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

Oct 25, 2017
6,491
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.
Just spitballing here but I would assume that by asking the question they would run afoul of the law. They do not ask heterosexual individuals if they are in a monogamous relationship.
 
Oct 27, 2017
440
Boston/Helsinki
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.
To my understanding 3 questions need to be asked from MSM population in the DHQ to selfdetermine low-risk MSM: during deferment window (3-12 months) a) no anal intercourse or b) monogamous relationship or c) consistent use of condoms with casual partners. With a) and b) being more deterministic for non-infection donors.
 
Oct 27, 2017
259
Tn, USA
Just spitballing here but I would assume that by asking the question they would run afoul of the law. They do not ask heterosexual individuals if they are in a monogamous relationship.
That is because the assumption is that they aren't (faithful). Everything about the screening questionnaire is meant to exclude the MOST PEOPLE POSSIBLE.

It doesn't just ask if you have malaria, but defers you for 12 months for being in an endemic area and 3 years if you contracted malaria. It doesn't care what illicit IV drug use you do or how safe you are when doing it. Same with money for sex. Same with MSM sex. It isn't about being gay, it's about engaging in a KNOWN HIGH RISK BEHAVIOR. Methods of reducing that risk, other than abstinence, just aren't good enough.

And even if you dont like it, the numbers dont lie.

Another example. During the West Nile Viris breakout in the early 2000's there was no test and almost no screening question that was effective. A donation ban of the entire southern US was floated around as a way to prevent WNV from being introduced into the blood supply. But ultimately that was rejected because that WOULD have hurt the blood supply as it affected a third of the US (plus it passed as the seasons changed and we developed a test for it). Probably as many donors are deferred for time spent in Europe as for MSM and the prion transmission data is extremely scant as opposed to HIV data.

That is the level of protection we are talking about with blood bankers. Virtually no measure to ensure safety is passed up. We still test for syphilis and that hasn't been transmitted since the 60's! Heck, women who have been pregnant can't even donate plasma/platelets anymore because of anti-HLA antibodies that cause a potentially fatal lung reaction.

But it is getting better. I can't stress enough that technology will eliminate many of these behavioral deferrals and there are other ways to help folks for those who can't donate.
 
Oct 25, 2017
6,491
most DHQs ask if you have had new sexual partner(s) within a deferment window.
In that case, disregard my comment.

That is because the assumption is that they aren't (faithful). Everything about the screening questionnaire is meant to exclude the MOST PEOPLE POSSIBLE.

It doesn't just ask if you have malaria, but defers you for 12 months for being in an endemic area and 3 years if you contracted malaria. It doesn't care what illicit IV drug use you do or how safe you are when doing it. Same with money for sex. Same with MSM sex. It isn't about being gay, it's about engaging in a KNOWN HIGH RISK BEHAVIOR. Methods of reducing that risk, other than abstinence, just aren't good enough.

And even if you dont like it, the numbers dont lie.

Another example. During the West Nile Viris breakout in the early 2000's there was no test and almost no screening question that was effective. A donation ban of the entire southern US was floated around as a way to prevent WNV from being introduced into the blood supply. But ultimately that was rejected because that WOULD have hurt the blood supply as it affected a third of the US (plus it passed as the seasons changed and we developed a test for it). Probably as many donors are deferred for time spent in Europe as for MSM and the prion transmission data is extremely scant as opposed to HIV data.

That is the level of protection we are talking about with blood bankers. Virtually no measure to ensure safety is passed up. We still test for syphilis and that hasn't been transmitted since the 60's! Heck, women who have been pregnant can't even donate plasma/platelets anymore because of anti-HLA antibodies that cause a potentially fatal lung reaction.

But it is getting better. I can't stress enough that technology will eliminate many of these behavioral deferrals and there are other ways to help folks for those who can't donate.
I was mostly looking at it strictly from a legal perspective. That said, you are right from a medical perspective. FWIW, a WNV diagnostic screen test was developed for the Japanese Red Cross/government in the mid 00s.
 
Oct 25, 2017
1,526
Canada
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
The odds of a false negative within 3 months are 5%.
Gay men electively test for STIs more frequently than any other population segment (those who engage in high-risk sexual activity test more frequently than others, often once a month). So the likelihood of 2 false negatives in that time window is 0.25%.
The likelihood that they would not know their HIV status is therefore MUCH lower than the 5% false negative rate, making the false negative rate close to a statistical irrelevance. With more diligent screening questions beyond "have you had sex with another man?" would render false negatives a definite statistical irrelevance.
 
