How great would be the risk of letting gay men donate blood?

Factual Questions
1

Currently (so far as I know), the American Red Cross does not accept blood from gay men who’ve been sexually active. I’m looking for a factual analysis of the risks of allowing gay men to donate. (Note: I’ll use “gay male” throughout to refer to someone who has had male-male sex at least once since the spread of AIDS began.)

Here’s basically what I want to know:

Presumably, at least some HIV infected people attempt to donate blood to the American Red Cross each year. Based on the RC’s average number of donors per year, and estimates of the percent of the non-[gay male] population unknowingly infected with HIV, about how many HIV infected donors do they actually get per year? (I’m assuming people who know they have HIV don’t donate.)

Based on the level of accuracy of whatever test they use to check the blood for HIV, about how many HIV infected samples actually enter the blood supply each year (if any).

Assuming that about the same percentage of gay males would donate if allowed as non-[gay males] do currently, and given the estimated percentage of American gay males unknowingly infected with HIV, how many more HIV infected samples would the American Red Cross receive if they accepted donations from gay males?

How many more would actually make it into the bloodstream? (Again, based on the level of accuracy of the tests they use to identify infected blood.)

If you don’t want to do the math, basically I need to know:

*- percent of American non-[gay male] population believed to be unknowingly infected with HIV. (If possible, intravenous drug users would be excluded from all counts, since they’re disallowed by a separate restriction).

  • percent of American gay male population believed to be unknowingly infected with HIV

  • percent and total number of non-[gay males] who donate blood to the American Red Cross

  • total number of gay males in America (really, I’d want the number who’d be elligible to donate if not for the no gay males restriction.)

  • percent chance that the method of testing blood for HIV used by the American Red Cross gives a false negative*

Obviously, a lot of these numbers will be estimates, but the more accurate the better.

Also, if you can suggest a better way to estimate the actual level of risk, I’d like to hear it.

2
      • In the US the issue is not so simple, because at various times in the past different pro-gay groups had won court cases stating that basically, mandatory AIDS tests at any time were a violation of privacy. I don’t know if this is still true–but at one point in the US–if you were admitted to a hospital unconcious, the AIDS test was the ONE test that medics were not allowed to perform on you. They were required to have your permission first. I can’t find anything that says if this has changed or not.

  • Also, from a political standpoint (relating to the above reason) it’s simply a minefield that no elected official wants their name remotely associated with. Some countries have already had scandalous problems with distributing AIDS and hepatitis tainted blood:
    China: http://www.google.com/search?num=30&hl=en&lr=&safe=off&c2coff=1&q=chinese+aids+blood+scandal&btnG=Search
    France: http://www.google.com/search?num=30&hl=en&lr=&safe=off&c2coff=1&q=french+aids+blood+scandal&btnG=Search
    Canada: http://www.google.com/search?num=30&hl=en&lr=&safe=off&c2coff=1&q=canadian+aids+blood+scandal&btnG=Search
    …The Canadian incident was not to much an issue with AIDS particularly as it was with the concept of willingly accepting blood donations from what is a very-small and very-high-risk group. Since it is reasonable to consider that only the same percentage of gays would ever donate blood that is typical of the straight population, then screening the higher-risk blood would pose a very large cost for what is really a minor benefit in supply at best.
    ~

3

I am told that the problem of accepting blood from higher-risk groups is the cost involved in testing blood that might not be usable.

In any case, I’d be interested to know the stats you come up with - perhaps afterwards you could add a cost for infected blood vs. good blood obtained datum.

4

But don’t they test all the blood anyway? I guess I just assumed they did. I mean, it’s not as if one can be sure that a straight, non-intravenous drug user who donates blood doesn’t have HIV.

5

Yes, they test all the blood, but there’s still a significant window of time when the blood contains the virus which causes AIDS, and can pass on the infection, but has no antibodies to the virus.

And the population of men who have sex with men is significantly more likely to carry the virus than the low-risk population.

Hence the reasoning to just eliminate a higher-risk population as donors.

Now, one could ask about testing every single sample of blood donated for the presence of the virus, rather than for antibodies to the virus, but the cost would be astronomically higher, and said blood sample would not be available for use for a longer period of time, as testing for the presence of the virus itself takes much longer than testing for antibodies to HIV.

6

You know, this issue makes me think back to the days before the Civil Rights movement when blacks were not considered suitable blood donors. If their blood was accepted at all, it was only used for black recipients. The reasoning behind it included the idea that blacks were more likely to be carriers of syphillis because they were sexually permiscuous.

Statistics aside, how is my blood really any safer than that of a gay man? I am a married woman who is faithful, but what if my husband was cheating, and I didn’t know? Couldn’t I be the same risk?

Seems like to me that rather than a dismissing sexually active gays, they should just dismiss all sluts, gay or straight. If you’ve had more than X number of parters within a certain number of years, then you would be considered a risk.

7

Wouldnt it be better to just say that if you have had unprotected sex within an allotted time period then you can not donate?

8

Well, if you add questions you’re going to complicate and lengthen the screening process, and turn more people off to donating. How do you phrase the questions? If you rule out folks who have unprotected sex, that’ll rule out married folks for the most part, unless they’re practicing safe sex, and most don’t. If you add the questions about whether you’re monogamous, then you have to ask about whether the spouse is monogamous, and how long they’ve been monogamous, and pretty soon you’re taking a whole lengthy sexual history from someone who just wants to donate blood.

