blood donation

I just got an email asking if I would give blood. Every time I get one of these I get annoyed because I am reminded that gay men can’t give blood. The FDA instituted this rule in 1983 (this made sense, at least in my view). Any man who has had sex with another man since 1977 is banned for life from giving blood (as are IV drug users and anyone who has been paid for sex). My issue here is not with the screening of donors on the basis of risk. And men who have sex with men are much more likely to be HIV positive (I believe it’s 7 times). But I’d still argue that it doesn’t make sense. This is simply because I think that behavioral screening would both lower the overall risk and increase the overall blood supply. That is, behavioral screening is favorable to categorical screening. Screening for people who have recently had unprotected sex strikes me as a much more sensible, less discriminatory, and indeed, safer policy. There’s evidence that this is the case. Spain and Italy switched their policies from banning gay men to asking all donors if they’d recently had unprotected sex. The result of this policy change was a dramatic reduction in the rates of HIV transmissions through the blood supply and an increase in the overall blood supply (though a strong causal story can’t be told here as there were other changes in their policies as well). I also suspect that asking people “have you recently had unprotected sex” further reinforces that all people would do well to engage in safe sex. As Arthur Caplan, former head of the government panel on Blood donation put it, “Letting gay men give blood could help bolster the supply. At one time, long ago, the gay-blood ban may have made sense. But it no longer does. Fear and prejudice are terrible reasons to let you or someone you love die.”

6 thoughts on “blood donation”

  1. I agree with you that the current screening rules for homosexual men are ridiculous. As a long-time blood donor I’ve also been amused/depressed at the weird questions that routinely crop up in the uniform donor history questionnaire. You know, questions like, “Are you a woman who has had sex with a man who has had sex with another man anytime since 1977?” Well? Are you?

    Anyway, a long time ago I used to monitor the FDA panel that sets blood regulations as part of a job I held. The interesting thing is that the FDA has more or less known that the ban on gay men doesn’t protect the blood supply directly since at least the late nineties. Last time I was keeping track, the ban was retained because it made other people feel more secure about the blood supply. In other words, if they relaxed it they believed fewer people would donate (“I just don’t want to be around all that gay blood!”) and some folks would refuse to accept blood products from the common supply. So, basically, the FDA accepted the loss of all the blood from homosexual men they could have been getting because they believed the loss if they did anything else would have been even more substantial.

    Similarly iffy exclusions crop up elsewhere in the UDHQ as well. Those questions about how much time you’ve spent in different parts of Europe? Those are mostly about Creutzfeldt-Jakob’s disease, the human form of “Mad Cow disease.” Interestingly, the FDA amended the UDHQ to try and exclude people thought to be at greater risk of CJD years before its transmission via blood was identified. Even now, CJD is extremely rare and doesn’t seem to readily move to new hosts. But when everyone was panicking over prion disease and, given the way the blood supply was burned by HIV, the FDA responded by banning as much as 7% of the potential U.S. donors- not because it made the blood safer, but to avoid a loss of faith among donors and recipients.

    I’m not a medical sociologist (or am I?) but that sounds like a sociological story to me.

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    1. There are a lot of sociologically interesting stories that could be done here – ones that you point to. Kieran Healy should write a book about this! But in all seriousness, I think it would be a great project on science, prejudice, moral panics, sexuality, etc. I thought about it as I wrote this post and then I recalled all the projects of my own I have yet to complete. Maybe I’ll try to convince someone to write it for a dissertation!

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  2. On a related but different note, there is a step in blood donation where the donor can privately and confidentially say “don’t use my blood.” This was instituted because there is often a lot of peer pressure to give blood in blood drives and the things that make your blood ineligible are often stigmatizing, so people won’t tell their friends “sorry, I am ineligible to give blood.” I am not sure, but I think the things you are reminded of at this step are behavioral risk factors.

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  3. In Quebec, I am permanently banned from giving blood on account of CJD/mad cow disease: one of the exclusions is “People who have spent one month or more in the United Kingdom between January 1, 1980 and December 31, 1996 inclusively.” Needless to say I am not banned from giving blood when I go back to the UK (although that’s before we get into anything to do with sexuality of course).

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