Oct 25, 2017
1,526
Canada
That is because the assumption is that they aren't (faithful). Everything about the screening questionnaire is meant to exclude the MOST PEOPLE POSSIBLE.

It doesn't just ask if you have malaria, but defers you for 12 months for being in an endemic area and 3 years if you contracted malaria. It doesn't care what illicit IV drug use you do or how safe you are when doing it. Same with money for sex. Same with MSM sex. It isn't about being gay, it's about engaging in a KNOWN HIGH RISK BEHAVIOR.
One of these things is not like the others.
Saying gay men having sex with men is "behavioural" is bordering REALLY close to homophobia.
 
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Oct 25, 2017
1,572
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.
So it's not that I'm assumed to be a monster intentionally trying to infect people because of my sexuality, it's that I/my partner are assumed to be cheating whores until proven otherwise when this is never relevant one way or the other to heterosexual individuals who could just as easily be cheating (and indeed, due to the greater number of heterosexual individuals, statistically more likely to do so, like way more), including with one of the two secretly being in a MSM relationship on the side, but nevermind that if their stated orientation is straight? Yeah, no duh I'm not exactly going to be comfortable with the implication there either and it somehow coming back to just the gays, the gays, the gays where people suddenly have these concerns. Like, seriously, what are the chances of someone actually cheating just because they're gay? Why's that suddenly matter, when it's not even a thought at all when those donating are straight? What actually justifies that, what research, what anything at all to even bring that up when it's not otherwise?

And to cut this off at the chase before it even goes there, I'm not a fan of how these arguments tend to magically shift between rather it's minimizing the risk as much as possible, no matter what that involves, that matters most, to, when something like the above is brought up that ultimately boils down to if people are going to lie about this stuff they're likely to just lie regardless so why not just ban men entirely or something if that's suuuuuch a concern, to suddenly, no, no, no, then it's the quantity of blood that matters and that minimizing the risk of infection stuff people were blabbering on about beforehand? Disappears as quickly as it appeared in the first place, as if that was never truly the concern to begin and the arguments just effortlessly flip back and forth, back and forth, always just magically settling on whatever just-so-happens to be most restrictive to MSM donations. Either people are committed to minimizing the risk of HIV infections, whatever the cost involved may be, however many donations need to be turned down to do that, or you're committed to increasing the amount of donations and accepting some (minimal) degree of risk to do so and just assuming the best of people (and the best of people willing to do something like donate blood in the first place, which, frankly, most people aren't for one reason or another). Wish people would pick one in these discussions, but alas.

Because the TL;DR version of all this is imagine this scenario. A happily-married heterosexual woman decides to donate blood after some form of tragedy happens near where she lives. However, unbeknownst to her, her husband is secretly cheating on her with another man. Statistically, due to number of heterosexual relationships out there, this type of scenario if anything is even more common than homosexual individuals in committed relationships cheating on each other, especially in too many areas where homophobic attitudes linger and it's not acceptable to be in an openly-homosexual relationship, resulting in homosexual men pretending to be straight and winding up in those exact kind of situations.

The point being, regardless of what question she's asked, she would answer "No" as she has no knowledge of her husband's affair.

But yet! But yet, despite that surely being a thing, it doesn't seem to cause any particular issues for our system, whatsoever. So any concerns about "opening the floodgates" for MSM donations just seems really misguided, particularly because of how few donations we're talking about, so how could that possibly cause any additional burden on the system, when scenarios like that don't? How can people simultaneously talk out both sides of their mouth, admitting that we're in the end not talking about a significant number of donations to begin with because of the percentage of homosexual individuals in the population, and thus try to use that to argue why it's not worth the risk or whatever, but yet just as effortlessly switch to arguing that despite that, "if the floodgates were opened" that suddenly it would nonetheless magically overwhelm the system or be too costly or whatever? Huh? Are we talking about a low number of donations, or aren't we? Is it huge, is it tiny? It seems to switch at well.

I see no actual evidence that that would be a significant problem, anywhere, instead of just homophobic assumption after assumption after assumption that this or that just MUST, simply naturally must be the case, without any actual evidence to back it. And so I'm not going to be cool with that, or at least that's how I feel, if that makes sense and helps to clear up my personal position at all.
 
