The blanket bans on MSM blood donors are teetering on the line of homophobia

Oct 26, 2017
4,947
#51
The data isn't subjective but the framing can be. The logic here would be that any man could be MSM and just isn't being honest about it. Banning all men would remove that potential high-risk completely. It doesn't make it a sound solution, however.
You're being extremely disingenuous when presenting this "logic" loop as some type of argument against baring high-risk populations from donating blood. The logic you're presenting is any group who has a higher risk than the next should be banned because a high-risk group is currently being banned from donating, and that you keep doing this endlessly, removing the next highest group until... what?

If your argument is that people could lie, then nobody will give blood because a women could easily lie about having sex with an active drug user, or lie about having sex with a bi-male who was sexually active with another male within a year.

What you're arguing is not how infectious disease risks function. Men aren't at higher risk because they are men, men are at higher risk because of the vectors of infection that disproportionately effect populations of men which are part of the screening process. Just like Black Americans aren't at higher risk because they are black, it's because mainly poverty is an excellent vector in aiding the spread of infectious diseases due to the lack of healthcare and proper government programs, and statistically the black population faces greater income inequality. So when you add in the effect of poverty, coupled with the risk of engaging in activities that have a higher risk of HIV infection, you get the outcome that black males in America are the largest HIV population by race.

Which is why when I posted about the screening process, I noted that it seems designed to be broad and wide and specifically designed to avoid minute details and breakdowns of higher risk populations. Could they have more specific screenings for populations that are high risk to deduce lower-risk sub populations? Very likely yes, but they aren't doing that.

Now my question is why aren't they doing more detailed screenings? Is it an issue with statistical accuracy, cost, money, risk and so forth?
 
Oct 27, 2017
2,829
Spain
#53
Regarding the map in OP - some precaution in terms if celebrating the progressive nature of these countries is also in order, for instance the DHQs in some of those countries (catholic ’state’ church) do not recognize condoms as risk mitigating factor, &!the reason for not using MSM as identified risk group is religious...
Which of the countries listed has a Catholic "state church" and low usage of condoms? Really curious.

Honestly, I had completely forgotten about this rule. Here in Spain you get an interview that doesn't ask about sexual orientation, a hemoglobin test, a short examination, and the blood is always analyzed before use. In fact, each time you donate you get a report on the tests for transmissible diseases they perform.
 
OP
OP
brainchild
Nov 25, 2017
4,889
Minnesota
#54
You're being extremely disingenuous when presenting this "logic" loop as some type of argument against baring high-risk populations from donating blood. The logic you're presenting is any group who has a higher risk than the next should be banned because a high-risk group is currently being banned from donating, and that you keep doing this endlessly, removing the next highest group until... what?

If your argument is that people could lie, then nobody will give blood because a women could easily lie about having sex with an active drug user, or lie about having sex with a bi-male who was sexually active with another male within a year.

What you're arguing is not how infectious disease risks function. Men aren't at higher risk because they are men, men are at higher risk because of the vectors of infection that disproportionately effect populations of men which are part of the screening process. Just like Black Americans aren't at higher risk because they are black, it's because mainly poverty is an excellent vector in aiding the spread of infectious diseases due to the lack of healthcare and proper government programs, and statistically the black population faces greater income inequality. So when you add in the effect of poverty, coupled with the risk of engaging in activities that have a higher risk of HIV infection, you get the outcome that black males in America are the largest HIV population by race.

Which is why when I posted about the screening process, I noted that it seems designed to be broad and wide and specifically designed to avoid minute details and breakdowns of higher risk populations. Could they have more specific screenings for populations that are high risk to deduce lower-risk sub populations? Very likely yes, but they aren't doing that.

Now my question is why aren't they doing more detailed screenings? Is it an issue with statistical accuracy, cost, money, risk and so forth?
I'm afraid you missed the point, mate. The logic isn't sound; that's the point! I'm obviously not advocating for all men or African Americans to be banned from donating blood, and I know why we're comprised of the statistics that we are. I brought up the examples because just like you felt like I was being disingenuous about the framing of the data, the same thing happens to everyone in the MSM group. Not all MSM donors are high risk, just like not all male donors are high risk. And just like there isn't a blanket ban on men donors, there shouldn't be a blanket ban on MSM donors. That's all I'm saying.
 
Oct 26, 2017
353
Rochester NY
#55
I haven't actually donated blood (outside of research studies), nor do I work in medicine, but is there testing done either before or after an inividual gives blood to check for any sort of viral infections or what not? I know that would be expensive, but it seems like a better way than just straight up saying certain people cannot donate due to whatever arbitrary rules they have.
 
Oct 26, 2017
4,947
#56
I'm afraid you missed the point, mate. The logic isn't sound; that's the point! I'm obviously not advocating for all men or African Americans to be banned from donating blood, and I know why we're comprised of the statistics that we are. I brought up the examples because just like you felt like I was being disingenuous about the framing of the data, the same thing happens to everyone in the MSM group. Not all MSM donors are high risk, just like not all male donors are high risk. And just like there isn't a blanket ban on men donors, there shouldn't be a blanket ban on MSM donors. That's all I'm saying.
There isn't a blanket ban on men donors because the high-risk population for men are people who shared needles and engaged in MSM are differed for either life or 12 months.

