The gay rights community is wrong about blood donations (again)

[Mr Spinkles]

Anyone who wants to can go to the CDC website and look at HIV prevalence in different sexual/ethnic/gender populations in the U.S.: HIV Incidence | Statistics and Surveillance | Topics | CDC HIV/AIDS

While the HIV prevalence among black men (for example) is several times higher than the prevalence among white men, this does not adjust for IV drug use, and the prevalence is still MUCH lower than the prevalence among men who have sex with men, IV drug users, and people who have sex with IV drug users.

 

[Mr Spinkles]

For example, the most common form of transmission among black men is male-to-male sexual contact. The second most common is IV drug use. The third most common is high-risk heterosexual contact (e.g. sex with an IV drug user).

According to the CDC in 2006 there were over 50,000 new transmissions of HIV in the U.S. 31% of the transmissions were due to heterosexual contact, 12% due to injection drug use, 4% due to injection drug use + men having sex with men, and 53% due to men having sex with men. The heterosexual contact section almost certainly was dominated by high-risk heterosexual sex, e.g. sex with an IV drug user or hemophiliac.

 

[Mr Spinkles]

I think that some of the other points are valid, but I don't think that either of these are... not for justifing a lifetime ban, anyhow. The "window period" for HIV testing is 3 months.

So this doesn't justify a lifetime ban on IV drug users either, then, since they also have a 3 month window period and they have a smaller prevalence of HIV than MSM.

 

[9-10ths_Penguin]

So this doesn't justify a lifetime ban on IV drug users either, then, since they also have a 3 month window period and they have a smaller prevalence of HIV than MSM.

I suspect you're right. However, I think there are additional issues when it comes to IV drug users.

 

[Mr Spinkles]

I think it's quite likely that the lifetime ban on donating for men who have had sex with men is a product of an era before effective (or maybe cost-effective) tests for HIV in donated blood, and when the disease could go decades without being detected.

And I agree with you that there's no such thing as the "right to donate blood", but there is such a thing as a right to equality. If a group of people are going to be banned from donating blood, then there should be a legitimate, scientific justification the ban.

I agree with you on both points, but your first point is missing something: it was also an era when new HIV infections were dominated by MSM. Today that is still true, but much less so, in this country. It might be time to change the policy. But, (1) it was the right policy at the time, and (2) it's not an outrageously unfair policy today. It might not be the best policy, but it's simply not discrimination, there's a legitimate medical debate to be had. Some in the gay rights / liberal community dispute these two points, I think they are totally off base this time. Let's have the medical debate, using actual numbers and statistics, not a civil rights debate.

 

[Mr Spinkles]

I suspect you're right. However, I think there are additional issues when it comes to IV drug users.

According to the American Red Cross: Those who have ever used IV drugs that were not prescribed by a physician are not eligible to donate. This requirement is related to concerns about hepatitis and HIV.

You're not banned if you have cocaine in your blood right now ... you're banned if you EVER used an IV drug, even once in your life. Because of the risk of HIV and Hep. Maybe you only used sterilized needles. Maybe you never shared. Maybe you only did it once and you've since been tested. Doesn't matter. All IV drug users, banned. The same reasoning applies to MSM, who have an even higher prevalence of HIV and Hep. If this is really about an "outdated system" then we should all be up in arms about IV drug users, who are being even more discriminated against since their prevalence is somewhat lower than among MSM.

 

[9-10ths_Penguin]

According to the American Red Cross: Those who have ever used IV drugs that were not prescribed by a physician are not eligible to donate. This requirement is related to concerns about hepatitis and HIV.

You're not banned if you have cocaine in your blood right now ... you're banned if you EVER used an IV drug, even once in your life. Because of the risk of HIV and Hep. Maybe you only used sterilized needles. Maybe you never shared. Maybe you only did it once and you've since been tested. Doesn't matter. All IV drug users, banned. The same reasoning applies to MSM, who have an even higher prevalence of HIV and Hep. If this is really about an "outdated system" then we should all be up in arms about IV drug users, who are being even more discriminated against since their prevalence is somewhat lower than among MSM.

The big difference I see is that the risk of homosexual men lying on the form in order to get money for their donated blood to enable them to continue being homosexual is virtually zero.

 

[Magic Man]

Everyone's blood is tested. Screening people with a questionnaire is just the first line of defense which further reduces the risk, since tests can fail. There have been 9 confirmed cases of people getting HIV from blood donations since 1991, the last occurred in 2002. This is despite the fact that there are screens and despite the fact that all blood is tested.

Good. Then there's no point in screening with questions, right?

Please explain why the above doesn't address your concerns. You say the test should ask about safe sex or a low number of partners, but that has not been demonstrated to work.

It hasn't been demonstrated to work because it hasn't been tested.

