American Morning
Despite shortage, blood donors turned away
From CNN's Ben Tinker
NEW YORK – Montclair State University junior Dustin Weinstein recalls the excitement leading up to his first blood drive.
"I had never been to donate blood before," he says, "and I actually believe it was a friend of mine who told me they were going to be on campus."
But then came the lengthy screening questionnaire, and his hopes of helping others in need were dashed.
"The question said, 'Are you a male who's had sexual contact with another male, even once, since 1977?'" he recalls. "I said yes, and sure enough, they came back to me with a pink slip that said 'You're being chosen to be deferred.'"
Weinstein didn't realize that a more than two-decade old FDA policy bars him and millions of other men – who admit to same-sex contact – from giving blood.
AIDS activist Phil Wilson calls the policy outdated. "I think in 1985, there's a lot we didn't know about HIV. There's a lot we didn't know about prevention. There's a lot we didn't know about treatment. But now we know a lot more."
Wilson is not alone. The American Association of Blood Banks has tried to get the FDA to loosen the restriction. They're not only running low on blood; donations are steadily declining as the need for healthy blood continues to rise.
Weinstein says he's HIV-negative and the FDA should take that into account, rather than his sexuality. "The fact that HIV came in as the 'gay disease,'" he says. "I think that stigma really sticks with people. They figure they can just block it all out that way."
The FDA says their primary concern is safeguarding the 4.5 million people who receive blood transfusions every year in the U.S. and Canada. In a written statement to CNN, FDA spokeswoman Peper Long writes:
"THE FDA'S DEFERRAL POLICIES ARE BASED ON SCIENTIFIC EVIDENCE CONCERNING INFECTION RATES FOR AGENTS SUCH AS HIV THAT ARE ASSOCIATED WITH CERTAIN SOCIAL BEHAVIORS."
If they allowed men who have sex with other men to donate blood, the risk of HIV would be 60 times greater, they say. But Wilson says that policy is discriminatory and not scientific.
"There's nothing inherently risky about being a gay or bisexual man," he asserts. "A gay or bisexual man who never has unprotected sexual contact is far less risky than a heterosexual man who has unprotected sex with a woman, flat out."
According to the Centers for Disease Control and Prevention, heterosexual HIV rates are rising, especially among African-American women. But neither heterosexuals nor Black women are barred from giving blood.
"I don't think it'd be allowed," says Weinstein. "There'd be a huge public outcry."
Wilson agrees. "We should educate people about their risk, and if you're engaged in a risky behavior," he says, "then we should educate people to refrain from giving blood because they're engaged in a risky behavior."
The FDA, for their part, says they regularly reevaluate the policy and would change it only if supported by scientific data showing that a change would not present a significant and preventable risk to blood recipients. Data, the agency says, has not yet been provided that shows blood donated by men who have sex with other men is as safe as blood from currently-accepted donors.
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As the medical director of a blood bank, I, along with a large number of my fellow AABB members, do not agree with the position of the AABB that MSM should be allowed to donate blood. A few points to ponder:
The argument that there is some sort of "right" to donate is ridiculous. There can be no right to donate anything, as such a right would by necessity allow the donor to impose an obligation to accept the gift on the recipient of the gift, thus terminating the recipient's right to refuse.
Those who state that our tests are "good enough" to allow us to detect the donations of HIV-infected blood demonstrate a fundamental lack of understanding of how scientific testing is performed and measured. At the risk of being technical, MSM advocates and those in the AABB who advance the MSM position are focused on the sensitivity and specificity of testing, when the appropriate measure to consider is the Negative Predictive Value (NPV) of the test.
To quote Wikipedia: "The negative predictive value is the proportion of patients with negative test results who are correctly diagnosed." When we are talking about testing blood for a terrible illness like HIV, that is exactly what we want to be certain of, that a negative test really means that the blood is truly free of HIV virus. And NPV is maximized by excluding as many people with the disease from the pool of tested blood.
I know the reader's eyes likely just glazed over with this talk of statistics, but this distinction is critical, since there are NO perfect medical tests, and some testing error is as inevitable as the sun coming up in the morning. Unlike the sensitivity and specificity of a test, the NPV is critically dependent on the numbers of people who have a disease in the population that is being tested. More infected units in your donated blood will ultimately lead to more disease- positive units slipping through, so you want to do everything you can to make sure that true cases of a disease in the population you are testing are as rare as you can make them. This maximizes the NPV.
According to the CDC data, MSM still account for approximately 75% of all the new cases of HIV in this country. Talk of rising numbers of heterosexuals who have the disease is a perfect example of journalistic obfuscation of the truth, as the absolute numbers of new cases of HIV among heterosexuals is dwarfed by the numbers of new cases in the gay community.
I would have no objection, at least theoretically, to accepting blood after a 12 month period of no MSM contact, but practically speaking, it is ludicrous to propose such a concept, as the gay and bisexual population, in order to donate, would have to be celibate for 12 months. How many people reading this really think that large numbers of people will practice celibacy for 12 months just so they can donate blood? It's absolute silliness to think people would do so, no matter that they are gay, bisexual or heterosexual!
Finally, those who state the FDA policy is somehow discriminatory against homosexuals often intentional ignore the obvious flaw in this argument: Women who have sex with other women (WSW) are not deferred. Why? Because the rate of new cases of HIV among the lesbian community is miniscule, if one excludes those who have sex with MSM, or those who do IV drugs.
The FDA's MSM deferral policy is not a "gay" bashing effort, nor is it an attempt to impose some official form of sexual morality. The FDA's policy is merely the cold, dispassionate application of irrefutable mathematical facts and methods on stemming the transmission of a terrible disease. The success of the current measures can be seen clearly in the vanishingly rare cases of transfusion transmission of HIV in the current day American health care system. Compare that with the situation 20 years ago.........
The bottom line is that unless those that advocate tallowing MSM's to donated blood fully understand these concepts (and that includes many of my colleagues who should know better), they should leave the decision making to the physicians and other scientists who have a full understanding of these fundamental principles of medical testing. If the MSM advocates want to help make the decisions, then they could start by educating themselves about the statistical concepts that drive the FDA's policy......of course, if they really understood the statistics, then they would understand why MSM donations are a bad idea and then they could no longer advocate (at least honestly) for the MSM blood donation cause.
The decision-making regarding MSM and blood donations seems to break into two camps: advocacy and critical thinking based on science. The advocacy camp believes that the FDA discriminates against MSM but donating blood is not a right. To my knowledge there have been no court cases in the US where discrimination has been alleged and won regarding the MSM and blood donation issue. The science camp wants to protect the blood supply and provides ample evidence regarding MSM health statistics to show why blood industry scientists are concerned about the deferral policy. Assume that the deferral period were cut to 12 months, how many MSM would be celibate for that entire year just to give blood? There are other groups that have horrible statistics regarding STDs but one cannot reason by analogy and therefore conclude that since they can give so to should MSM.