I'm not missing the point, I know you're arguing that there should be more specified questions to deduce lower-risk people within the high-risk population. It's well within reason to ask why the questioner doesn't get into specifics, but again it's not just the MSM population who within the question sheet that gets a wide net cast on them.

I haven't actually donated blood (outside of research studies), nor do I work in medicine, but is there testing done either before or after an inividual gives blood to check for any sort of viral infections or what not? I know that would be expensive, but it seems like a better way than just straight up saying certain people cannot donate due to whatever arbitrary rules they have.
All donor blood is tested after
 
Oct 25, 2017
1,168
Canada
#57
I've always been conflicted about this, as a queer man.

There is some good evidence in the OP though to reverse the ban.

lol I used to not be able to donate blood because of the countries I had travelled to recently. Then I came out, touched some penis, and I'm back to square one lmao
 
OP
OP
brainchild
Nov 25, 2017
4,889
Minnesota
#59
It's well within reason to ask why the questioner doesn't get into specifics, but again it's not just the MSM population who within the question sheet that gets a wide net cast on them.
Yes, but they're the only group that gets descriminated against based on their sexual orientation, regardless if they're actually high risk or not, which is a problem, hence the thread. You're free to make another thread about another group, but your whataboutism is not relevant here.
 
Oct 26, 2017
4,947
#60
Ah, ok. Then it seems even more stupid that these bans are in place.
It's not though because

1) Chance for false negatives greatly increase if there is zero screenings for high-risk population groups
2) High risk population groups have an obvious higher risk of having non-viable blood, which means it takes a lot more time and money for something you could have just screened in the first place
 
Oct 27, 2017
254
#62
From what I understand, they test every donation anyway as at the time of donation they just make sure your blood is viable to be drawn, so I'm not sure why they continue to have blanket bans when it's not like your blood goes straight into someone else without checking it.
 
Oct 26, 2017
353
Rochester NY
#63
It's not though because

1) Chance for false negatives greatly increase if there is zero screenings for high-risk population groups
2) High risk population groups have an obvious higher risk of having non-viable blood, which means it takes a lot more time and money for something you could have just screened in the first place
Do you mean to say they decrease here for the bolded? Your second line of reasoning makes some sense, but given the proportion of the population that identifies as LGBT is relatively small would it really add that much of an economic burden?
 
Oct 26, 2017
4,947
#64
Do you mean to say they decrease here for the bolded? Your second line of reasoning makes some sense, but given the proportion of the population that identifies as LGBT is relatively small would it really add that much of an economic burden?
False negatives means the screening fails to detected diseases that are actually there. False positive means the screening detected a disease that wasn't there.
 
OP
OP
brainchild
Nov 25, 2017
4,889
Minnesota
#66
It's not though because

1) Chance for false negatives greatly increase if there is zero screenings for high-risk population groups
2) High risk population groups have an obvious higher risk of having non-viable blood, which means it takes a lot more time and money for something you could have just screened in the first place
Ultimately, there needs to be a more proactive effort for more accurate testing because there are still too many cases where people are simply not going to know if they've been exposed to infectious diseases or not, regardless of which group they belong to. Not every woman is gonna know that the man she had sex with was MSM, for example.
 
Oct 26, 2017
353
Rochester NY
#67
False negatives means the screening fails to detected diseases that are actually there. False positive means the screening detected a disease that wasn't there.
Yeah, so wouldn't screening an at risk population that would have proportionally higher frequencies of disease also in turn increase the absolute number of false positives?

Edit: Wait, I think I get it now. Are you saying false negatives would increase if there was no screening for high-risk populations but they were still allowed to donate? I was assuming you meant no screening meant no donation.
 
OP
OP
brainchild
Nov 25, 2017
4,889
Minnesota
#68
Yeah, so wouldn't screening an at risk population that would have proportionally higher frequencies of disease also in turn increase the absolute number of false positives?
Yes.

Edit: Wait, I think I get it now. Are you saying false negatives would increase if there was no screening for high-risk populations but they were still allowed to donate? I was assuming you meant no screening meant no donation.
Yeah, more false negatives of the high-risk group would be introduced into the pool without pre-screening. My issue isn't with filtering these people out though, it's that there are people being labeled high risk who shouldn't be labeled high risk.
 
Oct 26, 2017
4,947
#69
Yes, but they're the only group that gets descriminated against based on their sexual orientation, regardless if they're actually high risk or not, which is a problem, hence the thread. You're free to make another thread about another group, but your whataboutism is not relevant here.
First off, if you're going to use "whataboutism", actually use it in the context that makes sense.

