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.

SANGRAM has long worked constructively with sex workers, to the fury of Congressman Mark Souder who stomped on USAID until they shut down funding for SANGRAM. In a letter to USAID as bombastic, self-righteous and threatening as any I have seen, Souder pontificated about the Bush administration’s record in promoting family values and women’s rights.

“There is a tragic irony in the fact that this administration seeks to elevate women in the United States to some of the most important positions in the country…; yet, USAID has funded groups outside the United States that promote the ultimate degradation of women.”

Souder might know something about the degradation of women. Six weeks ago he resigned as congressman after 15 years, admitting to having an affair with a staffer. He started off on script, apologising for the pain he had caused his supporters. But then, with breathtaking arrogance, he stuck up for his own hypocrisy, saying “The ideas we advocate are still just and right.” I’m sure his wife agrees.

Here’s the pompous windbag being fake-interviewed by his girlfriend about the importance of abstinence-only education programmes.

Of course abstinence-only programmes are only meant to work until people get married. Since both Mark Souder and his squeeze Tracy Jackson are married, they hardly count as failures of morality-based sex ed, do they?

(Thanks to Paddy Woodburn for pointing out the Seshu profile and setting me off wondering whatever happened to that windbag Souder…)

Until last Monday, America’s unfathomably illogical health service for the properly poor, Medicaid, refused to pay for HIV testing just as it refuses to pay for all sorts of other screening measures that could allow conditions to be treated early or in some cases prevented enitirely. Now, Medicaid has finally agreed to test its clients for HIV, if they fall into certain categories.

Here’s where the bad reporting comes in. This, for example, from The Goverment Monitor, which reports public sector news:

“The Centers for Medicare & Medicaid Services (CMS) today announced its final decision to cover Human Immunodeficiency Virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service.”

So, the two groups that they single out as being “at increased risk” for HIV are pregnant women, and people asking for a test. In fact, of people who have recently had unprotected sex in the United States, pregnant women are among the least likely to be infected with HIV.

The actual decision reads as follows:

CMS will cover both standard and U.S. Food and Drug Administration (FDA)-approved HIV rapid screening tests for:

1. Annual voluntary HIV screening of Medicare beneficiaries at increased risk for HIV infection per USPSTF guidelines:

* Men who have had sex with men after 1975;
* Men and women having unprotected sex with multiple [more than one] partners;
* Past or present injection drug users;
* Men and women who exchange sex for money or drugs, or have sex partners who do;
* Individuals whose past or present sex partners were HIV-infected, bisexual or injection drug users;
* Persons being treated for sexually transmitted diseases;
* Persons with a history of blood transfusion between 1978 and 1985;
* Persons who request an HIV test despite reporting no individual risk factors, since this group is likely to include individuals not willing to disclose high-risk behaviors; and

2. Voluntary HIV screening of pregnant Medicare beneficiaries when the diagnosis of pregnancy is known, during the third trimester, and at labor.

In other words, perfectly sensibly, pregnant women are NOT classified as at high risk for HIV infection, but are offered tests in any case since services to prevent transmission to their babies are available if need be. Now look at the list of those who ARE considered at higher risk. Again, it is mostly perfectly sensible. I’d prefer to see some sort of time stamp on number two — the overwhelming majority of Americans have had more than one partner in their lives, and most will probably have had unprotected sex with at least two of them. But that really doesn’t put them into a “high risk” category unless they are having sex with those multiple partners during overlapping time periods. Because HIV isn’t highly infectious for very long, you’d really like something more precise, such as “unprotected sex with multiple partners in any given three month period”. The biggest group at higher risk missing from the list is “men who have been incarcerated”. I agree that it is not the incarceration but the behaviours while incarcerated that put people at risk for HIV, and those behaviours are covered elsewhere on the list. But many people zone out what happens in jail — they are unlikely to report having sex with other men if it is something that they only do when they are banged up, for example. And yet we know many people in jail are infected with HIV, and we also know that many of them are having anal sex and shooting up drugs, and therefore likely to pass the virus on to other prisoners.

Another piece of good sense: the decision specifically authorises rapid tests. We know that people are far more likely to get their results and to be tied in to the support and care services they may need if they are offered on-the-spot tests, rather than having to come back or call in for results a week later. It would be nice if other countries (with generally better records on preventative medicine) followed this lead. Any Canadians reading this…?

