Ethical discussion about blood donation.

TiffyRN, BSN, PhD · Jul 21, 2011

I hear you- and you are right. My concern is that not all sexuall contact between all males is "high risk." What about a concordant seronegative monogamous male couple that have been together for 20 years? Their HIV risk is nil. They should be allowed to donate. What a about a single straight woman that has sex with multiple partners and has had anal intercourse without a condom? Her risk is relatively elevated, and she is permitted to donate. This is why we need to test donated blood, and not stigmatize potential donors.

I agree with you. Sadly I think expense is going to keep things the way they are. It is cheaper to draw sweeping conclusions.

Rob72, ASN, RN · Jul 21, 2011

I hear you- and you are right. My concern is that not all sexuall contact between all males is "high risk." What about a concordant seronegative monogamous male couple that have been together for 20 years? Their HIV risk is nil. They should be allowed to donate. What a about a single straight woman that has sex with multiple partners and has had anal intercourse without a condom? Her risk is relatively elevated, and she is permitted to donate. This is why we need to test donated blood, and not stigmatize potential donors.

True, but again, this is placing the "rights" of the donor to particiapte in a social function above the relative safety of the society as a whole. This is Lowest Common Denominator reasoning- because we may offend some in exclusion, we may exclude none until the criteria are PERFECT.

The AABB form is not the best, but is certainly not inappropriate. Local blood centers frequently have their own questionnaires, and I know that several regional facilities do ask about multiple sexual partners w/in the preceding 6 months.

czyja, MSN, RN · Jul 21, 2011

True, but again, this is placing the "rights" of the donor to particiapte in a social function above the relative safety of the society as a whole. This is Lowest Common Denominator reasoning- because we may offend some in exclusion, we may exclude none until the criteria are PERFECT.

Nobody has a right to donate blood. If I implied this, I was most certainly in error.

Actually it is the current policy that uses lowest common denomonator reasoning. The reasoning is that if you you are a man and you have ever had sexual relations with a man then you are at elevated risk for HIV, no matter what sexual actions took place and how long ago they took place, and therefore you must be prohibited from donating blood.

Again, there is no evidence to show this policy makes our blood supply safer. It does, however, make our blood supply substantially smaller. This is foolish.

xtxrn, ASN, RN · Jul 21, 2011

Agree :)

And the initial article referred to someone the blood bank thought "looked" gay.... that's abhorrent to assume anything by appearance, and stigmatize someone because of prejudice. NOT actual facts...

Horseshoe, BSN, RN · Jul 21, 2011

it is a statistical fact that the rate of hiv infections of homosexual males have been decreasing while that of heterosexuals have been increasing.

seems to be conflicting information about gay men being at higher risk for carrying the hiv virus. from yale university:

"new hiv infections have been declining among heterosexuals and injection drug users, but rates have been steadily rising among gay and bisexual men, a trend that is alarming public health officials in connecticut and beyond.

in a “call to action” to stem the tide of infections, the center for interdisciplinary research on aids at yale (a research group within the school of public health) partnered with the connecticut department of public health to sponsor a daylong hiv-prevention and educational conference in early june. nearly 200 hiv counselors, educators, outreach workers, researchers and others attended to learn about the current infection trends, innovative strategies to reach the gay community and some of the interventions that are being used to prevent the spread of the infection.

men who have sex with men are now 44 times more likely than others to become infected with the virus nationwide, and the rate of new infections is particularly pronounced among young, gay black males, said edward white, m.p.h., ph.d., an associate research scientist at the school of public health. current projections show that 59 percent of gay black males in the united states could become infected by the time they reach age 40, he said. this would be higher than the rate in sub-saharan africa."

http://publichealth.yale.edu/news/news/2010/hiv.aspx

yelnikmcwawa · Jul 21, 2011

"Gay sex" as you call it, does not carry inherent risk. You are correct in noting that receptive anal intercourse is (much) riskier than receptive lady partsl sex. But sex, in all its splendor, is varied thing. Many, many gay men do not have receptive anal sex and are therefore at no increased risk for HIV infection.
IMO, screening should be for sexual behavior, not orientation, if we even need to screen donors (as opposed to donated blood) at all. As it stands now a celibate gay priest is prohibited from donating. The current practice is not supported by evidence and must be changed in favor of an evidence based approach The current practice does not make our blood supply safer but it fosters the view of gay men as as "other" and as diseased.

I very much agree with your statement about screening for sexual behavior and not orientation! It's not about being "gay", it's about whether or not you have engaged in behavior that carries higher risk of acquiring blood born viral pathogens. I never meant to imply that sex is not a varied thing and that all homosexual men engage in anal sex. That is something I am in no way shape or form stereotypical about. But whatever. I agree with you, you just articulated it better.

