View source for MSM blood donor controversy

[[Men who have sex with men]] (MSM) are often prohibited from donating [[blood donation|blood]] or tissue for [[Organ transplant|transplantation]] because they are considered to be at high risk for [[HIV]] 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.  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]].  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 on based on valid medical concern since donations are rigorously [[HIV test|tested]] to rule out donors that are infected.  Proponents of the lifetime restriction defend it because of the risk of false negative test results<ref>{{cite web |url=http://www.huffingtonpost.com/jeff-stier/blood-for-sale_b_52046.html |title=Blood for Sale |accessdate=2008-04-05 |last=Stier|first=Jeff |date=2007-06-13 |format=HTML |publisher=HuffingtonPost.com, Inc}}</ref> and because the MSM population tends to have a relatively high prevalence of HIV 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.<ref>http://www.fda.gov/biologicsbloodvaccines/bloodbloodproducts/questionsaboutblood/ucm108186.htm</ref>

LGBT organisations have focused their opposition on the lifetime ban and away from more limited restrictions placed on MSM donors.{{Citation needed|date=February 2010}}

== MSM and HIV/AIDS ==
In many developed countries AIDS is more prevalent among MSM than among the general population.<ref>UNAIDS 2006 report on the global AIDS epidemic, [http://data.unaids.org/pub/GlobalReport/2006/2006_GR_CH05_en.pdf Chapter 05], June 2006</ref>  In the United States, MSM accounted for 49 percent of new HIV diagnoses reported in 2005.<ref>CDC [http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2005report/pdf/2005SurveillanceReport.pdf HIV/AIDS Surveillance Report: HIV Infection and AIDS in the United States and Dependent Areas, 2005.]</ref>  Estimates of MSM in the US [[Demographics_of_sexual_orientation#Modern_survey_results|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.<ref>{{citeweb|url=http://www.avert.org/america.htm|title=HIV and AIDS in America|publisher=avert.org}}</ref>  The MSM risk group is the only group in which the annual number of infections is increasing.<ref>{{cite web|url=http://www.cdc.gov/NCHHSTP/newsroom/docs/FastFacts-MSM-FINAL508COMP.pdf|title=HIV and AIDS among Gay and Bisexual Men|publisher=Centers for Disease Control and Prevention}}</ref>

== Current restrictions ==
=== Countries with known restrictions ===

Countries, as of 2005, that had restrictions on blood donors<ref>{{cite web|url=http://www.bloodservices.ca/CentreApps/Internet/UW_V502_MainEngine.nsf/resources/Reports/$file/McLaughlin_Report.pdf|format=pdf|title=Mclaughlin  Report on Risk Management for Canadian Blood Services|date=2007-01-31|publisher=McLaughlin Center for Population Health Risk Assessment, University of Ottawa|pages=28|accessdate=2008-05-25}}</ref>

*Indefinite (permanent) deferral:
**{{flag|Algeria}}
**{{flag|Belgium}}<ref>https://portal.health.fgov.be/pls/portal/docs/PAGE/INTERNET_PG/HOMEPAGE_MENU/ABOUTUS1_MENU/INSTITUTIONSAPPARENTEES1_MENU/HOGEGEZONDHEIDSRAAD1_MENU/ADVIEZENENAANBEVELINGEN1_MENU/ADVIEZENENAANBEVELINGEN1_DOCS/AVIS8094VALID.PDF</ref>
**{{flag|Canada}}
**{{flag|Czech Republic}}
**{{flag|Denmark}}
**{{flag|Estonia}}
**{{flag|Finland}}
**{{flag|France}}
**{{flag|Germany}}
**{{flag|Hong Kong}} ([[People's Republic of China|PRC]])
**{{flag|Iceland}}
**{{flag|Ireland}}
**{{flag|Malta}}
**{{flag|Netherlands}}<ref>[http://www.sanquin.nl/Sanquin-nl/sqn_donorstart_nl.nsf/All/Mag-Ik-Bloed-Geven-.html Mag ik bloed geven?<!-- Bot generated title -->]</ref>
**{{flag|Norway}}
**{{flag|Portugal}}
**{{flag|Philippines}}
**{{flag|Slovenia}}<ref>[http://www.ztm.si/sl/krvodajalstvo/kdo_lahko_daje_kri/kdo_nikoli_ne_sme_dati_krvi/ The Republic of Slovenia Institute for Transfusion: Who cannot donate blood<!-- Bot generated title -->]</ref>
**{{flag|Sweden}}<ref>[http://www.geblod.nu/general.aspx?PageId=2599]</ref>
**{{flag|Switzerland}}
**{{flag|United Kingdom}}
**{{flag|United States}}
*Deferral for thirty years since last exposure:
**{{flag|Israel}}
*Deferral for five years since last exposure:
**{{flag|New Zealand}}
**{{flag|South Africa}}
*Deferral for one year since last exposure:
**{{flag|Argentina}}
**{{flag|Australia}}
**{{flag|Brazil}}
**{{flag|Hungary}}
**{{flag|Japan}}
*Deferral for six months since last exposure:
**{{flag|South Africa}}
*Deferral based on a different definition of risk:
**{{flag|Italy}}