Bi-women are affected by this question (question being two questions, if you've had MSM or been with someone who has had MSM in 12 months)
Bi-men are affected by this question
Lesbians are clearly lower risk group due to the lack of potential infection from anal sex with ejaculation (although infected sex toys is a risk, just not an inherently high one iirc)
Gay men are affected by this question
Straight women are affected by this question
Straight men aren't affected by this question because you're already dealing with a non-high risk population and the transmission rate from female -> male is almost always lower than male -> female

Yes, gay/bi men are the target of this question because MSM usually involves anal sex, and anal sex (Both insertive and receptive) has the highest sexual transmission rates, but this doesn't just discriminate against gay/bi men, even if they are the core of the question.

Now obviously a straight man and women can engage in anal sex (highest sexual transmission rate), but then you point back to the risk group of straight men and women, and they aren't a high-risk group for HIV compared to gay/bi men.

So if you just want to focus on the"Male: Have you had MSM in the last 12 months?" question, then looking at the HIV rates among gay/bi men should be an obvious next step into seeing why such a question is asked and deducing why that group is differed as of current.

MSM accounts for 66% of all new cases HIV in 2017 which is 82% of the total number of new infections in men

Now again, I know your point is you want more specific questions to deduce lower risk people within a high risk population. My point I was making by including the topic of the other questions is the screening test does not seem to be designed to do such a thing and it seem very much intentional to be broad and non-detail oriented in deducing if a person is "high-risk" and not suitable for donation

Which is why I posted previously that asking why the screening is designed in such a way is something I'm interested in knowing

Yeah, so wouldn't screening an at risk population that would have proportionally higher frequencies of disease also in turn increase the absolute number of false positives?
I think you're confused. The screening process is just asking questions. After the blood is donated it gets tested.

Not having any screening means a higher percent of infected blood is put into testing, which increases the risk that during testing a donation that is infected with something won't be picked up by the blood testing.
 
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Oct 26, 2017
353
Rochester NY
#70
Yes.



Yeah, more false negatives of the high-risk group would be introduced into the pool without pre-screening. My issue isn't with filtering these people out though, it's that there are people being labeled high risk who shouldn't be labeled high risk.
I agree with you. I was just trying to make sense of the other post.
 
Oct 26, 2017
353
Rochester NY
#71
First off, if you're going to use "whataboutism", actually use it in the context that makes sense.

Bi-women are effected by this question
Bi-men are effected by this question
Lesbians are clearly lower risk group due to the lack of potential infection from anal sex with ejaculation (although infected sex toys is a risk, just not an inherently high one iirc)
Gay men are effected by this question
Straight women are effected by this question
Straight men aren't effected by this question because you're already dealing with a non-high risk population and the transmission rate from female -> male is almost always lower than male -> female

Yes, gay/bi men are the target of this question because MSM usually involves anal sex, and anal sex (Both insertive and receptive) has the highest sexual transmission rates, but this doesn't just discriminate against gay/bi men, even if they are the core of the question.

Now obviously a straight man and women can engage in anal sex (highest sexual transmission rate), but then you point back to the risk group of straight men and women, and they aren't a high-risk group for HIV compared to gay/bi men.

MSM accounts for 66% of all new cases HIV in 2017 which is 82% of the total number of new infections in men



I think you're confused. The screening process is just asking questions. After the blood is donated it gets tested.

Not having any screening means a higher percent of infected blood is put into testing, which increases the risk that during testing a donation that is infected with something won't be picked up by the blood testing.
No, I understand what you are saying now. I think the confusion just came from what we meant by screening (based on risk group or blood test). I thought you meant screening in reference to the latter.
 
OP
OP
brainchild
Nov 25, 2017
4,889
Minnesota
#72
First off, if you're going to use "whataboutism", actually use it in the context that makes sense.

Bi-women are effected by this question
Bi-men are effected by this question
Lesbians are clearly lower risk group due to the lack of potential infection from anal sex with ejaculation (although infected sex toys is a risk, just not an inherently high one iirc)
Gay men are effected by this question
Straight women are effected by this question
Straight men aren't effected by this question because you're already dealing with a non-high risk population and the transmission rate from female -> male is almost always lower than male -> female

Yes, gay/bi men are the target of this question because MSM usually involves anal sex, and anal sex (Both insertive and receptive) has the highest sexual transmission rates, but this doesn't just discriminate against gay/bi men, even if they are the core of the question.

Now obviously a straight man and women can engage in anal sex (highest sexual transmission rate), but then you point back to the risk group of straight men and women, and they aren't a high-risk group for HIV compared to gay/bi men.

MSM accounts for 66% of all new cases HIV in 2017 which is 82% of the total number of new infections in men
I never said that there weren't other groups affected by these kinds of regulations. My point is that the non-MSM groups are asked questions that evaluate risks within their own groups instead of determining their qualification solely based on their sexual orientation, while for MSM, sexual orientation alone is enough to disqualify. However you slice it, this is a topic of homophobia being institutionalized, so you bringing up cases of non-MSM groups also being affected doesn't change that.