Oct 26, 2017
5,143
So it's not that I'm assumed to be a monster intentionally trying to infect people because of my sexuality, it's that I/my partner are assumed to be cheating whores until proven otherwise when this is never relevant one way or the other to heterosexual individuals who could just as easily be cheating (and indeed, due to the greater number of heterosexual individuals, statistically more likely to do so, like way more), including with one of the two secretly being in a MSM relationship on the side, but nevermind that if their stated orientation is straight? Yeah, no duh I'm not exactly going to be comfortable with the implication there either and it somehow coming back to just the gays, the gays, the gays where people suddenly have these concerns. Like, seriously, what are the chances of someone actually cheating just because they're gay? Why's that suddenly matter, when it's not even a thought at all when those donating are straight? What actually justifies that, what research, what anything at all to even bring that up when it's not otherwise?

And to cut this off at the chase before it even goes there, I'm not a fan of how these arguments tend to magically shift between rather it's minimizing the risk as much as possible, no matter what that involves, that matters most, to, when something like the above is brought up that ultimately boils down to if people are going to lie about this stuff they're likely to just lie regardless so why not just ban men entirely or something if that's suuuuuch a concern, to suddenly, no, no, no, then it's the quantity of blood that matters and that minimizing the risk of infection stuff people were blabbering on about beforehand? Disappears as quickly as it appeared in the first place, as if that was never truly the concern to begin and the arguments just effortlessly flip back and forth, back and forth, always just magically settling on whatever just-so-happens to be most restrictive to MSM donations. Either people are committed to minimizing the risk of HIV infections, whatever the cost involved may be, however many donations need to be turned down to do that, or you're committed to increasing the amount of donations and accepting some (minimal) degree of risk to do so and just assuming the best of people (and the best of people willing to do something like donate blood in the first place, which, frankly, most people aren't for one reason or another). Wish people would pick one in these discussions, but alas.

Because the TL;DR version of all this is imagine this scenario. A happily-married heterosexual woman decides to donate blood after some form of tragedy happens near where she lives. However, unbeknownst to her, her husband is secretly cheating on her with another man. Statistically, due to number of heterosexual relationships out there, this type of scenario if anything is even more common than homosexual individuals in committed relationships cheating on each other, especially in too many areas where homophobic attitudes linger and it's not acceptable to be in an openly-homosexual relationship, resulting in homosexual men pretending to be straight and winding up in those exact kind of situations.

The point being, regardless of what question she's asked, she would answer "No" as she has no knowledge of her husband's affair.

But yet! But yet, despite that surely being a thing, it doesn't seem to cause any particular issues for our system, whatsoever. So any concerns about "opening the floodgates" for MSM donations just seems really misguided, particularly because of how few donations we're talking about, so how could that possibly cause any additional burden on the system, when scenarios like that don't? How can people simultaneously talk out both sides of their mouth, admitting that we're in the end not talking about a significant number of donations to begin with because of the percentage of homosexual individuals in the population, and thus try to use that to argue why it's not worth the risk or whatever, but yet just as effortlessly switch to arguing that despite that, "if the floodgates were opened" that suddenly it would nonetheless magically overwhelm the system or be too costly or whatever? Huh? Are we talking about a low number of donations, or aren't we? Is it huge, is it tiny? It seems to switch at well.

I see no actual evidence that that would be a significant problem, anywhere, instead of just homophobic assumption after assumption after assumption that this or that just MUST, simply naturally must be the case, without any actual evidence to back it. And so I'm not going to be cool with that, or at least that's how I feel, if that makes sense and helps to clear up my personal position at all.
The screening is just that, a screening. It's not meant to reduce the potential risk of infected blood to zero, it's meant to reduce obvious cases where a person is part of a high-risk population to be infected, so that instead of going through the process of giving blood then having to test it with a higher likely hood of it coming back as contaminated, they can forgo the donation all together and avoid the time, money and potential risk of false negatives.
 
Oct 27, 2017
440
Boston/Helsinki
The odds of a false negative within 3 months are 5%.Gay men electively test for STIs more frequently than any other population segmen
(those who engage in high-risk sexual activity test more frequently than others, often once a month). So the likelihood of 2 false negatives in that time window is 0.25%.
The likelihood that they would not know their HIV status is therefore MUCH lower than the 5% false negative rate, making the false negative rate close to a statistical irrelevance. With more diligent screening questions beyond "have you had sex with another man?" would render false negatives a definite statistical irrelevance.
There’s a pretty strong agreement in the science community that *a* deferral window is sound and in line with science-driven policy, the question is more if the deferral window (‘s length) is in line with available testing technology. You are not claiming that there is not a difference in terms of false negatives when testing day after infection with 20 days I pressume?

You are free to disagree but I’d love to see some backup by scientific sources that espouse no deferral window for high risk groups for blood donation. Yes 3 months is conservative for HIV new tests, syphilis / HTLV I don’t know. Usually the precaution standard is that deferral is twice the window.

