MSM blood donor controversy
Encyclopedia
The Men who have sex with men
(MSM) blood donor controversy is a dispute over prohibitions on donations of blood
or tissue for transplantation
. MSM is a classification of men who engage (or have engaged in the past) in sex with other men, regardless of whether they identify themselves as homosexual, bisexual or heterosexual. This group is considered to be at high risk for HIV/AIDS and some types of hepatitis
, viruses that can be transmitted in blood transfusion
s. Restrictions on donors are often called "deferrals" since in some cases blood donors who are found ineligible may be accepted at a later date. The restrictions vary from country to country, and in many cases men are deferred who have not had sex with men for many years. The restrictions affect MSM and the female sex partners of MSM. They do not otherwise affect women, including women who have sex with women
.
Many LGBT
organizations view the restrictions on donation as based on homophobia
and not based on valid medical concern since donations are rigorously tested
to rule out donors that are infected. Proponents of the lifetime restriction defend it because of the risk of false negative test results and because the MSM population tends to have a relatively high prevalence of HIV/AIDS infection. For instance, in the United States
, men who have had sex with a man after 1977 have an HIV prevalence 60 times higher than the general population. An evaluation, in Australia, of relative risk between a year deferral after the most recent MSM contact and a 5-year deferral showed no evidence of a significantly increased risk of transfusion-transmitted HIV.
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} People of any orientation involved in any kind of sexual activity are welcome to donate blood, unless their sexual behaviour is risky and does expose them to STDs by i.e. unprotected sex with non-trusted partners.
}
Female sexual partners of MSM are deferred for one year since the last exposure. This is the same policy used for any sexual partner of someone in a high risk group. The intent of these policies is to ensure that blood is collected from a population that is at low risk for disease, since the tests are not perfect and human error may lead to infected units not being properly discarded. The policy was first put in place in 1985.
Donors of what the FDA calls "HCT/P's", a category that includes transplants (other than organs) and some reproductive tissue, notably anonymous semen donations, are ineligible for five years after the most recent contact. UNOS policies for Organ donation
require the hospital receiving the organ to be notified if the donor was an MSM within the past 5 years. The organs are generally used unless there is a clear positive test for a disease.
A similar policy exists in the rest of the European Union and is the prevailing interpretation of the European Union Directive 2004/33/EC article 2.1 on donor deferrals. The policy, however, is not very specific and refers to "high risk sexual contact."
In Finland the parliamentary ombudsman launched an investigation on the possible unconstitutionality of the life-time ban in January 2006. In June 2008 it was concluded that the ban was not unlawful in Finland as it is based on "appropriately reasoned epidemiological information" and because it is related to sexual behaviour rather than sexual orientation. The ombudsman added that people over the age of 65 and people who lived in Britain during the bovine spongiform encephalopathy
(mad cow disease) outbreak are also screened out during blood donor interviews.
) and 2000 (ACT
, NSW
).
A comparison of confirmed HIV positive blood donations before and after the change did not see a statistically significant difference, though the number of HIV positive blood donations during the period with a 12 month deferral was greater. In all of the cases of HIV positive donations associated with MSM after the 12 month deferral, the donors had lied about their medical history and would not have been eligible under either criterion.
Other criticism stems from the fact that the ban is a blanket ban encompassing all men who have had sex with another man, even once during their lifetime. Critics claim that a promiscuous heterosexual male is a higher-risk donor than a gay or bisexual man in a monogamous relationship, for example a civil partnership in the United Kingdom
, but the former will usually be allowed to donate blood. Furthermore, other high-risk activities such as paying (or being paid) for sex have a set deferral period before the donor is allowed to donate blood, whereas MSM donors are deferred indefinitely. In the US, for example, potential donors that are MSM may never donate, but those who have engaged in being paid for sex or have ever injected non-medical drugs are also deferred indefinitely. Their sexual partners, including those that pay for sex, are deferred for twelve months.
method looked for antibodies, which are the immune system's response to the virus. However, there is a window period
when using this method in which a person who has been infected with HIV is able to spread the disease but may test negative for the virus. This window period can be as long as three to six months, with an average of 22 days. Tests using the ELISA methods are often still used in developed countries because they are extremely sensitive
. In developing countries, these tests are often the only method used to screen donated blood for HIV. To cover the window period resultant from the use of these tests, donors are also screened for high risk behaviors, one of which is a history of same-sex sexual activity among male potential donors. Other groups with similar restrictions include commercial sex workers and injection drug users.
