A Stitch in Haste

I have to admit I’ve been rather ambivalent about the American Red Cross and their policy of blanket exclusion of anyone who has had gay sex, um, ever.

I had two reasons for giving the Red Cross a bye:

--The policy is actually a Food and Drug Administration policy rather than a Red Cross policy.

--In terms of giving aid to international disaster relief, such as the Boxing Day tsunami, I am adamant that my charitable giving abroad be clearly and unequivocally labeled “American” money.

But after further review, inspired by this story about a student government boycott of American Red Cross blood drives at the University of Maine, I find that the Red Cross isn’t as unwilling a participant in the gay blood ban as one might hope.

Dr. Rebecca Haley, interim chief medical officer for the American Red Cross, told the committee that the Red Cross did not support changing the current ban on blood donation by from men who have engaged in homosexual behavior during the past 24 years because of the risk of introducing HIV-positive blood into the national blood supply. Although Dayton's risk analysis found that "introduction of a five year floating deferral for male-to-male sexual behavior, even using conservative estimates, would result in minimal increased morbidity in the blood supply by HIV," the Red Cross urged caution in changing a policy that so far has kept the blood supply virtually free of tainted blood.
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"If the Public Health Service could assure us that introducing previously deferred donors into the pool could be accommodated without increasing risk, the American Red Cross would support appropriate actions to do so," Haley said.

Dayton estimated that there are 62,300 men who want to donate blood, but are prohibited from doing so by the current law.

Considering the known incidence and prevalence rates of HIV infection in this population, he said, changing to a five-year deferral policy could potentially introduce 1,246 units of HIV-positive blood into the system to be screened. Testing done on each of these units would likely result in an added 1.7 units of HIV-infected blood into the nation's blood supply, experts said at the meeting.

On the one hand, that “62,300” figure is a joke — there are probably that many gays in New York City alone who would give blood if allowed. On the other hand, 1.7 units! What exactly is the difference between “virtually free” and 1.7 units? (Remember, all donated blood is tested for HIV — we are talking here about mistaken transfusion due to testing failures, the rates for which are obviously miniscule.)

Of course allowing gays to donate blood increases the hypothetical risk that a less-than-negligible amount of HIV+ blood makes it way into the blood supply. But what of the very real offsetting risk of having a severe chronic blood shortage? This is not about risky versus riskless, it’s about a (small) potential risk versus a (large) actual risk. What unbiased observer would choose the latter?

That’s not science. That’s not public health. That’s politics. And it’s a politics that kills.

Still not satisfied? How about this: Allow anyone to donate blood if they meet all the other screening criteria and can produce lab results indicating that they tested HIV negative within the past year? That would reduce the 1.7 units estimate to essentially zero. Anyone who would be opposed to that (which would still be discriminatory, but better than a blanket exclusion) is clearly more interested in keeping the blood supply gay-free rather than HIV-free.

I still can’t say without reservation that boycotting the American Red Cross’ disaster relief work is necessarily the proper course of action when disaster strikes abroad. But it’s time for the junk science and political undertows at work in the gay blood donor ban to stop. Not just in the name of gay dignity, but also in the name of alleviating the public health crisis spawned by this unwarranted hysteria.

Gay doctors, nurses and public health specialists need to speak out. Symbolic protests like that at the University of Maine can't hurt either. Education is the weapon; we need to start using it.

Just a few days ago I decried the outdated, bigoted and dangerous ban on gays donating blood.

Well, it terms out I had a case of premature elucidation:

To the dismay of gay-rights activists, the Food and Drug Administration is about to implement new rules recommending that any man who has engaged in homosexual sex in the previous five years be barred from serving as an anonymous sperm donor.

The FDA has rejected calls to scrap the provision, insisting that gay men collectively pose a higher-than-average risk of carrying the AIDS virus. Critics accuse the FDA of stigmatizing all gay men rather than adopting a screening process that focuses on high-risk sexual behavior by any would-be donor, gay or straight.

"Under these rules, a heterosexual man who had unprotected sex with HIV-positive prostitutes would be OK as a donor one year later, but a gay man in a monogamous, safe-sex relationship is not OK unless he's been celibate for five years," said Leland Traiman, director of a clinic in Alameda, Calif., that seeks gay sperm donors.
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In a letter to the FDA, Lambda Legal has suggested a screening procedure based on sexual behavior, not sexual orientation. Prospective donors -- gay or straight -- would be rejected if they had engaged in unprotected sex in the previous 12 months with an HIV-positive person, an illegal drug user, or "an individual of unknown HIV status outside of a monogamous relationship."

Now certainly there isn't the same national urgency with sperm donation as with our ubiquitous blood shortage. Nevertheless, there can be no justification for rules that are not only discriminatory but also downright irrational. This policy is based on and perpetuates the most nonsensical of gay stereotypes. Shame on the FDA.

As I blogged about blood donation: This is not science. This is not public health. This is politics.

I like the sound of the Lambda proposal. But if that's not enough, then why not implement the same proposal I suggested in my post on the blood donor ban: Allow anyone to donate if they meet all the other screening criteria and can produce lab results indicating that they tested HIV negative within the past year?

