MSM blood donor controversy

Men who have sex with men (MSM) are often prohibited from donating blood or tissue for transplantation because they are considered to be at high risk for HIV, a virus 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.

MSM is a classification of men who engage in sex with other men, regardless of whether they identify themselves as homosexual, bisexual or heterosexual. Some organizations view the ban or restrictions on donation as homophobia or an infringement of the civil rights of the LGBT community since donations are rigorously tested to rule out donors that are infected. [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] 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.

MSM and HIV/AIDS

In many developed countries AIDS is more prevalent among MSM than among the general population. [UNAIDS 2006 report on the global AIDS epidemic, [http://data.unaids.org/pub/GlobalReport/2006/2006_GR_CH05_en.pdf Chapter 05] , June 2006] In the United States, MSM accounted for 49 percent of new HIV diagnoses reported in 2005. [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.] ] Critics charge that political correctness has led to the association of MSM and HIV being downplayed. [James Chin, “The risks in hiding the HIV/AIDS truth”, "Business Day" (March 12, 2007), 9.] ["The people punish Mr Blair", "Daily Mail" (UK) (May 6, 2005), 14.]

Current restrictions

Countries with known restrictions

Countries, as of 2005, that had restrictions on blood donors [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]

*Indefinite (permanent) deferral:
**Algeria
**Canada
**Denmark
**Finland
**France
**Germany
**Holland
**Hong Kong (PRC)
**Iceland
**Ireland
**Norway
**Sweden
**Switzerland
**United Kingdom
**United States

*Deferral for ten years since last exposure:
**New Zealand

*Deferral for five years since last exposure:
**South Africa

*Deferral for one year since last exposure:
**Argentina
**Australia
**Hungary
**Japan

*Deferral based on a different definition of risk:
**Italy

United States

In the US, the current guidance from the AABB and the FDA is to permanently defer any MSM donor who has had sex with another man, even only once, since 1977. [ [http://www.fda.gov/cber/faq/msmdonor.htm FDA/CBER - FDA Policy on Blood Donations from Men Who Have Sex with Other Men ] ] 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. [ [http://www.fda.gov/oashi/aids/1992policy.html 1992 Recommendations for the prevention of Human Immunodeficiency Virus Transmission by Blood and Blood Products ] ] 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.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]

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. [ [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) ] ] 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. [http://www.unos.org/PoliciesandBylaws2/policies/pdfs/policy_16.pdf] The organs are generally used unless there is a clear positive test for a disease.

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. [ [http://iospress.metapress.com/content/c1r9rx5fc499m1rm/fulltext.pdf untitled ] ] 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 were in Europe during the bovine spongiform encephalopathy (mad cow disease) outbreak are also screened out during blood donor interviews.

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 3 day supply, but many blood centers struggle to meet this demand. [ [http://members.americasblood.org/plsql/ecat/supply_monitor_pkg.web_report ABC Blood Supply Status Report ] ]

Protests and boycotts

In the 2000s, college communities in the United States have threatened boycotts against blood donation events based on these concerns and the apparent discrimination against gay and bisexual men. [ [http://www.pressdemocrat.com/article/20080529/NEWS/805290332/1350&title=SSU_president_says_yes_to_blood_drives SSU won't ban blood drives | PressDemocrat.com | The Press Democrat | Santa Rosa, CA ] ] [ [http://www.iowastatedaily.com/home/index.cfm?event=displayArticle&ustory_id=d317896d-d5c8-4bdf-acd4-8c3a805d46e2 Iowa State Daily ] ]

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, the immune system's response to the virus. This led to a window period where a person who had been infected with HIV would be able to spread the disease but would show up negative on tests. This window period can be from three to six months, [ [http://www.sfaf.org/aids101/hiv_testing.html#window San Francisco AIDS Foundation: HIV Testing ] ] but the average is 22 days. [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) ] ] This test is still used in developed countries because it is extremely sensitive and in developing countries is often the only test used for HIV to screen donors.

To cover this gap, donors were also screened for high risk behaviors, one of which was the MSM group. Other groups with similar restrictions included commercial sex workers and injection drug users.

Newer tests looked for the virus itself, such as the p24 antigen test that looks for a part on the surface of the virus, and Nucleic acid tests (NAT) that look for the genetic material of the virus. With these tests, the window period is shorter, on average 12 days. Opponents of the restrictions 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. [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] 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.

ee also

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

References

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]