Newer tests look for the virus itself, such as the p24 antigen test, which looks for a part on the surface of the virus, and Nucleic acid tests (NAT), which look for the genetic material of the virus. With these tests, the window period is shorter, with an average duration of 12 days. Opponents of donation restrictions in certain groups believe that this is an acceptable risk.
Men who have sex with men
Men who have sex with men are male persons who engage in sexual activity with members of the same sex, regardless of how they identify themselves; many men choose not to accept sexual identities of homosexual or bisexual...
(MSM) blood donor controversy is a dispute over prohibitions on donations of blood
Blood donation
A blood donation occurs when a person voluntarily has blood drawn and used for transfusions or made into medications by a process called fractionation....
or tissue for transplantation
Organ transplant
Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be...
. MSM is a classification of men who engage (or have engaged in the past) in sex with other men, regardless of whether they identify themselves as homosexual, bisexual or heterosexual. This group is considered to be at high risk for HIV/AIDS and some types of hepatitis
Hepatitis
Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
, viruses that can be transmitted in blood transfusion
Blood transfusion
Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...
s. Restrictions on donors are often called "deferrals" since in some cases blood donors who are found ineligible may be accepted at a later date. The restrictions vary from country to country, and in many cases men are deferred who have not had sex with men for many years. The restrictions affect MSM and the female sex partners of MSM. They do not otherwise affect women, including women who have sex with women
Women who have sex with women
Women who have sex with women is a term used to identify women who engage in sexual activities with other women, whether or not they identify themselves as lesbian or bisexual...
.
Many LGBT
LGBT
LGBT is an initialism that collectively refers to "lesbian, gay, bisexual, and transgender" people. In use since the 1990s, the term "LGBT" is an adaptation of the initialism "LGB", which itself started replacing the phrase "gay community" beginning in the mid-to-late 1980s, which many within the...
organizations view the restrictions on donation as based on homophobia
Homophobia
Homophobia is a term used to refer to a range of negative attitudes and feelings towards lesbian, gay and in some cases bisexual, transgender people and behavior, although these are usually covered under other terms such as biphobia and transphobia. Definitions refer to irrational fear, with the...
and not based on valid medical concern since donations are rigorously tested
HIV test
HIV tests are used to detect the presence of the human immunodeficiency virus , the virus that causes acquired immunodeficiency syndrome , in serum, saliva, or urine. Such tests may detect antibodies, antigens, or RNA.- Terminology :...
to rule out donors that are infected. Proponents of the lifetime restriction defend it because of the risk of false negative test results and because the MSM population tends to have a relatively high prevalence of HIV/AIDS infection. For instance, in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, men who have had sex with a man after 1977 have an HIV prevalence 60 times higher than the general population. An evaluation, in Australia, of relative risk between a year deferral after the most recent MSM contact and a 5-year deferral showed no evidence of a significantly increased risk of transfusion-transmitted HIV.
MSM and HIV/AIDS
In many developed countries HIV is more prevalent among MSM than among the general population. In the United States, MSM accounted for 49 percent of new HIV diagnoses reported in 2005. Estimates of the percentage of men in the US who have had sex with men vary from 0.5% to 13.95%. The US Census does not ask about sexual practices. African Americans, who are also at high risk but are not banned from donating blood, accounted for 49 percent of new HIV diagnoses reported in 2007 and 12% of the population. The MSM risk group is the only group in which the annual number of infections is increasing.Countries with known restrictions
This list shows countries that had restrictions on blood donors. Most national standards require direct questioning regarding a man's sexual history, but the length of deferral varies.- Indefinite (permanent) deferral:
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- Deferral for five years since last exposure:
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- Deferral for one year since last exposure:
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- Deferral for six months since last exposure:
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- Previously deferred MSM, now uses screening criteria that do not mention MSM:
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} People of any orientation involved in any kind of sexual activity are welcome to donate blood, unless their sexual behaviour is risky and does expose them to STDs by i.e. unprotected sex with non-trusted partners.