The American Red Cross has lost its third president in a decade:

[Marsha] Evans was hired in 2002 after the stormy departure of its former CEO, Bernadine Healy, who was forced out in 2001, shortly after the Sept. 11 terrorist attacks.

Jack McGuire, executive vice president of the Red Cross' biomedical services, has been named interim president and chief executive, the charity said today.

"The organization will maintain its current strategy, direction and programs and will continue to ensure the continuity and stability of ongoing Red Cross operations," the Red Cross said in a statement on its Web site.

If McGuire, a biomedical insider, were to become the permanent president of the ARC, then perhaps that would be an opportunity for the American Red Cross to revisit its ongoing support of the archaic, ineffective and insultory practice of banning any male potential blood donor who has ever had any homosexual intercourse, ever. (Recall that the gay blood donor ban is actually an FDA policy, but the ARC has been fully supportive of the ban since it was implemented.)

All donated blood is already tested for HIV (and other diseases). Blood can be preserved long enough to re-test after the incubation period for HIV. In short, there is already far less risk — and that could become zero risk — from transmitting HIV through donated blood than there is from the alternative: not having enough donated blood to meet healthcare needs.

It isn't just about the indignity and illogic of the gay blood ban. It isn't just about the legitimacy that the (putatively "scientific") ban provides for bona fide anti-gay bigots. It is also about saving lives. The gay blood ban unnecessarily worsens an already critical blood shortage.

The shakeup at the ARC may be "only" about money and possible mismanagement. But that doesn't mean that other aspects of the ARC's operations can't also be shaken up a bit.

Because this is one ARC policy that certainly needs shaking up.

It's about time:

Officials from the American Red Cross, speaking at a recent blood donation conference in Maryland, called for an end to the federal government's ban on gay and bisexual blood donors, the Washington Blade reports.

A Food and Drug Administration policy in place since 1985 bans donations from any man who's ever had sex with another man -- even one time -- since 1977. Even gay men who've tested negative for HIV antibodies and those who are in monogamous relationships are barred for life from donating blood.
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"The [American Association of Blood Banks, America's Blood Centers] and ARC believe that the current lifetime deferral for men who have had sex with other men is medically and scientifically unwarranted and recommend that deferral criteria be modified and made compatible with criteria for other groups at increased risk for sexual transmission of transfusion-transmitted infections," the groups said in a joint statement issued at the advisory panel meeting.

The shift in position had been widely anticipated in the days before the FDA conference.

The ARC and the FDA have had something of an incestuous relationship regarding the gay blood ban, with the ARC insisting that it was an FDA policy and the FDA insisting that the ARC supported it. Meanwhile, in the pharmaceutical arena, the FDA almost always adopts the recommendations of its advisory panels. Hopefully the same deference to experts will finally prevail here.

Of course, the reaction in the anti-gay community will be swift and vicious, as it always is. Expect gobbledygook such as "people's lives will be put at risk to promote an agenda" and such. Of course, the real risk is from having too little blood in our blood banks, but so what -- the "gay lifestyle" must be opposed at all costs (especially in an election year), right? Maybe there will even be some proposals for state constitutional amendments banning the use of gay blood.

The people who tend to be rabidly anti-gay also tend to be rabidly anti-science (e.g., "Intelligent Design"). The hysteria from religious fundamentalists and the pandering politicians who cater to them will be loud, ugly and wrong. But for the most part we are winning the war of ideas on the science-versus-religion front. Perhaps a similarly favorable trend will emerge on this very important public health and gay equality issue.

In any event, congratulations to the American Red Cross for (finally) being on the right side of history.

(Cross-posted at Spectrum Bloggers.)

Oh bloody hell...

[Dr. Robert] Jones, the chief executive of the New York Blood Center, said that New York City is facing a critical blood shortage, with seasonal summer shortages lasting into the fall.

His organization, which is the major supplier of blood to New York area hospitals and medical facilities, has only a two-day stockpile of some blood types.

"It's still a scary thought that hospitals might run short," he said. "Hospitals, when they feel they don't have the blood supply," Jones said, "may postpone or cancel elective surgery."

He also noted that there was an instance several years ago of a hospital's blood supply becoming so dangerously low that administrators temporarily closed their emergency room.

None of which, of course, appears to be a sufficient reason to press harder for a lift of the nonsensical (and perhaps lethal) ban on all gay blood donors — even those who have not had sex, even safe sex, in a decade and who know, with absolute certainty, that they are HIV-. And even though all donated blood is screened, with literally near-perfect certainty, for HIV.

Because, of course, it is still more logical to incur a near-certain risk of shortage than a near-zero risk of contamination. At least where gays are concerned.

Madness. Sheer madness.

Namely, the gay blood ban:

City blood supplies have dropped to dangerously low levels, raising concern that hospitals do not have enough blood to cope with a major emergency, blood donation officials warn.