 

[Mr Spinkles]

Good. Then there's no point in screening with questions, right?

No, there is a point to screening with questions. I repeat:

• Blood donor testing using current advanced technologies has greatly reduced the risk of HIV transmission but cannot yet detect all infected donors or prevent all transmission by transfusions. While today's highly sensitive tests fail to detect less than one in a million HIV infected donors, it is important to remember that in the US there are over 20 million transfusions of blood, red cell concentrates, plasma or platelets every year. Therefore, even a failure rate of 1 in a million can be significant if there is an increased risk of undetected HIV in the blood donor population.

Screening with questions greatly reduces the amount of blood-borne diseases in the blood donor population, and thus reduces the number of people who get blood-borne diseases from transfusions due to the small but nonzero failure rate in blood testing.

It hasn't been demonstrated to work because it hasn't been tested.

So, you advocate switching to an alternative questionnaire for blood donors which has not been tested for safety?

 

[Mr Spinkles]

The big difference I see is that the risk of homosexual men lying on the form in order to get money for their donated blood to enable them to continue being homosexual is virtually zero.

An interesting point but I don't see how this is relevant .... drug users might lie, therefore .... ? Deferring people who say they are drug users doesn't make the blood supply safer? Deferring MSM doesn't make the supply safer?

From the CDC, HIV/AIDS and Men Who Have Sex with Men (MSM) (for the Public) | Topics | CDC HIV/AIDS

MSM made up more than two thirds (68%) of all men living with HIV in 2005, even though only about 5% to 7% of men in the United States reported having sex with other men.

In a 2005 study of 5 large US cities, 46% of African American MSM were HIV-positive.
...
Since HIV/AIDS in MSM was first diagnosed in 1981, gay and bisexual men have been leaders in dealing with the challenges of the epidemic. Gay organizations and activists, through their work, have contributed greatly to many of the guidelines for prevention, treatment, and the care of people living with HIV/AIDS.

For complex reasons, HIV/AIDS continues to take a high toll on the MSM population. For example, the number of new HIV/AIDS cases among MSM in 2005 was 11% more than the number of cases in 2001. It is unclear whether this increase is due to more testing, which results in more diagnoses, or to an increase in the number of HIV infections. Whatever the reasons, in 2005, MSM still accounted for about 53% of all new HIV/AIDS cases and 71% of cases in male adults and adolescents.
​

 

[Magic Man]

No, there is a point to screening with questions. I repeat:

• Blood donor testing using current advanced technologies has greatly reduced the risk of HIV transmission but cannot yet detect all infected donors or prevent all transmission by transfusions. While today's highly sensitive tests fail to detect less than one in a million HIV infected donors, it is important to remember that in the US there are over 20 million transfusions of blood, red cell concentrates, plasma or platelets every year. Therefore, even a failure rate of 1 in a million can be significant if there is an increased risk of undetected HIV in the blood donor population.

Screening with questions greatly reduces the amount of blood-borne diseases in the blood donor population, and thus reduces the number of people who get blood-borne diseases from transfusions due to the small but nonzero failure rate in blood testing.

So, then, why don't we ask the correct questions? Wouldn't that make it even safer?

So, you advocate switching to an alternative questionnaire for blood donors which has not been tested for safety?

So, you advocate for retaining the same system, even though you could try a new one that could very well work even better?

 

[Mr Spinkles]

So, then, why don't we ask the correct questions? Wouldn't that make it even safer?

"We", as in, virtually the entire western world, are asking the correct questions when it comes to blood donations. We are asking about IV drug use, hemophilia, high-risk heterosexual sex and male-to-male sex. Those are the right questions. Maybe a visual aid would help, from HIV/AIDS in the United States | Factsheets | CDC HIV/AIDS :

Sex of adults and adolescents with HIV/AIDS diagnosed during 2007

So 74% of people diagnosed in 2007 were males. Of those males, here's the breakdown:

Transmission categories of adults and adolescents
with HIV/AIDS diagnosed during 2007.
Male Adults and Adolescents

Gee, one almost gets the crazy idea from this data that we should be asking about high-risk heterosexual contact, male-to-male contact, and IV drug use.

So, you advocate for retaining the same system, even though you could try a new one that could very well work even better?

I didn't advocate retaining the current MSM policy. I advocate changing the policy based on data that shows the change will make the blood safer, instead of based on misguided ideas of fairness and equality. I've answered your question, will you answer my question?

 

[Gunfingers]

Am i reading that wrong, or is "male-to-male sexual contact" on that chart twice? Is it just so dangerous it warranted a second mention?

 

[Mr Spinkles]

One category is "male-to-male sexual contact" and another category is "male-to-male sexual contact and injection drug use".