And those MSM infection statistics are obviously in reference to people with certain lifestyles and practices and doesn't suggest that every man from the MSM group is high risk.
 
Oct 27, 2017
407
Boston/Helsinki
#73
Basically, not enough high quality studies with enough evidence to properly inform deferral policies, which defaults to 'expert opinion', and we all know what that means.
It really sounds that your beef us with the system being precautionary principle driven with a focus on recepients (rather than rights of the donors) - which means that if there is no clear science-based evidence to suggest that you will get lower/same risks of infected donors without 3 months deferral (I have not been able to find a study that as blanket suggestion would propose getting rid if deferral for MSM - most studies seem to suggest that 3 months shifting downwards is feasible in most contexts ) there is little reason considering also supply issues to change the system. The problem with a science led precautionary approach is that, I quote ”a study assessing the HIV incidence in a low-risk group of potential MSM donors is not feasible due to both the large sample size necessary to accurately quantify incidence in a low-risk group and the difficulty of obtaining a representative sample of MSM”.

(Goldman, M., W‐Y Shih, A., O'Brien, S. F., & Devine, D. (2018). Donor deferral policies for men who have sex with men: past, present and future. Vox sanguinis, 113(2), 95-103.)

If you know of such study, please feel free to refer to it. Lifetime bans on MSM donors is unscientific, but as is the demand of getting rid of deferrals all together or rejecting MSM as one of several high risk populations.
 
Oct 26, 2017
4,947
#74
I never said that there weren't other groups affected by these kinds of regulations. My point is that the non-MSM groups are asked questions that evaluate risks within their own groups instead of determining their qualification solely based on their sexual orientation, while for MSM, sexual orientation alone is enough to disqualify. However you slice it, this is a topic of homophobia being institutionalized, so you bringing up cases of non-MSM groups also being affected doesn't change that.
Again, I agree with you, kinda. I think the screening process is pretty archaic and overly simplistic (which like I mentioned, seems to be by design). But again, you can make that point of contention with everyone who is in a high-risk group. I don't know if I agree that it's institutionalizing homophobia, but the root of such fear that HIV/AIDS is a "gay disease" isn't a point of contention at all.

And those MSM infection statistics are obviously in reference to people with certain lifestyles and practices and doesn't suggest that every man from the MSM group is high risk.[
It's not really about that, it's the fact that while the gay male population is around 4% of the US, nearly 1:5 gay/bi men are infected with HIV and around 44% of those infected don't even know it.

However, like you said this study does have cavities as it focuses on primarily single, sexually active men and doesn't include demographic factors. The national average when this study was taken was around 12% for the gay/bi population. So you're looking between 1:10 to a high of 1:5 infection rate for gay/bi men when you factor in lifestyle (if that was a major factor of the study, which we don't exactly know).

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5937a2.htm?s_cid=mm5937a2_w

It's a small population with a high per-capita infection rate.
 
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OP
OP
brainchild
Nov 25, 2017
4,889
Minnesota
#75
It really sounds that your beef us with the system being precautionary principle driven with a focus on recepients (rather than rights of the donors) - which means that if there is no clear science-based evidence to suggest that you will get lower/same risks of infected donors without 3 months deferral (I have not been able to find a study that as blanket suggestion would propose getting rid if deferral for MSM - most studies seem to suggest that 3 months shifting downwards is feasible in most contexts ) there is little reason considering also supply issues to change the system. The problem with a science led precautionary approach is that, I quote ”a study assessing the HIV incidence in a low-risk group of potential MSM donors is not feasible due to both the large sample size necessary to accurately quantify incidence in a low-risk group and the difficulty of obtaining a representative sample of MSM”.

(Goldman, M., W‐Y Shih, A., O'Brien, S. F., & Devine, D. (2018). Donor deferral policies for men who have sex with men: past, present and future. Vox sanguinis, 113(2), 95-103.)

If you know of such study, please feel free to refer to it. Lifetime bans on MSM donors is unscientific, but as is the demand of getting rid of deferrals all together or rejecting MSM as one of several high risk populations.
Those that are high risk should be deferred as long as necessary and those that are not should not be deferred any longer than necessary. Some MSM donors should be deferred and some shouldn't be deferred, that's the crux of my argument.
 
OP
OP
brainchild
Nov 25, 2017
4,889
Minnesota
#76
Again, I agree with you, kinda. I think the screening process is pretty archaic and overly simplistic (which like I mentioned, seems to be by design). But again, you can make that point of contention with everyone who is in a high-risk group. I don't know if I agree that it's institutionalizing homophobia, but the root of such fear that HIV/AIDS is a "gay disease" isn't a point of contention at all.
Not being able to donate blood isn't the only issue; the normative implications it puts forth specifically due to the generalization of sexual behavior in gay/bi/pan men (that is unique to this group) is also harmful to the community.

It's not really about that, it's the fact that while the gay male population is around 4% of the US, nearly 1:5 gay/bi men are infected with HIV.