}
United States
In the US, the current guidance from the U.S. Food and Drug Administration (FDA) is to permanently defer any male donor who has had sex with another man, in the period from 1977 to the present day.Female sexual partners of MSM are deferred for one year since the last exposure. This is the same policy used for any sexual partner of someone in a high risk group. The intent of these policies is to ensure that blood is collected from a population that is at low risk for disease, since the tests are not perfect and human error may lead to infected units not being properly discarded. The policy was first put in place in 1985.
Donors of what the FDA calls "HCT/P's", a category that includes transplants (other than organs) and some reproductive tissue, notably anonymous semen donations, are ineligible for five years after the most recent contact. UNOS policies for Organ donation
Organ donation
Organ donation is the donation of biological tissue or an organ of the human body, from a living or dead person to a living recipient in need of a transplantation. Transplantable organs and tissues are removed in a surgical procedure following a determination, based on the donor's medical and...
require the hospital receiving the organ to be notified if the donor was an MSM within the past 5 years. The organs are generally used unless there is a clear positive test for a disease.
History of calls to change the policy
- In 2006, the AABBAABBThe AABB is a United States-based professional body and standards organization that was founded in 1947 as the American Association of Blood Banks. The organization is now international with members in 80 countries and has taken on a broader scope to include all of transfusion medicine as well as...
, American Red CrossAmerican Red CrossThe American Red Cross , also known as the American National Red Cross, is a volunteer-led, humanitarian organization that provides emergency assistance, disaster relief and education inside the United States. It is the designated U.S...
, and America's Blood CentersAmerica's Blood CentersAmerica’s Blood Centers is North America’s largest network of non-profit blood centers. Made up of 600 donor centers in 45 states and Quebec, America’s Blood Centers’ members collect more than 8 million units of whole blood, nearly half of the U.S. and Quebec, Canada volunteer donor blood supply...
all supported a change from the current US policy of a lifetime deferral of MSM to one year since most recent contact. One model suggested that this change would result in one additional case of HIV transmitted by transfusion every 32.8 years. The AABB has suggested making this change since 1997. The FDA did not accept the proposal and had concerns about the data used to produce the model, citing that additional risk to recipients was not justified.
- In April 2010, the New York City Council passed a resolution calling on the U.S. Food and Drug Administration (FDA) to eliminate the ban stating "This ban was based on prejudice, a knee-jerk reaction, and misunderstandings about the HIV/AIDS disease. Given the constant need for blood, it does not make common sense to prohibit donations from an entire population."
- On August 19, 2009, the Assembly Judiciary Committee in California passed AJR13, the U.S. Blood Donor Nondiscrimination Resolution, calling upon the FDA to end the MSM blood ban.
- On June 1, 2010, the Washington, DC City Council passed a resolution calling on the FDA to "reverse the lifetime deferment of blood donations by men who have had sex with men since 1977 in favor of a policy that protects the safety and integrity of the blood supply that is based on an up-to-date scientific criteria."
European Union
The UK lifted its ban on gay male blood donation in September 2011. However, any man who reports having sex with another man within the twelve months will remain deferred from donating. The Advisory Committee on the Safety of Blood, Tissues and Organs recommended the policy change after a study concluded that a total ban may breach equality legislation and that the risk of HIV reaching the blood supply would only increase by approximately 2%.A similar policy exists in the rest of the European Union and is the prevailing interpretation of the European Union Directive 2004/33/EC article 2.1 on donor deferrals. The policy, however, is not very specific and refers to "high risk sexual contact."
In Finland the parliamentary ombudsman launched an investigation on the possible unconstitutionality of the life-time ban in January 2006. In June 2008 it was concluded that the ban was not unlawful in Finland as it is based on "appropriately reasoned epidemiological information" and because it is related to sexual behaviour rather than sexual orientation. The ombudsman added that people over the age of 65 and people who lived in Britain during the bovine spongiform encephalopathy
Bovine spongiform encephalopathy
Bovine spongiform encephalopathy , commonly known as mad-cow disease, is a fatal neurodegenerative disease in cattle that causes a spongy degeneration in the brain and spinal cord. BSE has a long incubation period, about 30 months to 8 years, usually affecting adult cattle at a peak age onset of...
