12/09/10

Blood donation: rights and wrongs

In the last few days, Canadian and American courts have ruled on gay rights. Somewhat unusually, activists are happy with the Yanks and cross with their northern neighbours. Even more unusually, I’m happy with both.

The Canadian ruling is the more complex, because it has given us the right decision for the wrong reasons. A judge has said the nation’s blood transfusion service can refuse gifts of blood from men who have had sex with other men. The right reason for this decision is that it is a cost-effective way of reducing the likelihood that sexually transmitted viruses, in particular HIV, make it in to the blood supply. The reason given (which I think sets a bad precedent) is that the blood transfusion service is not bound by legislation intended to reduce discrimination against people who choose anything other than vanilla sex, because it is not a government agency.

Of course that’s nonsense. You shouldn’t be allowed to discriminate against people on the basis of who they choose to have sex with in the private sector, in NGOs, in schools or anywhere else, unless they are choosing to have sex with someone who doesn’t or can’t consent. But I don’t believe that asking gay men not to give blood is discriminatory. None of us has a right to put out body fluids into a pool from which the public will draw, and the judge, Catherine Aitken, agreed, saying: “Put simply, blood donation is a gift. A gift is freely offered, but also must be freely received, or freely declined….There is no requirement under the law for CBS, or any other blood provider, to accept the gift of blood from anyone.”

I do agree that the exclusion criteria are a little draconian. “A man who has had sex with another man even once since 1977 is not allowed to donate blood in Canada or the United States,” says the blood service. In terms of HIV, what we’re most worried about are brand new infections — people who have lots of virus in their blood but haven’t yet got enough antibodies to HIV to show up on the screening tests that blood banks use. Those are the ones more likely to lead to the “tainted blood scandals” (blerch) that got the voters so exercised about blood safety in the first place. Blood donated by people who’ve been infected for longer will get picked up in the normal screening process so it’s not quite such a drama if they give blood. In most countries, it make it more expensive for the taxpayers who foot the bill, because blood is pooled into batches for testing, and any reactive test, including false positives, mean the whole batch gets thrown out. (Canada tests individual units so that’s less of a problem).

Activists whine say that refusing to accept blood from gay men tars them with the brush of “AIDS victim” and reinforces stigma. “Not everyone who is gay has AIDS”, declared Kyle Freeman when he brought the case against the blood service that precipitated the ruling. Well of course not. Not everyone who is gay has HIV, either. But in Canada, a gay man is around 20 times more likely to be infected than a heterosexual (pdf) (51% of HIV infections are concentrated in the roughly 4% of sexually active adults who are gay men). If gay guys think that fact is stigmatising, they might want to reinvigorate HIV prevention efforts in their community. Screening men who have sex with men out of the pool of blood donors is not discrimination, it is common sense. (As an aside, I find it interesting that no-one seems to be whining complaining about the rights of drug injectors being violated because the blood service won’t accept their blood. Surely their rights are being violated in exactly the same way, even though they are actually less likely to be infected with HIV than gay men in some Canadian cities).

Meanwhile, across the border, American courts continue to chip away at the great edifice of true discrimination against people who choose their sex partners according to their own taste, rather than that of the Sex Police in groups like the Traditional Values Coalition. Hot on the heels of a ruling that repealed a ban on gay marriage in California, another California judge, Virginia Philips, has ruled that the “don’t ask, don’t tell” rule that makes it impossible for openly gay people to serve in the military is unconstitutional. This is very good news indeed; let’s hope the mid-term elections don’t scare the administration and the Senate into prolonging the agony for gay men and women who want to invest their lives waging war on behalf of the citizens of the US.

Thanks to Sarah Chown for nudging me to write about this.

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This post was published on 12/09/10 in Ideology and HIV, Men, women and others.

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  1. Comment by roger, 12/09/10, 11:08:

    once more, individuals right pitted against public health…

  2. Comment by Greg, 12/09/10, 09:13:

    As a gay man I tend to agree with most of your views here, with the exception of equating gay men to drug users who inject. A gay man in a 15 year monogamous relationship can hardly be equated to someone injecting drugs for recreational purposes. And herein lies the problem, there are plenty of gay men who have sex responsibly, protecting themselves and their partners. And yet they are lumped into this groups of perceived irresponsible, diseased people.

    In reality do you really believe that it is the gay party-boy, high on meth every weekend, newly infected with a sky-high viral load that is going to be donating blood?

    Nope. The gay men that would be donating blood are the settled, coupled, dare I say boring, argyle sweaters, two labrador dogs, gay men. Risk of them being undetectable (from new HIV infection) low.

    Wouldn’t the data tell us this? Rather than taking the WHOLE gay population and taring them with the brush of ‘diseased sluts’. How about let’s look at the sub-set of gay men who would donate, and fairly gauge their risk.