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5937a2.htm?s_cid=mm5937a2_w

It's a small population with a high per-capita infection rate.
Well that's what happens when homosexuality is stigmatized and people don't get the help and resources that they need in order to protect themselves. At any rate, those other 4 out of 5 men (a majority of the MSM population) should still be able to donate blood.
 
Oct 26, 2017
4,947
#77
Not being able to donate blood isn't the only issue; the normative implications it puts forth specifically due to the generalization of sexual behavior in gay/bi/pan men (that is unique to this group) is also harmful to the community.

Well that's what happens when homosexuality is stigmatized and people don't get the help and resources that they need in order to protect themselves. At any rate, those other 4 out of 5 men (a majority of the MSM population) should still be able to donate blood.
Again, that's not how you handle high-risk groups and that's not even how the screening process works.

You're not selecting the non-infected people in the population, you're hoping that the people you select are part of the 80%/90% who aren't infected (which in terms of having a 10%/20% chance of contamination is a statistical a nightmare)
 
Oct 27, 2017
407
Boston/Helsinki
#78
Those that are high risk should be deferred as long as necessary and those that are not should not be deferred any longer than necessary. Some MSM donors should be deferred and some shouldn't be deferred, that's the crux of my argument.
Ok, you are for fully individualized risk assessments - two ways of doing that 1) the Spain-way, a DHQ and individual interview with a doctor (this does not feel feasible in the US considering the system) to identify high risk profiles or b) predonation screens, which have been tested at least in the Netherlands. Gold standard (if standard is to minimize infected donations) is probably a combination of both as neither has proven individually more effective than 3 months (or whatever current window is) blanket deferrals for high risk groups.
 
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Stinkles

343 Industries
Verified
Oct 25, 2017
9,480
#81
The "once ate beef" in the UK rule is ludicrous and unscientific. And because I'm a universal donor they won't take me off the list and every time they beg me to come in I ask if they fixed that nonsense and they're like, "nope."
 
Oct 25, 2017
9,729
#83
???

Map might be outdated or wrong, unless guidelines changed in the last 10 months, Mexico still has a ban on gay donors, in theory, since it's a honor code thing and you can just lie, but it's totally still a shameful reality. I donate a lot (well, used to since a false positive in my last test landed me a 3 year ban from donating) and every time they still have the doctor sternly tell you that you cannot donate if you're a gay man.
 
OP
OP
brainchild
Nov 25, 2017
4,889
Minnesota
#84
Again, that's not how you handle high-risk groups and that's not even how the screening process works.

You're not selecting the non-infected people in the population, you're hoping that the people you select are part of the 80%/90% who aren't infected (which in terms of having a 10%/20% chance of contamination is a statistical a nightmare)
Let me rephrase...

Those not infected (which are a significant majority portion of the MSM group) should have a chance to be screened fairly. Obviously they shouldn't automatically be accepted without being screened. And no, I'm not suggesting they be preselected on the basis that they're not infected, but if they know they're not they should have the chance to give blood if it's viable.

Ok, you are fir fully individualized risk assessments - two ways of doing that 1) the Spain-way, a DHQ and individual interview with a doctor (this does not feel feasible in the US considering the system) to identify high risk profiles or b) predonation screens, which have been tested at least in the Netherlands. Gold standard (if standard is to minimize infected donations) is probably a combination of both as neither has proven individually more effective than 3 months (or whatever current window is) blanket deferrals for high risk groups.
A combination of both sounds good to me.
 

Terrell

Banned
Member
Oct 25, 2017
1,510
Canada
#85
How many of those in HIV infections are related to unprotected sex? My guess? Nearly 100%. But every gay man is painted with the same brush, despite the fact that a single word added to the screening question would dramatically increase blood donation with a statistically-insignificant increase in risk.

When a single word can make such an impact to blood donations, at a time when blood donation has fallen every year since 2009, down by more than 1 million people in the US, it's unacceptably prejudicial, beyond the means of safety.

In Canada, the blood supply has frequently reached critical levels. Coincidentally, the MSM blood ban was lifetime as recently as 2012, reduced to 5 year deferral in 2013 and reduced to 1 year in 2016. My deferred eligibility has only existed for the past 6 years, with an actually achievable deferral timeline only available for the past 2 and a half years.

In the article above, medical evidence states that the most conservative deferral should be 12 weeks, "to account for the longest potential window between HIV exposure and detection." So even at their most conservative timeframe, that would still be far more acceptable than what we have now. The full quote from a Toronto sexual health clinic director, someone who should absolutely be an authority on this, being a physician on the frontlines of this "high-risk" group:

There’s no, no basis for it. In the face of science, it just smacks of very old and very prejudicial notions about HIV and gay men. Everybody knows that. I don’t even know what they’re thinking. I can say with absolute certainty that the policy is outdated, it’s stigmatizing, and it does not reflect the science we have available to us now.
But hey, as long as I'm stigmatized for having protected sex with 1 to 2 sexual partners a year, I'm not gonna shed a single god-damn tear about hospitals not having enough blood to treat patients.
 