Does this signal a new wave of common sense in HIV prevention in the United States? That’s certainly what we expected when Obama was elected. During his campaign, for example, he recognised that sterile needle programmes cut HIV infection among injectors, saving lives and money, and pledged to end a ban on funding those programmes from federal coffers. So cities such as his home town of Chicago, pictured in the map below, will now be able to use central money to provide clean needles to the inner city injectors that need them most. As long as they set up in one of the grey spaces. In the cemetary, in other words.

(Click to enlarge)

On this fantastic map, which comes from Yale University’s Dr. Russell Barbour by way of Stop the Drug War, the red areas are the parts of town where it would be illegal to operate a federally funded needle exchange under new rules proposed by Congress. The Drug War Chronicle provides an interesting history of the needle exchange shenannigans. Essentially, Obama did not remove the ban from a budget bill because he thinks policy shouldn’t be made through sub-clauses in budget bills. Democrats on the committee discussing the bill disagreed, and dropped the ban. Then Republicans, not willing to give up the idea that the availability of clean needles would have us all racing to start shooting up smack, decided to protect the innocent by forbidding needle programmes within 1,000 feet of “a public or private day care centre, elementary school, vocational school, secondary school, college, junior college, or university, or any public swimming pool, park, playground, video arcade, or youth centre, or an event sponsored by any such entity”. That’s the red bits on the map of Chicago above. Here’s Dr, Barbour’s map of needle exchange exclusion zones in San Francisco:

This is clearly just a way of pulling the rug from under any effort to increase access to clean needles. We’ve come to expect this kind of implaccable opposition from conservative Drug Warriors in the United States. We used to expect the Brits to be more rational about their drug policy, and the UK has, thank God, held on to its policy of providing clean fits for anyone that needs them. But with the sacking of the government’s independent advisor on drugs David Nutt for repeating his independent advice after the government chose to ignore it, I’m not so sure.

I’m not even going to wade in here about whether or not idependent scientific advisers to government should shut up after their advice is ignored, but I will commend to you a wonderful paper by Dr Nutt on the dangers of Equasy, (pdf) an irrational addiction to horse riding. This has been seized on by many who have not read it as an example of his inappropriate analyses. Irony, where art thou?

The US Drug Warriors also joyously seized on the latest round of anonymous surveillance of HIV among drug injectors in Britain, sending out an e-mail crowing about rising rates of HIV and drawing a link between that and the fact that the UK was the first country in the world to have national injection safety programmes. My next post will put those rather one-eyed claims into perspective.

So we’ll have more pregnant teenagers, more ill-equppied child-mothers, more kids being poorly raised by resentful single parents whose own opportunities in life were cut short for lack of a pill or a condom. None of which leads to great health outcomes for either mother or child. Is it any wonder that the world’s wealthiest country trails the likes of Cypress, Morrocco and the Dominican Republic in health care?

If this depresses you, this gem from Paul Hipp might cheer you up.

Thanks to Txema and Kim Thomas.

The governors of the United Nations Organisation on Drugs and Crime (not Drugs and Pleasure, you note, or Drugs and Health, but Drugs and Crime) gather in Vienna from tomorrow to take stock of the dismal failure of the world’s attempts to erradicate addiction by spraying crops, locking up dealers, in some countries even shooting junkies (Thailand, step forward and take a bow). Former Colombian President Cesar Gaviria, who also chairs the Latin American Commission on Drugs and Democracy, was yesterday quoted by The Guardian as saying “Prohibitionist policies based on eradication, interdiction and criminalisation have not yielded the expected results. We are today farther than ever from the goal of eradicating drugs.” The Economist goes further, calling the century-old war on drugs (launched at a conference in Shanghai in 1908) “illiberal, murderous and pointless”.