=== 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, even only once, in the period from 1977 to the present day.<ref>[http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/QuestionsaboutBlood/ucm108186.htm Blood Donations from Men Who Have Sex with Other Men Questions and Answers]</ref> 

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.<ref>[http://www.fda.gov/oashi/aids/1992policy.html 1992 Recommendations for the prevention of Human Immunodeficiency Virus Transmission by Blood and Blood Products<!-- Bot generated title -->]</ref>  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.<ref name="harbus">{{cite web | title=American Red Cross Dogged by Allegations of Discrimination (published: January 28, 2002) |publisher=The Harvard business school newspaper |url=http://www.harbus.org/main.cfm?include=detail&storyid=171199&page=2 | accessdate=2006-12-17}}</ref>

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.<ref>[http://www.fda.gov/Cber/gdlns/tissdonor.htm#iv FDA/CBER - Guidance for Industry: Eligibility Determination for Donors of Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps)<!-- Bot generated title -->]</ref>  [[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.<ref>[http://www.unos.org/PoliciesandBylaws2/policies/pdfs/policy_16.pdf OPTN/UNOS POLICY 4<!-- Bot generated title -->]</ref>  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, America's Blood Centers and American Red Cross recommended to the FDA that the deferral period for men who had sex with other men should be changed to be equivalent with the deferral period for heterosexuals judged to be at risk.<ref>http://www.aabb.org/Content/Members_Area/Members_Area_Regulatory/Donor_Suitability/bpacdefernat030906.htm</ref> The FDA chose to uphold the blood ban. 
* In April 2010, the New York City Council passed a resolutions 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."<ref>http://search1.nyc.gov/search?q=cache:dGBI_AUMHLEJ:www.council.nyc.gov/d7/html/members/pdf/community_report_04.30.2010.pdf+blood+donations+gay&output=xml_no_dtd&site=council_collection&proxystylesheet=council_frontend&client=council_frontend&ie=UTF-8&access=p&oe=UTF-8</ref>
* On August 19th, 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.<ref>http://www.californiaprogressreport.com/site/?q=node/252</ref>
* 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."<ref>http://www.dccouncil.washington.dc.us/images/00001/20100607125919.pdf</ref>

=== European Union ===

A similar policy exists in the European Union and is the prevailing interpretation of the European Union Directive 2004/33/EC article 2.1 on donor deferrals.<ref>[http://iospress.metapress.com/content/c1r9rx5fc499m1rm/fulltext.pdf untitled<!-- Bot generated title -->]</ref> 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.

== 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%. 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%.<ref>http://www.blood.co.uk/can-i-give-blood/exclusion/</ref> <ref>http://www.tht.org.uk/informationresources/policy/healthpolicy/blooddonations/statisticalevidence/</ref>

== 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.<ref>[http://members.americasblood.org/plsql/ecat/supply_monitor_pkg.web_report ABC Blood Supply Status Report<!-- Bot generated title -->]</ref> 

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 give 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 give blood, whereas MSM donors are deferred indefinitely.  In the US, for example, potential donors that are MSM may not 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 twelve months.