  3. Comment by Daniel Reeders, 13/09/10, 02:23:

    Blood services charge a fee for the units of blood they provide – usually hundreds of dollars. This covers the cost of testing the blood for all sorts of pathogens. When they test for HIV they pool the samples (usually in batches of 1,000). The tests they run vary from country to country – some run the antibody test only, but most are running NAAT to detect the virus directly, reducing the effective window period to 8-12 days. If you start accepting samples from gay men, the odds that you get a positive result for the pool are increased. When you do, you have to do more tests to find the positive sample(s).

    So this isn’t about public safety, unless you think a gay man can’t remember all the sex he’s had in the past 14 days. And that “gift” stuff is bulldust – this is purely about money. I would argue that, if it’s public money, the government should require it be spent in as non-discriminatory a way as possible.

  4. Comment by Jim Pickett, 13/09/10, 02:32:

    UGH Elizabeth!

    Not all gay men have HIV. If fact, most gay men don’t have HIV. All gay men don’t have sex. Many haven’t had sex in a LONG time. Gay men who do have regular sex lives – gasp – often engage in behaviors that have NOTHING to do with HIV transmission. Straight women in the U.S. can give blood after having sex with a HOMO after one year… What’s that about?

    Am surprised you would call activism whining.

    Um, no.

  5. Comment by Bears Are Fat, 13/09/10, 04:31:

    Jim: Elizabeth almost always takes the ‘anti-activist’ line. This is part of the way she sells herself — it’s her pose. The activists are deluded by politics, but she has the hard truth on her side. Supposedly. But problems emerge:

    Elizabeth: According to your logic, shouldn’t blacks also be banned from giving blood? Prevalence is much higher in black communities than white. See, e.g.:

    http://www.slate.com/id/2257655/

    If black blood shouldn’t be banned, then why should gay blood be banned? Alternately, in order to have cost-effective reduction of risk, should sexually-active black blood donors also be banned?

  6. Comment by elizabeth, 13/09/10, 06:25:

    Good points made by all (though I’m not sure it’s fair to say I take the “anti-activist” line — without activism we wouldn’t have had the US court ruling celebrated in the same blog post, for instance).

    As I said in the post, although perhaps not clearly enough, I think the definitions used for deferral in Canada are far too broad; a point that several of you also make. They could be far more sophisticated about pin-pointing actual risk of recent exposure to HIV and other pathogens. But that doesn’t alter my opinion that in a situation where resources are limited and choices have to be made, behavioural risk screening is a cost-effective way to triage health service provision, including blood safety.

  7. Comment by Muscleguy, 13/09/10, 10:52:

    Meanwhile despite being a platelet donor in this country were I to return home to New Zealand I would be barred from donating any blood products since I have lived in the UK since ’93 and this puts me at an extremely (to put it mildly) risk of contracting vCJD* since I am a carnivore (but I do not eat at McDonalds).

    *Assuming of course that vCJD is caused by BSE in bovines and not because we started looking for it when we discovered BSE and found something. But since we weren’t looking before . . .

  8. Comment by Joey, 17/09/10, 05:19:

    “But that doesn’t alter my opinion that in a situation where resources are limited and choices have to be made, behavioural risk screening is a cost-effective way to triage health service provision, including blood safety.”

    But that’s the problem with your argument. It might be fair to screen for risky behavior, but that’s not what’s happening right now. While blood services are pretending that they’re doing a behavioural risk screening, they’re really discriminating against a whole class of people. What does it even mean to have sex with a man? Does that include handjobs, blowjobs? Most likely, yes. Yet both these behaviors have low risk of HIV transmission (oral sex is a little less clear, but overall there are very few cases where tranmission has occured, unless there was a wound of some kind in the mouth). So what we’re REALLY talking about here is anal intercourse (particularly outside of a monogamous commitment). Which not all gay men engage in, and certainly not all gay men engage in outside of a committed relationship.

    So there’s a problematic assumption at work here, that gay men (“men who have sex with men” or the gay men in the stats) are primarily defined by their behavior, not their identity. That’s not true. Gay men are not gay men because they have anal intercourse with other men; their sexual lives are as diverse and complex as that of heterosexual people.

    We understand that in principle with black donors, for example, because it’s no longer acceptable to overtly associate black people with certain (risky) sexual behaviors. So even though the stats show that HIV is more prevalent in black communities than other ethnic communities, we don’t blanketly ban black donors. We understand that within the black community, we need to make sure that it’s the individuals with risky behaviors that we need to prevent from donating. With gay men, however, we still feel welcome to associate them with certain (risky) sexual behavior. So we blanketly ban them from donating.

    If we really cared about protecting the blood supply, we’d ask people about REAL risky behaviors (engaging in anal sex, maybe even anal sex outside of a monogamous relationship) as opposed to discriminating against a whole class of people based on the ASSUMPTION of risky behavior.

