MSM blood donor controversy

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 transfusions. 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^[1] 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.^[2] 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.^[3]

Contents 1 MSM and HIV/AIDS 2 Current restrictions 2.1 Countries with known restrictions 2.2 United States 2.2.1 History of calls to change the policy 2.3 European Union 2.4 Australia 3 Reasoning for the restrictions 4 Criticism of the restrictions 5 Protests and boycotts 5.1 United States 5.2 United Kingdom 6 Testing and screening 7 See also 8 References 9 External links

MSM and HIV/AIDS

In many developed countries HIV is more prevalent among MSM than among the general population.^[4] In the United States, MSM accounted for 49 percent of new HIV diagnoses reported in 2005.^[5] 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.^[6] The MSM risk group is the only group in which the annual number of infections is increasing.^[7]

Current restrictions

Countries with known restrictions

This list shows countries that had restrictions on blood donors.^[8][3] Most national standards require direct questioning regarding a man's sexual history, but the length of deferral varies.

• Indefinite (permanent) deferral:
  •  Algeria
  •  Austria^[9]
  •  Belgium^[10]
  •  Canada^[3]
  •  China
    •  Hong Kong^[11]
  •  Croatia^[12]
  •  Czech Republic
  •  Denmark
  •  Estonia
  •  Finland
  •  France
  •  Greece
  •  Iceland
  •  Ireland
  •  Israel
  •  Malta
  •  Netherlands^[13]
  •  Norway
  •  Portugal
  •  Philippines
  •  Slovenia^[14]
  •  Switzerland
  •  Turkey
  •  United States^[3]
• Deferral for five years since last exposure:
  •  New Zealand^[3][15]
• Deferral for one year since last exposure:
  •  Argentina^[3]
  •  Australia
  •  Brazil
  •  Hungary^[3]
  •  Japan^[3]
  •  Sweden^[16]
  •  United Kingdom^[17] (Except in Northern Ireland)
• Deferral for six months since last exposure:
  •  South Africa^[3]
• Previously deferred MSM, now uses screening criteria that do not mention MSM:
  •  Germany^[18]
  •  Italy^[3]
  •  Poland^{[3][19][20][21]} People of any sexual orientation involved in any kind of sexual activity are welcome to donate blood, if they are confident that their sexual behaviour is safe and does expose them to sexually transmitted diseases by i.e. unprotected sex with non-trusted partners, whether homo-, bi- or heterosexual.
  •  Spain^[3]

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.^[22]

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.^[23] 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.^[24]

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.^[25] 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.^[26] 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 AABB, American Red Cross, and America's Blood Centers all supported a change from the current US policy of a lifetime deferral of MSM to one year since most recent contact.^[27] 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."^[28]

• 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.^[29]

• 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."^[30]

European Union

The UK lifted its ban on gay male blood donation in September 2011^[17]. However, any man who reports having sex with another man within the twelve months will remain deferred from donating.^[31] 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%.^[32]

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.^[33] 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.

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 (SA) and 2000 (ACT, NSW).^[3]

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.^[3]

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%.^[34][35] Under the soon-to-be-implemented ten year deferral policy, risk to the blood supply is expected to increase by 2%.^[32]

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.^[36]

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.

Protests and boycotts

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.^[37] In 2007, an Iowa State University student group sparked controversy when they pulled their support for a blood drive.^[38] In 2008, a faculty member at Sonoma State University proposed a ban on blood drives on campus,^[39] and at San Jose State University President Don Kassing suspended all blood drives on campus.^[40] In 2010, students from Keene State College protested blood drives on their campus.^[41] 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.^[42] 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.^[43] 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".^[44]
• As of March 2011^[update], an online petition promoted along with the forthcoming documentary movie Save A Life^[45], has 2,383 signatures.^[46]

United Kingdom

• The National Union of Students LGBT Campaign 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 ELISA 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,^[47] with an average of 22 days.^[48] 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.^[48] Opponents of donation restrictions in certain groups believe that this is an acceptable risk.

See also

• Terminology of homosexuality
• Men who have sex with men ("MSM")
• Women who have sex with women ("WSW")

References

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