While it is true that MSM population might test more, all empirical studies I have read points to higher rates of infection among high risk group donators including MSM than among heterosexual population (excluding other high risk elements)- then as has been repeated, all donor populations within an honor code system have lower infection rates than populations overall and studies equally suggest that it makes sense to divide the MSM population into high/medium risk and low risk and automatically defer only the former.
 
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Oct 25, 2017
1,526
Canada
There’s a pretty strong agreement in the science community that a deferment window is sound and in line with science-driven policy, the question is more if the deferment window is in line with available testing technology. You are not claimung that there is not a difference in terms of false negatives when testing day after infection with 20 days I pressume? You are free to disagree but I’d love to see some backup by scientific sources that espouse no deferment window for high risk groups for blood donation.

While it is true that MSM population might test more, all empirical studies I have read points to higher rates of infection among high risk group donators including MSM than among heterosexual population (excluding other high risk elements)- then as has been repeated, all donor populations within an honor code system have lower infection rates than populations overall and studies equally suggest that it makes sense to divide the MSM population into high/medium risk and low risk and automatically defer only the former.
I am for deferment, but not without further and more detailed screening to divide that population and more questions that do the same for the risks inherent in the heterosexual population, because there is a population in the heterosexual cohort that has an equal risk factor, beyond porn stars and sex workers.
15% of all HIV contractions in Canada are related to heterosexual sex within Canada. When you include heterosexual sex among residents who had sexual contact in areas of the world where HIV is endemic (Africa, the Caribbean, etc), heterosexual sex made up 32% of HIV contraction. Where's the deferment for straight people who have had unprotected sex, either consensual or otherwise, with unfamiliar sex partners? They also represent a "high-risk" group, but 15-32% of HIV infections are apparently somehow an acceptable risk. At the same time, needle drug use is on the screening, which makes up less of new HIV contractions in the country than straight sex.
An uneven application of scrutiny to "high-risk" groups is the major issue, one that is unlikely to be addressed.
 
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Oct 27, 2017
259
Tn, USA
One of these things is not like the others.
Saying gay men having sex with men is "behavioural" is bordering REALLY close to homophobia.
Oh get off it. At no point am I even implying anything of the sort.

A high risk behavior is just that, a high risk behavior. The question isn't "are you gay" but rather "are you a man that has engaged in intercourse with another man". It focuses on the behavior, not the motivation for the act. A celibate x12 months gay man would likely be eligible to donate. It's not a homophobic policy.

And right now HIV is overwhelmingly transmitted by MSM sexual contact compared to other forms of sexual contact. Simple fact. Thus that is the behavior, amongst others, that is screened for and gets a deferral. In 5-10 years I suspect it wont be a question. Instead it will just be "have you had a new sexual partner in the past week" if even that as testing plus pathogen reduction eliminates the window period entirelly.
 
Oct 25, 2017
1,526
Canada
Oh get off it. At no point am I even implying anything of the sort.

A high risk behavior is just that, a high risk behavior. The question isn't "are you gay" but rather "are you a man that has engaged in intercourse with another man". It focuses on the behavior, not the motivation for the act. A celibate x12 months gay man would likely be eligible to donate. It's not a homophobic policy.
For gay people, it's a distinction without a difference.

Where's the celibacy for straight people who have sex with multiple unfamiliar sex partners, who have an extraordinarily higher rate of HIV infection than the average? Oh wait, that's right, the blood test safety net is apparently good enough for them, in spite of all of the same arguments working against their participation.
 
Oct 27, 2017
440
Boston/Helsinki
I am for deferment, but not without further and more detailed screening to divide that population and more questions that do the same for the risks inherent in the heterosexual population, because there is a population in the heterosexual cohort that has an equal risk factor, beyond porn stars and sex workers.
15% of all HIV contractions in Canada are related to heterosexual sex within Canada. When you include heterosexual sex among residents who had sexual contact in areas of the world where HIV is endemic (Africa, the Caribbean, etc), heterosexual sex made up 32% of HIV contraction. Where's the deferment for straight people who have had unprotected sex, either consensual or otherwise, with unfamiliar sex partners? They also represent a "high-risk" group, but 15-32% of HIV infections are apparently somehow an acceptable risk. At the same time, needle drug use is on the screening, which makes up less of new HIV contractions in the country than straight sex.
An uneven application of scrutiny to "high-risk" groups is the major issue, one that is unlikely to be addressed.
I agree and this varies in different countries, I work part of the year in the Nordics and there heterosexuals who have had new sexual partners within 3-4 months are not allowed to donate, deferring for MSM is 12 months...should be 3 for both groups
 
Oct 25, 2017
1,526
Canada
In addition, the concept that the lack of further narrowing is to make the screening questions "non-invasive" is a joke. Do people honestly think that questions like "have you had sex with a man?", "have you had sex with a sex worker?" and "are you a sex worker?" aren't inherently invasive questions? That line has already been crossed for marginalized groups, why are straight people's sex lives somehow sacrosanct unless they involve a prostitute?