 

[Magic Man]

Those are the right questions.

No, they're not. The correct questions would be "Have you had unprotected sex with another man?" and "Have you been tested for HIV since the last time you had sex?" and maybe "When was the last time you had anal sex with another man?" and for women "When was the last time, if ever, you had anal sex with a man?".

I didn't advocate retaining the current MSM policy. I advocate changing the policy based on data that shows the change will make the blood safer, instead of based on misguided ideas of fairness and equality.

Good for you. I advocate changing it based on the fact that we're disallowing perfectly good blood donors. And yes, that doesn't just go for gay men; it goes for people who have lived abroad and others, too.

I've answered your question, will you answer my question?

I'd love to, but you'll have to tell me what it is. Also, you answered my question incorrectly.

 

[Mr Spinkles]

No, they're not. The correct questions would be "Have you had unprotected sex with another man?" and "Have you been tested for HIV since the last time you had sex?" and maybe "When was the last time you had anal sex with another man?" and for women "When was the last time, if ever, you had anal sex with a man?".

Okay, you are claiming these are the right questions, but which facts back it up? How do the rates of MSM who have protected sex compare to the rates of MSM who have unprotected sex? These are critical pieces of information, without them your argument is just a claim with nothing to back it up. Let's be precise and look at the facts.

I've tried to get those pieces of information:

The rate of new HIV diagnosis among [gay] men who attempted always to use condoms was 1.5%, among patients who had unprotected sex but tried only to do it with same-status partners was 2.6%, and among men who had unprotected sex regardless was 4.1%. Adjusting for the number of partners (though not for their HIV status), attempted consistent condom use was 76% effective in preventing new HIV infections.
​

That's according to aidsmap.com | Condom efficacy in gay men .

So based on this data, let's estimate that a gay man who uses condoms has only one-third or perhaps only one-quarter the risk of HIV infection as a gay man who does not use condoms, since the rate drops from 4.1% to 1.5% for gay men who attempt to always use condoms.

MSM have an HIV prevalence 6,000% larger than the general population. So MSM who report always using condoms might have a prevalence of only one-third of that, or 2,000% higher than the general population. That is still an extremely high number, I believe the only groups that would compare are IV drug users and hemophiliacs, and their sex partners. In other words, it seems MSM are in a high-risk group even if they report always using condoms.

Good for you. I advocate changing it based on the fact that we're disallowing perfectly good blood donors.

But that would remain true if we took your advice and asked questions like "Have you had unprotected sex?" We would still be disallowing perfectly good blood donors in that case, too, right?

I'd love to, but you'll have to tell me what it is.

My question was: So, you advocate switching to an alternative questionnaire for blood donors which has not been tested for safety? (post #109)

You don't, right?

Also, you answered my question incorrectly.

You asked: So, you advocate for retaining the same system, even though you could try a new one that could very well work even better?

I answered: I advocate changing the policy based on data that shows the change will make the blood safer.

That is what I advocate. I answered your question correctly.

 

[Magic Man]

Okay, you are claiming these are the right questions, but which facts back it up? How do the rates of MSM who have protected sex compare to the rates of MSM who have unprotected sex? These are critical pieces of information, without them your argument is just a claim with nothing to back it up. Let's be precise and look at the facts.

I've tried to get those pieces of information:

The rate of new HIV diagnosis among [gay] men who attempted always to use condoms was 1.5%, among patients who had unprotected sex but tried only to do it with same-status partners was 2.6%, and among men who had unprotected sex regardless was 4.1%. Adjusting for the number of partners (though not for their HIV status), attempted consistent condom use was 76% effective in preventing new HIV infections.
​

That's according to aidsmap.com | Condom efficacy in gay men .

So based on this data, let's estimate that a gay man who uses condoms has only one-third or perhaps only one-quarter the risk of HIV infection as a gay man who does not use condoms, since the rate drops from 4.1% to 1.5% for gay men who attempt to always use condoms.

MSM have an HIV prevalence 6,000% larger than the general population. So MSM who report always using condoms might have a prevalence of only one-third of that, or 2,000% higher than the general population. That is still an extremely high number, I believe the only groups that would compare are IV drug users and hemophiliacs, and their sex partners. In other words, it seems MSM are in a high-risk group even if they report always using condoms.

Wait, so what you're telling me is that having safe sex doesn't help very much? That's seriously your argument?

But that would remain true if we took your advice and asked questions like "Have you had unprotected sex?" We would still be disallowing perfectly good blood donors in that case, too, right?

Sure, you're always going to. The difference is at least that's a relevant question. Having sex with another man isn't inherently going to give you HIV. Like with any sex, if you're careful about it, you can have sex with other guys and not be at much risk for HIV. I'd gladly take a guy's blood who had had very careful protected sex with other guys before I'd take a woman's blood who had had unprotected sex with a bunch of guys.