  9. Comment by Jen, 18/09/10, 02:39:

    Jim, calm the heck down. I’ve never met Elizabeth but she seems like a highly intelligent and rational person who is doing many great things in the world, moreso than those who whine and do very little aside from alienate the mainstream with bizarre antics. I personally think activism is great, but it has been highjacked by a loud few who are anti-establishment (any kind of establishment), who discredit their movement through hostile, belligerent slogans and “fuck all y’all” antisocial aggressiveness. Take the G20 protests — that’s the kind of useless activism we have these days.
    Many gay men practice safe sex. All very nice. Now perhaps these guys can take a leadership role in their community to bring down those infections stats to something more like 3 times as likely to have HIV, rather than 20. Have you ever heard of Japanese youth whose lives were ruined because they got AIDS through a blood transfusion?

  10. Comment by Thomas, 03/10/10, 08:42:

    @ Bears are Fat

    Black women are 13 times more likely than white women to get infected not 20 times. That’s still a big difference. Phill Wilson, executive director of the Black AIDS Institute in Los Angeles, suggests, rather, that the single biggest driver of the heterosexual spread to black women is the incarceration of black men. “The prison industry in America is an almost exact replication of the mining industry in South Africa, where you take large groups of men and move them from their families for an extended period of time,” says Wilson. As studies conducted in South Africa have shown, men who leave their homes for the mines often have new sexual partners—as do the women they leave behind. The increased sexual mixing spreads HIV in both the migrant men and their regular partners. When they return home, the men may infect their regular partners—or vice versa. This pattern of sexual networking is called concurrent partnering, which means that relationships overlap, and there’s nothing that HIV likes more.
    Wilson and others argue that with so many men cycling in and out of the African American community, women end up at a greater risk because of similar disruptions of sexual networks and the resultant concurrency patterns: They mix with new partners when their men leave and often reunite with them when they are released. Incarceration also exposes many men to anal sex, whether by coercion or choice, and injection-drug use, the two most efficient ways to spread HIV. And if the locked-up man was the main wage earner, poverty can be a factor, too.
    One superb study of concurrency in African Americans in rural North Carolina found that 53 percent of the men and 31 percent of the women reported concurrent partners during the preceding five years. Interestingly, 80 percent of the men in the study who said they had been incarcerated for more than 24 hours reported having had concurrent partners within five years; that percentage plummeted to 43 percent if a man had not been locked up for a day or longer.
    Equally important, black women have a small pool of black men to choose from at any given time. “African American women are the only group in the United States where there are fewer men than women,” says Gail Wyatt, an associate director of the AIDS Institute at the University of California, Los Angeles. “The availability of a partner who shares the same values is much less likely. The women are more likely to be educated than their partners. They’re more likely to be employed.” As a result of the shortage of black men, black women are vulnerable to becoming involved with men who are engaging in risky behaviors that they don’t know about, whether it be having unprotected sex with other partners, female or male; visiting sex workers; or injecting drugs.

  11. Comment by Thomas, 03/10/10, 08:50:

    @ Bears are Fat

    Black women are 13 times more likely than white women to get infected not 20 times. That’s still a big difference. In 2006, black men who have sex with men (MSM)2 represented 63% of new infections among all black men. I think you are forgetting that black gay men are representing a high percentage of HIV/AIDS infection.

    Even more interesting, Phill Wilson, executive director of the Black AIDS Institute in Los Angeles, suggests, rather, that the single biggest driver of the heterosexual spread to black women is the incarceration of black men. “The prison industry in America is an almost exact replication of the mining industry in South Africa, where you take large groups of men and move them from their families for an extended period of time,” says Wilson. As studies conducted in South Africa have shown, men who leave their homes for the mines often have new sexual partners—as do the women they leave behind. The increased sexual mixing spreads HIV in both the migrant men and their regular partners. When they return home, the men may infect their regular partners—or vice versa. This pattern of sexual networking is called concurrent partnering, which means that relationships overlap, and there’s nothing that HIV likes more.

    Wilson and others argue that with so many men cycling in and out of the African American community, women end up at a greater risk because of similar disruptions of sexual networks and the resultant concurrency patterns: They mix with new partners when their men leave and often reunite with them when they are released. Incarceration also exposes many men to anal sex, whether by coercion or choice, and injection-drug use, the two most efficient ways to spread HIV. And if the locked-up man was the main wage earner, poverty can be a factor, too.

    One superb study of concurrency in African Americans in rural North Carolina found that 53 percent of the men and 31 percent of the women reported concurrent partners during the preceding five years. Interestingly, 80 percent of the men in the study who said they had been incarcerated for more than 24 hours reported having had concurrent partners within five years; that percentage plummeted to 43 percent if a man had not been locked up for a day or longer.
    Equally important, black women have a small pool of black men to choose from at any given time. “African American women are the only group in the United States where there are fewer men than women,” says Gail Wyatt, an associate director of the AIDS Institute at the University of California, Los Angeles. “The availability of a partner who shares the same values is much less likely. The women are more likely to be educated than their partners. They’re more likely to be employed.” As a result of the shortage of black men, black women are vulnerable to becoming involved with men who are engaging in risky behaviors that they don’t know about, whether it be having unprotected sex with other partners, female or male; visiting sex workers; or injecting drugs.

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