Let's call out the blanket bans for what they are.
 
OP
OP
brainchild
Nov 25, 2017
4,926
Minnesota
You don't really want to have a blood donation person asking more details than that. You want it to be minimally invasive.
Ok, then the screeners don't have to ask. But there should an option so that when the donors volunteer information that would suggest that they are low risk (or even provide recent documentation that strongly suggests that they are free of infectious diseases) they should be evaluated differently than the donors who don't know that they are infected. Right now, even if donors voluntarily provided proof that they are low risk, they'd still be treated just like every other person in the MSM group, which is inexcusable.

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.
Thanks for the links. As I suggested above, allowing an opt-in option for donors who know/can prove that they're low risk would be better than lumping all risk groups in MSM together.

Let's call out the blanket bans for what they are.
It's homophobia. There are so many ways this issue can be resolved RIGHT NOW to allow for a distinction between risk groups and they're not being pursued because of assumptions about how MSM donors behave. It's disgusting.
 
Proposed alternative to the ban
OP
OP
brainchild
Nov 25, 2017
4,926
Minnesota
BTW, for those who missed the analysis that I linked in the OP, here's a proposed alternative to the ban:

Alternatives to the ban
In lieu of a permanent and categorical ban or the proposed deferral, the FDA should shift to an “Assess and Test” screening system. After assessing the donor’s personal sexual practices, a deferral may be given only for those in whom a risk of infection has been identified, such as individuals who have engaged in frequent, unprotected sex with multiple partners since their prior HIV test. For this risky group, a short period of abstinence may be appropriate to allow for reliable test results. For donors who are not high risk, the deferral should be eliminated altogether.



This model can be applied to both homosexual and heterosexual donors and would not consider monogamous or safe sex to be risky, mirroring the current protocol for straight donors.



As has been the standard since 1985, all blood is tested for HIV after donation, so these initial screening questions serve as only the first step in an Assess and Test approach.24Under current testing protocol, the risk of transfusion-transmission of HIV is one in two million.25



The United States is not alone in its treatment of MSM. South Africa uses a six-month deferral period, while the UK, Australia, and Sweden defer for twelve months. Canada and New Zealand defer MSM for five years.26 As with the FDA’s stipulations, these policies require celibacy during the deferral period, maintaining illusory associations between HIV and gay sex, rather than between HIV and risky sex. Italy, however, has adopted an Assess and Test model that uses “risk behavior” screening questions and blood testing, which it applies to all donors, regardless of sexual orientation.27 It defers individuals who are flagged by screening, not by lifestyle. Italy has not experienced an increase in infected donations since implementing this policy.28



This approach can identify individuals, rather than categories, who may present a risk to the blood supply. AABB, America’s Blood Centers, and the American Red Cross have advocated for the adoption of similarly comprehensive approaches.29 Unlike the ban on MSM donors or the new deferral, the Assess and Test approach uses rational and scientifically based deferral periods, applied fairly, to maximize the donor pool and minimize risk.30
https://medicalreview.columbia.edu/article/ban-the-ban/

The only modification I'd add to this proposal would be to have the more detailed questioning reserved as an opt-in process so people who don't feel comfortable answering more intrusive questions aren't deterred from donating, and those that don't opt-in can default to the current system that we have now. I don't see how this would be a problem.
 
Oct 26, 2017
1,789
I don’t understand why people are defending blood donation screening staying as it is as if it’s a result of some perfect science? It’s just a pre-screening, it wasn’t created in a lab just because nurses are taking your blood.
 
OP
OP
brainchild
Nov 25, 2017
4,926
Minnesota
I don’t understand why people are defending blood donation screening staying as it is as if it’s a result of some perfect science? It’s just a pre-screening, it wasn’t created in a lab just because nurses are taking your blood.
It's probably due to the precautionary principle where the recipients' rights are more important than anything else. The problem is that MSM isn't something that should be seen as inherently risky behavior and worthy of extreme precaution. It's not like anal sex on its own gives a person HIV, but the way things are now, that's the message it's continuing to perpetuate.