(mad cow disease) outbreak are also screened out during blood donor interviews.
Australia
Australia's individual states and territories each had their own policies on blood donations by MSM. Most previously had some form of the indefinite deferral, and they all changed to a 12 month deferral at different times between 1996 (SASouth Australia
South Australia is a state of Australia in the southern central part of the country. It covers some of the most arid parts of the continent; with a total land area of , it is the fourth largest of Australia's six states and two territories.South Australia shares borders with all of the mainland...
) and 2000 (ACT
Australian Capital Territory
The Australian Capital Territory, often abbreviated ACT, is the capital territory of the Commonwealth of Australia and is the smallest self-governing internal territory...
, NSW
New South Wales
New South Wales is a state of :Australia, located in the east of the country. It is bordered by Queensland, Victoria and South Australia to the north, south and west respectively. To the east, the state is bordered by the Tasman Sea, which forms part of the Pacific Ocean. New South Wales...
).
A comparison of confirmed HIV positive blood donations before and after the change did not see a statistically significant difference, though the number of HIV positive blood donations during the period with a 12 month deferral was greater. In all of the cases of HIV positive donations associated with MSM after the 12 month deferral, the donors had lied about their medical history and would not have been eligible under either criterion.
Reasoning for the restrictions
Blood services commonly justify their bans against MSM using the statistically high prevalence of HIV and hepatitis of MSM in population studies. The last statistical and epidemiological review into blood service policy in the UK found that if the ban on MSM donating blood were to be lifted, the risk of HIV entering blood stocks would increase by 500%. This brings into question the effectiveness of blood testing services of all blood donors. The review also found that if the ban was changed to only exclude men who have had sex with another man in the previous 12 months, the increase would still be roughly 60%. Under the soon-to-be-implemented ten year deferral policy, risk to the blood supply is expected to increase by 2%.Criticism of the restrictions
Objections to the restrictions are generally based on the idea that improvements in testing and other safeguards have reduced the risk from transfusion transmitted HIV to an acceptable level. Blood shortages are common, and critics of the policies point out that excluding healthy donors only makes the problem worse. "Ideal" inventories are at least a three day supply, but many blood centers struggle to meet this demand.Other criticism stems from the fact that the ban is a blanket ban encompassing all men who have had sex with another man, even once during their lifetime. Critics claim that a promiscuous heterosexual male is a higher-risk donor than a gay or bisexual man in a monogamous relationship, for example a civil partnership in the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, but the former will usually be allowed to donate blood. Furthermore, other high-risk activities such as paying (or being paid) for sex have a set deferral period before the donor is allowed to donate blood, whereas MSM donors are deferred indefinitely. In the US, for example, potential donors that are MSM may never donate, but those who have engaged in being paid for sex or have ever injected non-medical drugs are also deferred indefinitely. Their sexual partners, including those that pay for sex, are deferred for twelve months.
United States
- Throughout the 2000s, several boycotts have been held on college campuses across the United States against blood drives. For example, in 2003, a blood drive at the University of Vermont was cancelled to protest the MSM donor policy. In 2007, an Iowa State UniversityIowa State UniversityIowa State University of Science and Technology, more commonly known as Iowa State University , is a public land-grant and space-grant research university located in Ames, Iowa, United States. Iowa State has produced astronauts, scientists, and Nobel and Pulitzer Prize winners, along with a host of...
student group sparked controversy when they pulled their support for a blood drive. In 2008, a faculty member at Sonoma State UniversitySonoma State UniversitySonoma State University is a public, coeducational business and liberal arts college affiliated with the California State University system. The main campus is located in Rohnert Park, California, United States and lies approximately south of Santa Rosa and north of San Francisco...
proposed a ban on blood drives on campus, and at San Jose State UniversitySan José State UniversitySan Jose State University is a public university located in San Jose, California, United States...
