The ban on gay blood

Since the HIV, Hepatitis B and Hepatitis C outbreaks of the 1980's, which killed thousands of hemophiliacs in the U.S. alone, governments around the world have adopted blood donation policies which ban, or temporarily defer, people who are in statistically high-risk groups for blood-borne diseases.  Every bag of donated blood is tested for a number of diseases, but excluding high-risk groups provides an additional measure of safety.  In most countries, the list of deferred donors includes IV drug users, people who have paid or been paid for sex, hemophiliacs and their sexual partners, and men who have had sex with other men since 1977 (MSM).

It's the permanent, lifelong ban on MSM blood donations (common in most countries) that is the most controversial policy.  People naturally find the insinuation that their own blood is somehow "unfit" for charitable donation insulting.  And the gay community is, understandably, especially sensitive to a policy which seems to throw wood into the fire of homophobia.

In the media, and especially on the Left, there appears to be near-unanimity that the MSM policy is outrageous, unfair, scientifically unsound.  A New York Times article reported:  "Gay Men Condemn Blood Ban as Biased".  A recent Washington Post blog agrees the policy is "unfair, outrageous, and just plain stupid," and unapologetically cites an article comparing the policy to "blood libel".  A writer at the Guardian apparently believes the UK National Blood Service, and others who support the MSM ban, are "bloody bigots".  Senator Kerry and several other Democrats wrote a letter to the FDA urging revision of the policy.  Both Canada and the U.S. revisited, but did not change, their MSM policies.

As a hemophiliac, and a scientist-in-training, and a proud LGBT rights supporter, I have a somewhat unique perspective on this issue. Opponents of the ban seem to make great use of rhetoric, but shy away from the most important and sobering facts of the matter.  Here are some of them:

Estimated Number of New HIV Infections, by Transmission Category, 2006

There were 53,600 new HIV infections in the U.S. in 2006.  Notice that more than 53% of new HIV infections were due to male-to-male sexual contact, even though the CDC estimates MSM constitute only 2% of the overall population.  (This contrasts with Italy, where HIV is transmitted primarily by heterosexual contact, and MSM are no longer banned from donating blood).  Furthermore, virtually all of the HIV transmissions by non-MSM behavior came from IV drug use and "high-risk" heterosexual contact.  Here, "high-risk" refers to heterosexual sex with (1) an IV drug user, (2) MSM, or (3) a person known to be HIV positive.  In other words, practically none of the new HIV transmissions were caused simply by heterosexual behavior which did not involve a condom--at least in the U.S.  This is remarkable, when you consider how many more heterosexuals than MSM there are in the U.S.

In many countries, anyone who has ever used an IV drug, or ever had MSM contact, is permanently banned from donating blood.  However, the other piece of the pie--the high-risk heterosexuals--are typically only deferred from donating for 12 months.  This difference, it is argued, is unfair.

But then, HIV is not the only concern.  MSM are also at higher risk of other viruses, such as Hepatitis B, Hepatitis C, and HHV-8 (herpes virus).  Then there is the concern about the new viruses that, like HIV and Hep, may one day appear in the blood supply, without warning, without testing.  This point is made rather well in this BBC show on the issue.  The host introduces "a scientist and a gay rights activist" (he says this without irony).  The scientist--medical director of a blood transfusion agency--says that a 12-month deferral of MSM "might be okay" to mitigate the risk of HIV transmission, but "it's not all about HIV ... [MSM] have in the past been a source for new and unknown infections coming through" to the blood supply.

In the scholarly literature, it is widely accepted that the ban on MSM donations has made the blood supply safer, and lifting the ban will increase the risk in most countries without significantly increasing the available blood supply (here, here, here, here, here).  Still, there is room for scientific debate.  It may be that today, a lifetime ban of MSM is overkill.  The American Red Cross and the blood banks say a one-year deferral would be sufficient.  The key point here is that governments should revise the MSM policy based on detailed, quantitative, empirical analysis of the risks and benefits such changes would pose to blood recipients (including, of course, gay recipients).  Policy should not be determined based on appealing (but misguided) feelings about what is fair to blood donors.

On a side note ....

I found this interesting:  the NY Times cited a "comprehensive report" on the blood donation issue published by an AIDS service organization.  The report is authored by people with PhDs in unspecified fields (they appear to be professors of various humanities).  Curiously, none of the "comprehensive reports" that appear regularly in peer-reviewed journals like Transfusion or Blood, where the authors have degrees in things like medicine and biochemistry, made it into the NYT article.  I also note the report mistakenly claimed that "Italy, Spain, and France defer donors solely based on high-risk behavior, not on a donor’s history of MSM behavior".  As a matter of fact, like most countries France permanently bans MSM from blood donation, as acknowledged by the report elsewhere, and its own sources, and this study from June 2011.  Nevertheless, the appealing idea that France does not exclude MSM blood donors has caught on (here, here, here, and in this blog post authored by eight Democratic representatives).