"We are down to a one-day supply in some of the critical areas like Type O Negative," said Robert L. Jones, president of the New York Blood Center. "When it gets down to that point hospitals feel like they don't have enough even for routine procedures."
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"We need everybody who possibly can -- between the ages of 16 and 75 -- to step forward and donate blood," said Jones. "Without their help we do not have a blood supply."

The shortages are also partly due to an ignorant, purely political policy that ignores the realities of the blood shortage and medical science in favor of the hysteria-pandering fiction that gay blood is an especial threat to public health.

"Better no blood than gay blood" is a worse disgrace of bigoted illogic than "undermines unit cohesion." And people may well start dying from it.

Just when there was some optimism that the FDA's irrational ban on all blood donations from gay males might reappear on the radar screen of policy priorities, word now comes that our northern neighbor -- generally thought to be far more enlightened on gay issues -- is relapsing into literally lethal bigotry:

A Health Canada regulation that bans most gay men from donating organs is scientifically unjustified, virtually unenforceable and could worsen critical transplant shortages, a prominent Toronto AIDS doctor says.

The regulation, which took effect in December and closely resembles blood-donor guidelines, prohibits organ donations from sexually active gay men, intravenous drug users and hepatitis victims.

[Dr. Gary Levy, head of Canada's largest organ transplant program] says transplant physicians will likely urge Health Canada to reconsider the ban to put the emphasis on high-risk behaviour, whether promiscuous sex or illicit needle use. In the end, however, Levy says transplant surgeons will continue to make the final decision on which organs are suitable for use.

No sane gay activist believes that blood or organ donations should not be screened for HIV or other diseases. Nor would we advocate that gay men -- or anyone else -- who is the least bit uncertain as to their status should donate blood or organs.

But many if not most of us know -- know -- that we are of no risk to the blood or organ supply, for the simple reason that we engage in no high-risk behavior. Given the utterly desperate need for both blood and organs in the U.S. and Canada, the Aristotelian mean between "no testing" and "no donating" -- informed self- and pre-screening based on behavior, coupled with testing of the tissue after the fact -- is surely the preferred policy approach, assuming that the goal is public health and not pandering to bigotry.

Perhaps that's simply too great an assumption.

To review: The gay blood ban demands that a male who has ever had sex with another male, even once, be banned for life from donating blood.

Even under normal circumstances, this ban, an FDA policy not vigorously opposed by blood banks, is objectively absurd now that all blood is screened by an essentially foolproof test, and given that a person can determine, within a window of six months, his HIV status. To retain such a ban during a blood shortage reaching crisis levels is absolute insanity.

To allow a gay man who currently tests HIV- and who has engaged in no high-risk activity for at least six months poses such a negligent risk as to be statistically indistinguishable from zero — and is undeniably warranted, in the name of public health, given the value of a pint of blood during a chronic, systemic shortage.

These facts, this scientific truth easily processed by any unbiased observer with a basic intellectual competence, creates something of a moral dilemma among HIV- negative gay men. Knowing that our blood is safe, and knowing that it is desperately needed, do we lie and indicate that we have never had sex with another man (i.e., deny our sexual orientation). Or do we remain honest, to ourselves and to others, thereby allowing ourselves to be banned and resigning ourselves to stand and watch helplessly while the blood shortage persists?

That is a question that every HIV- gay male must answer in the privacy of his own conscience, and is in fact not the point of this post (though all are certainly free to weigh in with comments).

Rather, this is the point of this post:

San Jose State University's decision this week to ban blood drives on the 30,000-student campus over discrimination concerns is drawing a gush of criticism from local blood banks.

Stanford Blood Center officials said they actually agree with San Jose State President Don Kassing that the federal Food and Drug Administration is wrong to prohibit blood donations from gay men.

But in a statement Friday, the center called his decision to suspend campus blood drives for that reason "a terribly misguided tactic that could have a devastating impact on the blood supply, and therefore, patients in our community."

So suddenly the dilemma is no longer confined to the HIV- gay community but reaches to the larger community of the enlightened. Does a major university, presumably committed not only to fair and equal treatment for gays but also (and more importantly) to scientific truth and statistical objectivity, "do the right thing" and forbid blood drives to help effect change, or does it "do the right thing" and facilitate donations by its students — who tend to be a major component of the donor pool — to alleviate the desperate blood shortage here and now? Improve the future or improve the present?

And, more importantly, how much longer are we going to impose these terrible moral dilemmas on ourselves for no legitimate reason whatsoever?

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Meanwhile:

The American Red Cross, the biggest operator of American blood banks, was fined $4.6 million after regulators found it failed to properly screen blood donations. The Food and Drug Administration sent a letter to the Red Cross describing the agency's findings, said an agency spokeswoman, Peper Long, in an interview. The penalty followed a agency review of blood that was recalled by the Red Cross, she said. Regulators have now fined the Red Cross more than $20 million since the agency and Red Cross entered into a legal agreement in 2003 allowing penalties for failing to follow federal standards to ensure blood is not contaminated, Ms. Long said.

If the Red Cross has even more reason to screen its blood properly, then there is even less reason to have an overreaching, scientifically unwarranted ban on perfectly qualified donors.