions and Answers". Fda.gov. Retrieved 2012-07-20.
- 1992 Recommendations for the prevention of Human Immunodeficiency Virus Transmission by Blood and Blood Products[dead link]
- "American Red Cross Dogged by Allegations of Discrimination (published: January 28, 2002)". The Harvard business school newspaper. Retrieved 2006-12-17.
- FDA/CBER - Guidance for Industry: Eligibility Determination for Donors of Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps)[dead link]
- "OPTN/UNOS POLICY 4" (PDF). Retrieved 2012-07-20.
- "Meeting of Blood Products Advisory Committee" (133MB). Food and Drug Administration. 2006-03-09. p. 66. Retrieved 2008-05-25.
- "Ending the Federal Ban on Gay Blood Donations". California Progress Report. 2009-08-19. Retrieved 2012-07-20.
- "Legislative and Community Report" (PDF). New York: New York City Council. 2010-04-30. p. 2. Archived from the original on 2011-04-20. Retrieved 2010-09-18.
- "A Resolution 18-486 : In the Council of the District of Columbia". Dcregs.dc.gov. June 1, 2010. Retrieved 2013-10-28.
- "American Medical Association Opposes FDA Ban on Gay Men Donating Blood - ABC News". Abcnews.go.com. 2013-06-20. Retrieved 2013-08-01.
- "American Osteopathic Association Calls for Removing FDA's Blood Donor Ban". Osteopathic.org. 2013-07-20. Retrieved 2013-08-01.
- Waygood, James (2011-09-08). "UK Government lifts lifetime ban on gay blood donation". So So Gay. Retrieved 2012-07-20.
- "Homosexual men allowed to give blood but sex banned for decade". Telegraph.co.uk. Retrieved 2012-07-20.
- "Commission Directive 2004/33/EC of 22 March 2004". Iospress.metapress.com. Retrieved 2013-10-28.
- "Behavioural Donor Deferral Criteria Review - Final Report to the New Zealand Blood Service". April 2008. Retrieved 20 July 2012.
- "San Francisco AIDS Foundation: HIV Testing". Sfaf.org. Retrieved 2012-07-20.
- FDA Approves First Nucleic Acid Test (Nat) System To Screen Whole Blood Donors For Infections With Human Immunodeficiency Virus (Hiv) And Hepatitis C Virus (Hcv)[dead link]
- "ABC Blood Supply Status Report". Members.americasblood.org. Retrieved 2012-07-20.
- Posted: Jul 10, 2012 8:41 AM ET (2012-07-10). "Blood clinic ban on campus upheld due to policy on gay men - Ottawa - CBC News". Cbc.ca. Retrieved 2013-03-02.
- [dead link]
- July 19, 2012 (2007-02-26). "LETTER: Political correctness may cripple blood drive turnout - Iowa State Daily: Opinion". Iowa State Daily. Retrieved 2012-07-20.
- Norton, Laura (2008-03-08). "Battle over blood". PressDemocrat.com. Retrieved 2012-07-20.
- "News: College protests blood drives". The Badger Herald. 2008-02-06. Retrieved 2012-07-20.
- "keeneequinox.com". keeneequinox.com. Retrieved 2013-08-01.
- "Queens College Bans Blood Drives (The City University of New York) blood drive is happening in flushing queens,york college cuny blood donation". Free-press-release.com. Retrieved 2012-07-20.
- David Badash (2010-06-10). "Revise the FDA’s Lifetime Ban On Gays Donating Blood". The New Civil Rights Movement. Retrieved 2012-07-20.
- Bink, Adam. "Open Left". Open Left. Retrieved 2012-07-20.
- "SAVE A LIFE: A Feature Documentary". Savealifemovie.com. Retrieved 2013-10-28.
- Share this signature on Facebook. "Gay Rights Petition: REPEAL THE FDA MSM BLOOD BAN". Change.org. Retrieved 2012-07-20.
- Share this signature on Facebook. "Gay Rights Petition". Change.org. Retrieved 2013-01-02.
- FDA:Blood Products Advisory Committee, 09Mar2006 transcript See page 53 (page 59 of the pdf) for the discussion of test error rates. Warning: this is a 133 MB scanned transcript.
- CDC: HIV/AIDS among Men Who Have Sex with Men
- British Medical Journal Debate: Should men who have ever had sex with men be allowed to give blood? No
- British Medical Journal Debate: Should men who have ever had sex with men be allowed to give blood? Yes