GM2RN · Jul 21, 2011

seems to be conflicting information about gay men being at higher risk for carrying the hiv virus. from yale university:
"new hiv infections have been declining among heterosexuals and injection drug users, but rates have been steadily rising among gay and bisexual men, a trend that is alarming public health officials in connecticut and beyond.
in a "call to action" to stem the tide of infections, the center for interdisciplinary research on aids at yale (a research group within the school of public health) partnered with the connecticut department of public health to sponsor a daylong hiv-prevention and educational conference in early june. nearly 200 hiv counselors, educators, outreach workers, researchers and others attended to learn about the current infection trends, innovative strategies to reach the gay community and some of the interventions that are being used to prevent the spread of the infection.
men who have sex with men are now 44 times more likely than others to become infected with the virus nationwide, and the rate of new infections is particularly pronounced among young, gay black males, said edward white, m.p.h., ph.d., an associate research scientist at the school of public health. current projections show that 59 percent of gay black males in the united states could become infected by the time they reach age 40, he said. this would be higher than the rate in sub-saharan africa."
http://publichealth.yale.edu/news/news/2010/hiv.aspx

that was exactly what i was attempting to uncover in asking for babylady's source.

from a link that someone else posted to the avert website: "adult or adolescent males accounted for three-quarters of new hiv diagnoses. the main transmission route among males was male-to-male sexual contact (74%)..." http://www.avert.org/usa-statistics.htm

and from the cdc website: "msm is the only risk group in the u.s. in which new hiv infections have been increasing since the early 1990s." http://www.cdc.gov/hiv/resources/factsheets/us.htm

czyja, MSN, RN · Jul 21, 2011

And from the CDC website: "MSM is the only risk group in the U.S. in which new HIV infections have been increasing since the early 1990s." http://www.cdc.gov/hiv/resources/factsheets/us.htm

Yes, thank heavens that MSM only group with an increasing incidence. It could be alot worse without good public health policy.

The incidence of HIV transmisission has gone down in IV drug users largely due to making clean needles available. And the indicence of HIV tranmission from blood products has declined to nil. I argue that this is due to carefull screening of donated blood products, not due to the current exclusion of any male donor that has had any sexual contact with any male at any time since 1979.

The epidemiology of HIV is fascinating. It is currently thought that one of the reasons african american men who have sex with men have a higher incidence of new infection is due to the stigma of same sex relations in that community. Many of these fellows have a level of denial about their sexuality and sexual practices - thus safer sex messages appear to elude them. I would also argue that current blood bank questionaires contribute to the stigmatization of men that have sex with men.

It is noteworthy that some of the nations leading blood banks oppose the current policy and would like to see it changed in favor of an evidence based approach:

http://www.nytimes.com/2010/08/03/health/03blood.html?adxnnl=1&adxnnlx=1311286491-Fqj+DqBCcM8HsOWoRxG2MA

and the GMHC in New York issued a thoughtfull position paper on the subject:

http://www.gmhc.org/files/editor/file/a_blood_ban_report2010.pdf

GM2RN · Jul 22, 2011

The incidence of HIV transmisission has gone down in IV drug users largely due to making clean needles available. And the indicence of HIV tranmission from blood products has declined to nil. I argue that this is due to carefull screening of donated blood products, not due to the current exclusion of any male donor that has had any sexual contact with any male at any time since 1979.

This statement has been exaggerated, but in any case, what do you think that it means to "screen" blood products if not to exclude some donors based on certain sexual activities/behaviors?

czyja, MSN, RN · Jul 22, 2011

what do you think that it means to "screen" blood products if not to exclude some donors based on certain sexual activities/behaviors?

There are three levels of screening:

1.Individal units of donated blood are screening for HIV antigen by ELISA (and screened for Hep C, CMV etc).

2.Pooled lots of blood are screened for HIV RNA - if this is found then the individual lots are tested.

3.Donors are screened for behaviors. If a prospective donor has is a man that has had any sexual contact with a man since 1979, then their donation is not accepted.

I argue that the present method for screening donors is irrational and does not make the blood suppy safer. Frankly, if we really want to minimize the risk of HIV transmission through donated blood then every unit should be tested for HIV RNA. At the present time this test is expensive. If, howeverr, it were required, then the cost would be minimal. It would be an easy assay to automate.

everwonder_y · Jul 22, 2011

The incidence of HIV transmisission has gone down in IV drug users largely due to making clean needles available. And the indicence of HIV tranmission from blood products has declined to nil. I argue that this is due to carefull screening of donated blood products, not due to the current exclusion of any male donor that has had any sexual contact with any male at any time since 1979.
The epidemiology of HIV is fascinating. It is currently thought that one of the reasons african american men who have sex with men have a higher incidence of new infection is due to the stigma of same sex relations in that community. Many of these fellows have a level of denial about their sexuality and sexual practices - thus safer sex messages appear to elude them. I would also argue that current blood bank questionaires contribute to the stigmatization of men that have sex with men.

^^This is absolutely spot on and I have also read similar hypotheses. I think evidence based practice supports empirical scientific testing reduces risk in donor blood transmission (which is practically nil, as is) than subjectively worded questionnaires, that have varying interpretations and motives. Furthermore, stigma breeds ignorance and fear which influences how "honest" people are in sharing private health behavior.

I've done some work with sex workers; providing a safe, non-judgmental place for them to receive screening allows them to be more honest about their behavior - which is crucial in providing adequate care and prevention through education.

GM2RN · Jul 22, 2011

There are three levels of screening:
1.Individal units of donated blood are screening for HIV antigen by ELISA (and screened for Hep C, CMV etc).
2.Pooled lots of blood are screened for HIV RNA - if this is found then the individual lots are tested.
3.Donors are screened for behaviors. If a prospective donor has is a man that has had any sexual contact with a man since 1979, then their donation is not accepted.
I argue that the present method for screening donors is irrational and does not make the blood suppy safer. Frankly, if we really want to minimize the risk of HIV transmission through donated blood then every unit should be tested for HIV RNA. At the present time this test is expensive. If, howeverr, it were required, then the cost would be minimal. It would be an easy assay to automate.

I wasn't suggesting that screening was based ONLY on sexual behaviors, but it does include eliminating those donors with admittedly riskier behaviors, even based on this post, but which you denied in the previous post.