The ban on “gay” blood

*** Update: The FDA has recently made alterations to the ban on blood donations from MSM.  Initially, there was a lifetime ban on any man who had ever had sex with a man.  It has now been changed to allow blood donations from any man who had not had sex with a man within the previous 12 months.  This is in line with other high risk groups, who are typically banned from donating blood until 12 months after they have ceased engaging in high risk behaviour.***

If you follow me on Twitter, you’ve likely seen a lot of talk about the ban on blood from MSM (men who have sex with men). There’s a lot of misinformation floating about so I thought I’d try to clear it up. First, a few things you need to know about me. 1) I’ve done a PhD in HIV immunology. I don’t expect anyone to believe what I say based on that criterion alone. But I hope it would give you enough confidence in what I say to evaluate it based on evidence rather than emotion, and to confirm it with your own research. 2) I have always been a supporter of equality and the LGBT community. My opinion on this topic is in no way bigoted or homophobic- it is simply based upon the available medical facts we currently have. It will change as I get new information. 3) Anything discussed here is in the context of HIV demographics within the US. Much of it will be similar in similar countries (Canada, the UK, Australia, most of Europe), as these regions have similar levels of HIV infection in MSM, and similar blood donor policies. It does not extend to sub-Saharan Africa, Latin America, or Southeast Asia, where the epidemics are very different. So, let’s start with the basics. 1) Why is there a ban on MSMs from donating blood? When the HIV epidemic was recognized in the early 1980’s, we didn’t have a reliable method to screen donated blood before using it in transfusions. Because of this, a blanket ban was applied on anyone who was considered to be at a higher risk of being HIV+. MSM are at a much higher risk of being HIV+ than the general heterosexual population. In the US, MSM are thought to comprise ~4% of the population, but are responsible for >50% of all current HIV infections, and >60% of all new infections. This makes MSM a “high risk” group for HIV infection. That is not a biased opinion- it is based on the stats I’ve just quoted. Similarly, injection drug users (IDUs) are a high-risk group, as they comprise 16% of the HIV infected people in the USA. Individuals who sell or buy sex are also considered to be high-risk. All of these groups are disallowed from donating blood, based entirely on the fact that they are at a higher risk of being HIV-infected. 2) But isn’t the donated blood tested for HIV before it’s given to people? Yes, it is! All blood is screened to be sure it is free from HIV, HCV, HBV and a host of other things I’m less familiar with. The trouble is this test is not 100% foolproof. There is a possibility that blood may be screened as HIV-uninfected but in fact be HIV+. More importantly, the test itself has a flaw in that it cannot detect HIV in the blood if the infection occurred in the last 7 days. That means if I become HIV+ today, and donate blood tomorrow, it would be screened as safe, when in fact it is not. Because the test is imperfect, we have additional screening criteria to decide who can safely donate blood. Anyone who falls into high-risk categories, for this reason, is not allowed to donate. Consider it this way. With our current demographic of blood donors, there is likely to be some HIV+ blood that is donated. We rely on the screening of this blood to catch any donations that are HIV+. If we removed the ban and allowed high-risk individuals to donate, it would increase the amount of HIV+ blood in the blood bank. This means that we’d have to rely more heavily on blood testing, which we know to be imperfect, to detect these infected samples. That, in itself, increases the risk that the test will fail, and HIV+ blood will slip through and be used in a transfusion. 3) Isn’t it ‘close enough’ to perfect? Seems pretty unlikely that transmission could occur! No. With our current system, the odds of a transfusion leading to an HIV infection is 1 in 2,000,000. My understanding is a transmission event from a transfusion hasn’t occurred in nearly a decade in Canada, the US, or the UK. This system is working. If we wanted to change the donor criteria to allow high-risk individuals to donate, we would need to be CERTAIN that doing so would not increase the risk of transmission. Any increase in risk above zero is completely unacceptable, and considering that we have enough donor blood to fill the need, it’s unnecessary. 4) No! Blood banks always need more blood! This is true. Blood banks are always asking for more blood. But the truth of the matter is, no matter how “critical” our need is for more donated blood, people simply do not die due to a donated blood shortage. I’ve yet to see a single case of this. At worst, some elective surgeries have been postponed while the blood supplies are low. That’s it. Everything here is based on risk vs. reward. Currently, our system allows for very low risk of HIV transmission, while filling the need of blood within our donation system. Increasing the pool of donors by including MSM doesn’t benefit us enough to justify a potential increase in risk of HIV transmission. 5) But not all MSM are high risk! This is discrimination! That’s true. There are thousands of MSM who are HIV-negative, in long-term relationships, or practice safe sex. The trouble is, despite this, we have not found additional screening criteria (safe sex practices, monogamy, etc) that identify MSM that are as “low risk” as groups that are currently allowed to donate. Until we can do that, it is simply not reasonable to potentially increase the risk of transmitting HIV by allowing high-risk groups to donate. Now, please listen. This DOES NOT mean that all MSM have ‘dirty blood’. It DOES NOT mean we assume all MSM are promiscuous. All this means is that we simply cannot reliably differentiate between truly high-risk MSM, and those who would be considered low-risk. Without being able to do this, it is unreasonable to lift the ban. Until we know for certain what the change in the level of risk is, it is unreasonable to lift the ban. 6) Other high-risk groups can donate! This is just bigotry! It’s not. It’s really, really not. Lesbians are welcome to donate because they are one of the lowest risk groups for HIV infection on earth. This ban IS partially based on “who you’re sleeping with”- because men having sex with men is inherently a ‘risky behaviour’ in this context. That does not mean we’re discriminating. It simply means we’ve identified where the risk is, and we’re doing what we can to reduce it. It’s been pointed out that other groups have a high prevalence of HIV, such as African Americans. This is true. However, the majority of male African Americans at a higher risk of HIV are also MSM, so by disallowing MSM from donating, this prevalence is greatly decreased. The same is true of individuals in the 18-24 year old age bracket, who are at an increased risk of being HIV-infected. And, despite the fact these other ‘potentially high-risk’ individuals can donate, our system is still working, as described above. In summary, I think the point can be made thusly- Our number one priority is to make donated blood as safe as possible. There is no right to donate blood- but every individual should be guaranteed a safe blood transfusion to the best of our abilities. So if this means we have to exclude certain groups from donating, we will, until it can be shown that allowing them to donate will not increase the risk of transmission. HIV stats in MSM in the USA: FDA basics of transfusion transmission: Female-to-female HIV transmission:

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One Response to The ban on “gay” blood

  1. Thank you so much for your informative piece.

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