Easier to just eliminate an entire high-risk category: Men of have sex with men. This has been shown to be factual, after all. Men who have sex with men, as a group, have higher rates of HIV infection, and therefore are at a greater risk to donate HIV containing blood. They eliminate other categories too, like a history of liver disease, or IV drug use. By doing so, they doubtless eliminate some potential donors who got their liver disease from metabolic conditions rather than blood infections, or who never used street drugs but only genuine pharmaceuticals with fresh needles every time.

Fair? Maybe not. But it’s not fair to get HIV from a transfusion, either. Life ain’t fair. Minimize risk to the public blood supply in the simplest way which will still ensure lots of donors. IMHO.

9

I don’t fully understand this. If I am correct in understanding you as saying, as you write later, that currently tests are carried out “for antibodies to the virus” (and not for the virus itself), then are you saying that blood which contains the AIDS virus is not screened out by testing for that, but by testing for presence of antibodies to the AIDS virus? Thus, if the antibodies are absent, said blood is rejected. Does this mean that after the “window” you mention is over, the blood will have developed antibodies, and therefore will be accepted as usable blood (despite the fact that the blood contains the AIDS virus)? In such situations, is it known to be certainly the case that such blood cannot pass on the infection?

How is this done today in the US? Does it vary by State? Do they get potential blood donors to fill out a form and reject all (self-reporting) practising homosexuals? Do they act on tip-offs from concerned citizens?

10

It isn’t a matter of civil rights. I’m not allowed to give blood because I used to live in the UK, which puts me in one of their high-risk groups. As long as there are enough people in the low-risk pool, why should they accept blood from groups that have an elevated risk of blood-borne diseases?

11

Yeah, my Hookers and Heroin tour of Haiti got me on their Do Not Call list. Who knew?

12

One of the questions is “Are you a male who has had sex with another male since 1977?” If you check yes you won’t be allowed to donate blood and you’ll be listed in the Red Cross database as permantly deffered. They don’t take tip-offs. If you lie you can donate blood. I know this because I’ve donated blood regularly since I was 17.

13

Really? By law?

Other agencies, such as the police here, act on tip-offs/advice. You mention a potential accident spot (say, because of traffic light timings at a junction) and they adopt your suggestion and ask you to mention any other problems you might come across. To save lives, of course. The Red Cross would end up looking right Charlies if you knew someone was an IV drug user (or otherwise high-risk person), if you saw them giving blood, reported them, then were ignored, and then learned that that blood bank had problems. Perhaps they can always fall back on the defence that the blood is unidentifiable. (Is it, incidentally - in terms of all going in a great vat, or is it kept until use in individual marked tubes? The former seems more manageable and likely to me, but I’ve no idea.) But that wouldn’t be much comfort to the families who’d just seen their loved-ones die.

As it happens, I’m disqualified from giving it in HK because of the cows in UK.

14

I thought it was a health issue,not civil rights. Your blood is safer than that of a gay man, because they are more likely to have HIV, you did not know this?
Gay men are more likely than “sluts” to have HIV,too.

15

You guys haven’t donated blood lately, have you?

Yes, it is identifiable. It does not go into a great vat. It is tested.

There is a questionnaire, which asks about gay sex, unprotected sex, needle usage, travel to certain countries within a certain time period (the UK, for instance, and Africa IIRC) and there is in fact a “slut question” that will get you rejected, although I forget the exact wording.

After the screening questionnaire, which is filled out in advance, a nurse or phlebotomist will ask most of those same questions again, in person.

16

I’m excluded from being a blood donor on lots of grounds.

  1. Underweight
  2. Lived in the UK (well, Northern Ireland) for longer than 5 years between 1980 and 1999.
  3. My mother was born in a country where malaria is endemic (Zimbabwe).
  4. One of my previous sexual partners was a bi-sexual man.
  5. I’ve travelled to a malarial country within the last 2 years.
    Despite having blood tests for malaria, HIV and Hep B&C and found negative, even if I put on weight and never develop CJD, I’d still be ineligible. I’m 100% sure I don’t have anything, but I’m still more of a risk than they want to take.

That’s fine, they have to be careful, I get that, but if I could donate I’d be a regular donor, because I work in hospitals and I know how much blood they need.

17

Is CJD a lifelong-ban criterion for those who fulfill the residency qualifications you state?

18

Yup.
They can’t test for it (yet), prions are hard to destroy, and a person later diagnosed with CJD donated blood and one of the recipients went on to develop CJD, so it is blood borne.

However, in the UK itself, because they assume pretty much everyone had the same exposure to BSE, they reckon that you pays your money and you takes your chances (and if they exluded those people their pool of potential donors would be about 5% of what it currently is), so they’re still accepting donations from that group.

Ireland is being more strict.
Irish cows were never fed bits of sheep, so BSE was never an issue, Northern Irish cattle are also on a silage and grass diet, so technically Northern Irish beef is safe too. Leading to the Rev. Ian Paisley’s comment “the people are British, but the cows are Irish!” when arguing that Northern Irish beef should be exempt from the export ban on British beef.

In Ireland, where many Rh -ve women and Haemophiliacs were infected with Hep C from factor VII and Anti-D, bought from America in the 1980s, before proper testing and screening practices were developed, everyone is hyper-vigilant about any kind of risk, because they REALLY don’t want that kind of thing to happen again.

19

Damn it, that should be “Factor VIII”.

Also, in Ireland, any instruments used on a patient who has received any kind of blood products is disposed of rather than being re-sterilised, to minimise any risk of CJD from undestroyed prions.

Hyper-vigilant, like I said.

20

I didn’t want to mention it…

What exactly does this mean, out of interest? Seems quite a broad categorisation to me.