My question was: So, you advocate switching to an alternative questionnaire for blood donors which has not been tested for safety? (post #109)

Oh, then I already answered it by saying it's a silly question. It's like saying "You advocate using these new-fangled 'cars' instead of the tried-and-true horses?". I advocate for using a method that weeds out the donors we want to weed out and keeps the ones we want to keep. Your question implies that we should never change the method ever, not at all, not in a million years. That's why I say it's silly.

You asked: So, you advocate for retaining the same system, even though you could try a new one that could very well work even better?

I answered: I advocate changing the policy based on data that shows the change will make the blood safer.

That is what I advocate. I answered your question correctly.

Ah, then you should have specified the particular question you meant, since this wasn't part of your last reply. So, by that answer, I assume you mean they should test everyone for HIV and get the results before letting them donate, and then test the blood again after they donate, right? That would make blood safer. Then you wouldn't need any questions.

 

[Smoke]

I've tried to get those pieces of information:

The rate of new HIV diagnosis among [gay] men who attempted always to use condoms was 1.5%, among patients who had unprotected sex but tried only to do it with same-status partners was 2.6%, and among men who had unprotected sex regardless was 4.1%. Adjusting for the number of partners (though not for their HIV status), attempted consistent condom use was 76% effective in preventing new HIV infections.
​

That's according to aidsmap.com | Condom efficacy in gay men .

So based on this data, let's estimate that a gay man who uses condoms has only one-third or perhaps only one-quarter the risk of HIV infection as a gay man who does not use condoms, since the rate drops from 4.1% to 1.5% for gay men who attempt to always use condoms.

There is, however, quite a significant difference between always using condoms and attempting to always use condoms.

MSM have an HIV prevalence 6,000% larger than the general population.

That is not correct. I've corrected you on this point before in this thread. Again, I don't object to the ban, but I do object to this dissemination of inaccurate information.

 

[Mr Spinkles]

There is, however, quite a significant difference between always using condoms and attempting to always use condoms.

But then this isn't about people using condoms, it's about people reporting on a questionnaire that they use condoms. What is the HIV prevalence among MSM who report they always use condoms?

That is not correct. I've corrected you on this point before in this thread. Again, I don't object to the ban, but I do object to this dissemination of inaccurate information.

My apologies, I don't recall you correcting me on this .... according to the FDA,

"Men who have had sex with men since 1977 have an HIV prevalence (the total number of cases of a disease that are present in a population at a specific point in time) 60 times higher than the general population"
​

... 60 times higher, which would be 5,900% higher, by my reckoning. This is inaccurate? Come to think of it I do remember you saying it was 44 times higher.

 

[Mr Spinkles]

Wait, so what you're telling me is that having safe sex doesn't help very much? That's seriously your argument?

No, that is not my argument.

Sure, you're always going to. The difference is at least that's a relevant question.

But is it an effective question? In other words, are MSM who report always using condoms in a low-risk group for HIV? If attempted condom use is 76% effective, as claimed in the source I cited, then MSM who report practicing safe sex are still in a high-risk group.

Having sex with another man isn't inherently going to give you HIV. Like with any sex, if you're careful about it, you can have sex with other guys and not be at much risk for HIV. I'd gladly take a guy's blood who had had very careful protected sex with other guys before I'd take a woman's blood who had had unprotected sex with a bunch of guys.

But according to the study I cited 1.5% of gay men who report attempting to always use a condom were newly diagnosed with HIV.

Oh, then I already answered it by saying it's a silly question. It's like saying "You advocate using these new-fangled 'cars' instead of the tried-and-true horses?". I advocate for using a method that weeds out the donors we want to weed out and keeps the ones we want to keep. Your question implies that we should never change the method ever, not at all, not in a million years. That's why I say it's silly.

It's not silly, it's quite serious. You could change the policy. I just think it should be changed based on facts. You haven't offered any facts to back up your claims. I made an effort to bring relevant facts into the discussion and you've mostly ignored them.

Ah, then you should have specified the particular question you meant, since this wasn't part of your last reply. So, by that answer, I assume you mean they should test everyone for HIV and get the results before letting them donate, and then test the blood again after they donate, right? That would make blood safer. Then you wouldn't need any questions.

I repeat: they do test every blood donation for blood-borne diseases. In spite of these tests, there have been 9 confirmed cases of people getting HIV from blood transfusions in the U.S. since 1991. That is because the tests sometimes fail and people who believe they do not have HIV end up donating blood. The number of people who will get HIV from blood transfusions every year due to test failure is reduced by excluding people who are at a statistically high risk of blood-borne diseases from donating. That's the purpose of the questionnaire.