Oct 27, 2017
407
Boston/Helsinki
#86
???

Map might be outdated or wrong, unless guidelines changed in the last 10 months, Mexico still has a ban on gay donors, in theory, since it's a honor code thing and you can just lie, but it's totally still a shameful reality. I donate a lot (well, used to since a false positive in my last test landed me a 3 year ban from donating) and every time they still have the doctor sternly tell you that you cannot donate if you're a gay man.
They still test the blood after DHQs, which are honor-based. But honor-based has proven rather effective because the donor populations displaying much lower infection rates than gen.pop nomatter which deferral window is used for high risk groups (lifetime, 1 year or 3 months)
 
Oct 25, 2017
6,378
#87
The "once ate beef" in the UK rule is ludicrous and unscientific. And because I'm a universal donor they won't take me off the list and every time they beg me to come in I ask if they fixed that nonsense and they're like, "nope."
Same here. Unfortunately this is more reasonable as there is no reliable diagnostic test to screen for mad cow. Plus, we make up a small portion of the donor pool. The MSM deferral is a relic of the past.
 
Oct 27, 2017
407
Boston/Helsinki
#88
Which of the countries listed has a Catholic "state church" and low usage of condoms? Really curious.

Honestly, I had completely forgotten about this rule. Here in Spain you get an interview that doesn't ask about sexual orientation, a hemoglobin test, a short examination, and the blood is always analyzed before use. In fact, each time you donate you get a report on the tests for transmissible diseases they perform.
Was unclear: in eg Italy the risk assessment does not recognize the use of condoms as risk mitigating factor when calculating risk profiles based on DHQs.. which is pretty insane as it is one of the most prevalent risk mitigating factors..
 
OP
OP
brainchild
Nov 25, 2017
4,889
Minnesota
#89
How many of those in HIV infections are related to unprotected sex? My guess? Nearly 100%. But every gay man is painted with the same brush, despite the fact that a single word added to the screening question would dramatically increase blood donation with a statistically-insignificant increase in risk.

When a single word can make such an impact to blood donations, at a time when blood donation has fallen every year since 2009, down by more than 1 million people in the US, it's unacceptably prejudicial, beyond the means of safety.

In Canada, the blood supply has frequently reached critical levels. Coincidentally, the MSM blood ban was lifetime as recently as 2012, reduced to 5 year deferral in 2013 and reduced to 1 year in 2016. My deferred eligibility has only existed for the past 6 years, with an actually achievable deferral timeline only available for the past 2 and a half years.

In the article above, medical evidence states that the most conservative deferral should be 12 weeks, "to account for the longest potential window between HIV exposure and detection." So even at their most conservative timeframe, that would still be far more acceptable than what we have now. The full quote from a Toronto sexual health clinic director, someone who should absolutely be an authority on this, being a physician on the frontlines of this "high-risk" group:



But hey, as long as I'm stigmatized for having protected sex with 1 to 2 sexual partners a year, I'm not gonna shed a single god-damn tear about hospitals not having enough blood to treat patients.
You articulated this much better than I have. Thank you for this post.
 
Oct 27, 2017
253
Tn, USA
#90
You guys gotta look at the broader numbers. If MSM accounts for 3-4% of the population, is opening them up to donation really going to result in a large increase in donation? No. But it does open up a lot of potential HIV exposures which could be devastating to the US blood supply (i.e. folks unwilling to receive blood, unwilling to donate because they think they will be infected, etc). Why risk that for a few % of POTENTIAL donors (since MSM would probably donate at the same low rate as other eligible donors).

It's not a homophobic policy. It IS a policy designed to reduce an infection risk from a population that has a very high risk of a specific disease due to a behavioral practice. And it will change. As data shows smaller deferral periods are acceptable due to better testing, it will get better. As pathogen reduction removes even more risk, it will get better.

There are other equally as conservative deferrals based on behaviors (typically travel). But also incarceration, paying for sex, receiving money for sex, IV drug use, etc. The screening tests are not perfect and even a 0.01% false negative rate over MILLIONS of units results in quite a few transfusion transmitted diseases. So behavioral screening combined with post-donation testing is the most safe way to go and it is what we can do while we have far more eligible donors than demand. Blood supply is critical mostly due to the need for rare blood types (AB plasma, O neg blood, etc) and platelets (very short shelf life), not so much O pos and A blood which accounts for 80% of donors. So bringing in 3% of the population isn't going to make that much better, a focus on getting the other 70% of currently eligible donors to donate is time/money better spent.
 
Oct 27, 2017
253
Tn, USA
#91
Was unclear: in eg Italy the risk assessment does not recognize the use of condoms as risk mitigating factor when calculating risk profiles based on DHQs.. which is pretty insane as it is one of the most prevalent risk mitigating factors..
Yeah, but condom use is HIGHLY variable and it would have to be 100%. People just can't be trusted to accurately comment on this, so a deferral based on the underlying risky behavior (MSM) is more appropriate.