President Don Kassing suspended all blood drives on campus. In 2010, students from Keene State CollegeKeene State CollegeKeene State College is a liberal arts college in Keene, New Hampshire. It is a member of the University System of New Hampshire and of the Council of Public Liberal Arts Colleges....
protested blood drives on their campus. On April 14, 2011, The Queens College Academic Senate of The City University of New York recommended that all blood drives on campus should cease. The recommendation was adopted by Queens College President James Muyskens but reversed in June 2011 when the CUNY chancellory expressed its disapproval. http://www.qc.cuny.edu/Academics/AcademicSenate/Documents/Minutes/110414.pdf In March of that same year (CCNY) The City College of New York, of The City University of New York also ceased all Blood Drives on their campus - On June 10, 2010, a group of bloggers led by Adam Bink of OpenLeft.com created a blog swarm asking people to submit a public comment to Dr. Jerry Holmberg of the Advisory Committee on Blood Safety and Availability, asking the committee to revise the ban. On June 11, 2010, the Committee voted 9-6 against lifting the ban. In a follow-up vote, the Committee voted 14-0 to declare the policy "sub-optimal" because "some potentially high-risk donations while preventing some potentially low-risk donations"., an online petition promoted along with the forthcoming documentary movie Save A Life, has 2,383 signatures.
United Kingdom
- The National Union of Students LGBT CampaignNational Union of Students LGBT CampaignThe National Union of Students LGBT Campaign is a self running part the National Union of Students to help liberate LGBT students. The LGBT liberation campaign runs autonomously to the NUS with its own constitution and elected officials.- Campaigns :...
runs a "Donation Not Discrimination" campaign to have the blood ban revised, while also advocating for those who are not banned from donating.
Testing and screening
In the earliest years of the AIDS epidemic, there were no reliable tests for the virus. In 1985, early tests using the ELISAELISA
Enzyme-linked immunosorbent assay , is a popular format of a "wet-lab" type analytic biochemistry assay that uses one sub-type of heterogeneous, solid-phase enzyme immunoassay to detect the presence of a substance in a liquid sample."Wet lab" analytic biochemistry assays involves detection of an...
method looked for antibodies, which are the immune system's response to the virus. However, there is a window period
Window period
In medicine, the window period for a test designed to detect a specific disease is the time between first infection and when the test can reliably detect that infection...
when using this method in which a person who has been infected with HIV is able to spread the disease but may test negative for the virus. This window period can be as long as three to six months, with an average of 22 days. Tests using the ELISA methods are often still used in developed countries because they are extremely sensitive
Sensitivity and specificity
Sensitivity and specificity are statistical measures of the performance of a binary classification test, also known in statistics as classification function. Sensitivity measures the proportion of actual positives which are correctly identified as such Sensitivity and specificity are statistical...
. In developing countries, these tests are often the only method used to screen donated blood for HIV. To cover the window period resultant from the use of these tests, donors are also screened for high risk behaviors, one of which is a history of same-sex sexual activity among male potential donors. Other groups with similar restrictions include commercial sex workers and injection drug users.
Newer tests look for the virus itself, such as the p24 antigen test, which looks for a part on the surface of the virus, and Nucleic acid tests (NAT), which look for the genetic material of the virus. With these tests, the window period is shorter, with an average duration of 12 days. Opponents of donation restrictions in certain groups believe that this is an acceptable risk.
See also
- Terminology of homosexualityTerminology of homosexualityThe terminology of homosexuality has been a contentious issue since the emergence of LGBT social movements in the mid-19th century. As with racial terms within the United States—such as negro, black, colored, and African American—the choice of terms regarding sexual orientation may imply a certain...
- Men who have sex with menMen who have sex with menMen who have sex with men are male persons who engage in sexual activity with members of the same sex, regardless of how they identify themselves; many men choose not to accept sexual identities of homosexual or bisexual...
("MSM") - Women who have sex with womenWomen who have sex with womenWomen who have sex with women is a term used to identify women who engage in sexual activities with other women, whether or not they identify themselves as lesbian or bisexual...
("WSW")
External links
- FDA:Blood Products Advisory Committee, 09Mar2006 transcript See page 53 (page 59 of the pdf) for the discussion of test error rates. Warning: this is a 133 MB scanned transcript.
- CDC: HIV/AIDS among Men Who Have Sex with Men
- British Medical Journal Debate: Should men who have ever had sex with men be allowed to give blood? No
- British Medical Journal Debate: Should men who have ever had sex with men be allowed to give blood? Yes