== Protests and boycotts ==
=== United States ===
* Througout 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.<ref>http://www.dailyfreepress.com/news/school-ends-blood-drives-in-protest-of-anti-gay-rules-1.582542</ref> In 2007, an Iowa State University a student group sparked controversy when they pulled their support for a blood drive <ref>http://iowastatedaily.com/opinion/article_ea75d8f6-dc39-53fb-9c16-aadf27c5c2d9.html</ref>. In 2008, a faculty member at Sonoma State University proposed a ban on blood drives on campus <ref>http://www.pressdemocrat.com/article/20080308/NEWS/803080311?p=all&tc=pgall</ref> and at San Jose State University President Don Kassing suspended all blood drives on campus.<ref>http://badgerherald.com/news/2008/02/06/college_protests_blo.php</ref> In 2010, students from Keen State College protested blood drives on their campus. <ref>http://www.keeneequinox.com/news/pride-protests-bad-blood-1.2187207</ref>
* 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. <ref>http://thenewcivilrightsmovement.com/revise-the-fdas-lifetime-ban-on-gays-donating-blood/civil-rights/2010/06/10/11377</ref>. 
* On June 11, 2010 the Committee voted 9-6 against lifting the ban. In a follow-up vote, the Committee also voted unanimously- 14-0 to declare the policy "sub-optimal" because "some potentially high-risk donations while preventing some potentially low-risk donations"<ref>http://www.openleft.com/tag/MSM%20blood%20donor%20ban</ref>.
* As of September 2010, an online petition promoted along with the forthcoming documentary movie [http://www.savealifemovie.com Save A Life], has 1,437 signatures.<ref>http://www.change.org/petitions/view/save_a_life_petition_to_repeal_the_fdas_msm_blood_ban</ref>

== Testing and screening==

{{Main|HIV test}}

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,<ref>[http://www.sfaf.org/aids101/hiv_testing.html#window San Francisco AIDS Foundation: HIV Testing<!-- Bot generated title -->]</ref> with an average of 22 days.<ref name=autogenerated1>[http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01140.html FDA Approves First Nucleic Acid Test (Nat) System To Screen Whole Blood Donors For Infections With Human Immunodeficiency Virus (Hiv) And Hepatitis C Virus (Hcv)<!-- Bot generated title -->]</ref>  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.<ref name=autogenerated1 /> Opponents of donation restrictions in certain groups believe that this is an acceptable risk.

== Proposals ==

For the US, in 2006, the [[AABB]], [[American Red Cross]], and [[America's Blood Centers]] all supported a change from a lifetime deferral of MSM to one year since most recent contact.<ref>{{cite web |url=http://www.fda.gov/ohrms/dockets/ac/06/transcripts/2006-4206t1.pdf |format=133MB |title=Meeting of Blood Products Advisory Committee |date=2006-03-09 |publisher=Food and Drug Administration |pages=66 |accessdate=2008-05-25}}</ref>  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.

==See also==
* [[Terminology of homosexuality]]
* [[Men who have sex with men]] ("MSM")
* [[Women who have sex with women]] ("WSW")

==References==
{{reflist}}

==External links==
*[http://www.fda.gov/ohrms/dockets/ac/06/transcripts/2006-4206t1.pdf 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.''
*[http://www.cdc.gov/hiv/topics/msm/resources/factsheets/msm.htm CDC: HIV/AIDS among Men Who Have Sex with Men]
*[http://www.bmj.com/cgi/content/full/338/feb26_1/b318 British Medical Journal Debate: Should men who have ever had sex with men be allowed to give blood? No]
*[http://www.bmj.com/cgi/content/full/338/feb26_1/b311 British Medical Journal Debate: Should men who have ever had sex with men be allowed to give blood? Yes]

[[Category:Food and Drug Administration]]
[[Category:Sexual orientation and science]]
[[Category:Sexual orientation and society]]
[[Category:Blood]]
[[Category:Transfusion medicine]]

[[Category:Discrimination]]
[[Category:Medical controversies]]
[[Category:Patient safety]]
[[Category:History of HIV/AIDS]]
[[Category:2Fix]]