It'd be like allowing IV drug users if they swear that they always use a clean needle. The chances of that being true 100% of the time is very small.

It's unfortunate that is does defer folks who would be great donors. But the overall numbers of those folks is pretty low. And there is always plasma donation if you really want to donate to help people. That product is heavily sterilized so the infectious risk is negligible.
 
OP
OP
brainchild
Nov 25, 2017
4,889
Minnesota
#92
You guys gotta look at the broader numbers. If MSM accounts for 3-4% of the population, is opening them up to donation really going to result in a large increase in donation? No. But it does open up a lot of potential HIV exposures which could be devastating to the US blood supply (i.e. folks unwilling to receive blood, unwilling to donate because they think they will be infected, etc). Why risk that for a few % of POTENTIAL donors (since MSM would probably donate at the same low rate as other eligible donors).

It's not a homophobic policy. It IS a policy designed to reduce an infection risk from a population that has a very high risk of a specific disease due to a behavioral practice. And it will change. As data shows smaller deferral periods are acceptable due to better testing, it will get better. As pathogen reduction removes even more risk, it will get better.

There are other equally as conservative deferrals based on behaviors (typically travel). But also incarceration, paying for sex, receiving money for sex, IV drug use, etc. The screening tests are not perfect and even a 0.01% false negative rate over MILLIONS of units results in quite a few transfusion transmitted diseases. So behavioral screening combined with post-donation testing is the most safe way to go and it is what we can do while we have far more eligible donors than demand. Blood supply is critical mostly due to the need for rare blood types (AB plasma, O neg blood, etc) and platelets (very short shelf life), not so much O pos and A blood which accounts for 80% of donors. So bringing in 3% of the population isn't going to make that much better, a focus on getting the other 70% of currently eligible donors to donate is time/money better spent.
Your "we don't need the gays" rhetoric needs to stop. There are blood supply crises all over the world and you're suggesting that potentially millions of samples won't make much of a difference...I don't even know how to properly respond to that.

People just can't be trusted to accurately comment on this, so a deferral based on the underlying risky behavior (MSM) is more appropriate.
MSM doesn't have to be risky and not all MSM donors participate in risky behavior.
 
Oct 25, 2017
1,565
#93
Fully agreed, OP. I can not understand the reasoning behind any policy that would treat people who are in say committed multi-year monogamous same-sex relationships the same as someone who's sleeping with a different partner every week or something. Those are clearly two very, VERY different classes of people with extremely different risk factors and treating them the same anyway just because THEY BOTH HAVE TEH GAYS THO is nothing other than homophobic through and through.

There's absolutely no reason why those two people should be treated the same, absolutely none other than flat-out homophobia. That is, unless you think TEH GAYS are going to lie about that and pretend to be monogamous when they're not, in which case, why stop there? Why wouldn't they lie about whether they're gay or not in the first place is they're so determined to infect people, and so we need to ban man entirely to prevent that because of how evil and untrustworthy gay individuals are apparently? If one catches oneself thinking such thoughts, that gay individuals who just want to donate looks are out to pull tricks like that, that should be thought through once more, because that too sounds pretty much just like homophobia to me.

So in short, I agree OP. Those kind of blanket bans on MSM donations, regardless of factors of whether the individual is in a committed relationship or not or when they last sex, definitely classify as homophobia to me and have no place anywhere.
 
Oct 25, 2017
19,711
#94
The UK rules moved it to a 3-month deferment which seems fair.
MSM doesn't have to be risky and not all MSM donors participate in risky behavior.
You don't really want to have a blood donation person asking more details than that. You want it to be minimally invasive.
 
Oct 26, 2017
4,947
#95
Yeah, but condom use is HIGHLY variable and it would have to be 100%. People just can't be trusted to accurately comment on this, so a deferral based on the underlying risky behavior (MSM) is more appropriate.

It'd be like allowing IV drug users if they swear that they always use a clean needle. The chances of that being true 100% of the time is very small.

It's unfortunate that is does defer folks who would be great donors. But the overall numbers of those folks is pretty low. And there is always plasma donation if you really want to donate to help people. That product is heavily sterilized so the infectious risk is negligible.
This is a pretty messed up way to view the situation
 

Terrell

Banned
Member
Oct 25, 2017
1,510
Canada
#96
Yeah, but condom use is HIGHLY variable and it would have to be 100%. People just can't be trusted to accurately comment on this, so a deferral based on the underlying risky behavior (MSM) is more appropriate.
So now we're at the point where MSM are more likely to both unknowingly or knowingly lie than heterosexual people who engage in high-risk behaviour. Awesome. /s

You guys gotta look at the broader numbers. If MSM accounts for 3-4% of the population, is opening them up to donation really going to result in a large increase in donation? No.
The 3-4% number is debatable, given that those numbers are often based on identity, not activity. But even beyond that, if the statistic is true, it's 9 TO 10 MILLION PEOPLE.
 