The Economist argues for legalisation. While their logic is impeccable, the likelihood that the honchos in Vienna will include legalisation as part of their roadmap for the next 10 years — or even a distant destination to put into the SatNav — is currently between nil and zero percent. It is not, however, impossible, that the balance might swing to an approach more tightly focused on cutting out the preventible harm associated with drug taking and addiction. (The two, I need hardly remind readers of this blog, are not the same, though it is hard to discern that from the approach of either the US or the UK government.) We think of “harm reduction” as needle programmes to reduce HIV and hepatitis transmission, but it is far more than that. A less prohibitionist approach might reduce the number of Mexicans killed every year while dilligently trying to keep up supplies to ever-voracious consumers in the US — around 6,000 a year. It might reduce the number of young black men who are put in touch with real criminals by being thrown into jail on drug-related offences — one in five black guys in the States spend time in the slammer, seven times the rate of white men in the same age groups. And it might shift some of the billions we spend supporting failed prohibition policies to demand reduction and quality treatment programmes. Demand reduction programmes may help young people stay off drugs in the first place, much as anti-smoking campaigns have made tobacco fundamentally uncool among young people in some populations. And we know that treatment helps people who are addicted and don’t want to be taking drugs to get clean.

In his inaugural speech, President Obama promised to “restore science to its rightful place”. Yesterday, he signed an initiative to take the church-led meddling of the Bush era out of science. “It is about ensuring that scientific data is never distorted or concealed to serve a political agenda — and that we make scientific decisions based on facts, not ideology,” Obama said.

The fact is that the 100 year long war on drugs — a war motivated by ideology not science — has failed. It has made life more dangerous and uncertain for people in the poor countries that produce most drugs, and the rich countries that consume them. Even the head of UNODC is begining to nod towards harm reduction. Perhaps, with Obama’s words ringing loudly in their ears, those gathered in Vienna this week will opt to try a new stratgey.

Pic by Jason Cragg via DCist

Many people are thrilled that the Bush Years are almost over. Few more so than sex workers, who have essentially been declared not to exist under the administration’s HIV funding rules. Though many are disappointed that Mark Dybul will stay at the helm of PEPFAR for a while, some of us hope that he’ll do away with the most egregious of his old boss’s idiocies, starting with the “anti-prostitution oath”. So yes, we should be thrilled that Bush is out and Obama in. But I’m not sure how thrilled sex workers in DC will be at the vaccation being forced on them in honour of Obama’s inauguration.

DC has declared downtown a hooker free zone until January 25th. No work during the party or the hangover, then. Seems like a shame; in these difficult times it would have been nice to take advantage of the boost in business that will almost inevitably come with tens of thousands of out-of-towners all intent on having a good time.

Thanks to Lisa M.

The US is one of nearly 60 countries which stamped its feet in opposition to France’s declaration (made in the United Nations general assembly) that homophobia is a bad thing. The New York Times reports that 66 nations supported France as it called for homosexuality to be decriminalised around the world — some 80 countries still forbid people with similar genitals from having sex with one another.

Needless to say the Vatican and the Organization of the Islamic Conference, well known bastions of tolerance and human kindness, were at the forefront of the bigotry. They said allowing people who love one another to have sex “threatened to undermine the international framework of human rights by trying to normalize pedophilia”. Merry Christmas to you, too.

And it wasn’t until much later that I learned that the other great barrier to equality had been shored up, for now. Three states have supported a ban on gay marriage and a fourth has entrenched its prejudice. Nowhere is this more disappointing than in California, which began to allow people so joyously to marry in June. Needless to say the support for Proposition 8, which reversed the ability of people who love one another to marry even if they happen to have similar genitals, is now bringing people out on the streets of San Francisco in protest. Needless to say, Sarah Palin’s mates at the Traditional Values Coalition are gloating over their victory. Their new book, “The Agenda: The homosexual plan to change America”, yours for just $19.99, is a textbook on how to play dirty in political campaigning.

It makes me cross, of course. But I can’t help agreeing with Andrew Sullivan that this is not a fatal blow to the right of people to be treated equally regardless of which adults they choose to have sex with. As he points out, when California last voted on this in 2008, 61 percent of people who cared enough to tick a box were opposed to gay marriage. This time it was just 52 percent. (There are some interesting graphics on the LA Times website.) Voters appear to become more in favour of gay marriage with every generation so as the dinosaurs age out of the voting pool and more younger voters replace them, the margin will almost certainly be reversed.

In fact, the ban on same-sex marriage in California would probably have been ditched on Tuesday if it weren’t for Obama. I find it somewhat ironic that the very voters who were tearing down one set of prejudices were busy shoring up another. Black voters, who turned out in unprecedented numbers to put a black family in the White House, voted heavily against gay marriage.

Stolen from Sean Casey, with thanks.