Oct 26, 2017
4,947
#97
How many of those in HIV infections are related to unprotected sex? My guess? Nearly 100%. But every gay man is painted with the same brush, despite the fact that a single word added to the screening question would dramatically increase blood donation with a statistically-insignificant increase in risk.

When a single word can make such an impact to blood donations, at a time when blood donation has fallen every year since 2009, down by more than 1 million people in the US, it's unacceptably prejudicial, beyond the means of safety.

In Canada, the blood supply has frequently reached critical levels. Coincidentally, the MSM blood ban was lifetime as recently as 2012, reduced to 5 year deferral in 2013 and reduced to 1 year in 2016. My deferred eligibility has only existed for the past 6 years, with an actually achievable deferral timeline only available for the past 2 and a half years.

In the article above, medical evidence states that the most conservative deferral should be 12 weeks, "to account for the longest potential window between HIV exposure and detection." So even at their most conservative timeframe, that would still be far more acceptable than what we have now. The full quote from a Toronto sexual health clinic director, someone who should absolutely be an authority on this, being a physician on the frontlines of this "high-risk" group:
Yea, I don't disagree. Like I said, I think the screening is being extremely conservative to a fault and it's designed that way, but when OP says something like "let the other 80% give blood" I can only assume they are missing the point of what a high-risk category is in terms of infectious diseases and the risk of contamination of the blood supply.

Based on everything I've read, a three month deferment seems way more reasonable than a 12 month deferment.

The UK rules moved it to a 3-month deferment which seems fair.

You don't really want to have a blood donation person asking more details than that. You want it to be minimally invasive.
This is true as well
 
Oct 27, 2017
407
Boston/Helsinki
#98
Your "we don't need the gays" rhetoric needs to stop. There are blood supply crises all over the world and you're suggesting that potentially millions of samples won't make much of a difference...I don't even know how to properly respond to that.



MSM doesn't have to be risky and not all MSM donors participate in risky behavior.
This is true but the way risk is calculated and what the implications for high risks groups are might not always be in congruence with a “right to donate” approach.

That someone (not you) in this thread says MSM deferral (by 3 months or whatever the window with reliable testing is) is BS, is a bit hard to agree with since the risk of false negative within the window is real and scientifically proven - and I cannot get behind the idea that in order to grant everyone the same right to donate we will have to increase risks for the receivers or make a pre-screening system so invasive that it affects supply to levels below current.

I agree with you it would be great to get more granular data on MSM population - and I know that is what they are doing within the EU - but more studies are needed. I looked at a couple of Dutch studies (couldn’t find good data from Spain/Portugal that have the non-gendered DHQs) and they point to some things that support both blanket deferrals:

”data show a clear link between MSM blood donors and infection with HIV, HBV, and syphilis” https://www.researchgate.net/profil...missible-infections-in-Dutch-blood-donors.pdf

but also strong indication of value for risk management purposes to separate between high and medium risk MSM and, low-risk MSM:

https://www.researchgate.net/profil...Men-and-Their-Suitability-to-Donate-Blood.pdf

I would really encourage people in this thead to read both papers.
 
Last edited:
Oct 25, 2017
1,565
#99
The UK rules moved it to a 3-month deferment which seems fair.

You don't really want to have a blood donation person asking more details than that. You want it to be minimally invasive.
What's invasive about simply asking about if you are gay, if you're in a committed monogamous relationship or not? 'Cause people who only have sex with one partner are obviously less of a risk factor than those that aren't. And then you have the whole self-selection thing, where those who try to donate blood are naturally going to be those in lower risk groups because most people, gay or not, aren't evil monsters and actually do know better than that.

Just ask the questions. Rather that than just be assumed I'm some kind of monster that's trying to infect people with HIV by default because they're totally oooooh so concerned about my privacy regarding stuff a minimal number of people should ever see to begin with, even less with actual identifying information attached. Between those two options, I know which one I would prefer, personally, especially when I've made the decision to donate blood regardless.
 
Oct 25, 2017
19,711
What's invasive about simply asking about if you are gay, if you're in a committed monogamous relationship or not? 'Cause people who only have sex with one partner are obviously less of a risk factor than those that aren't. And then you have the whole self-selection thing, where those who try to donate blood are naturally going to be those in lower risk groups because most people, gay or not, aren't evil monsters and actually do know better than that.

Just ask the questions. Rather that than just be assumed I'm some kind of monster that's trying to infect people with HIV by default because they're totally oooooh so concerned about my privacy regarding stuff a minimal number of people should ever see to begin with, even less with actual identifying information attached. Between those two options, I know which one I would prefer, personally, especially when I've made the decision to donate blood regardless.
Committed monogamous relationship doesn't mean anything when partners canh cheat.

You are going low-level blanket ban because the people you are screening for are the ones who don't know they're infected and who were infected recently, because there's a waiting period till the virus is detectable. And because having a detailed discussion on sexual habits between a 55 year old lady at the blood donation center and a random male stranger is something that won't be comfortable for anyone. It's keeping it as generic/clinical as possible.