Sunday, March 23, 2008

Gay Men, Blood Donation, Homophobia and HIV

"Girls are always running through my mind. They don't dare walk." - Andy Gibb

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"In July 1982, the CDC reported that three hemophiliacs had died of AIDS-related infections; none of the infected individuals had any risk factor other than that they had received blood transfusions. In December 1982, the CDC reported that five more hemophiliacs had contracted AIDS, and that there were five other AIDS cases that might have resulted from blood transfusions.

The Hemophilia Foundation proposed in 1982 that blood banks proscribe donations by gay men. However, because they did not want to foster an exclusionary policy, and because gay men were considered “crucial to the donor pool,”* blood banks did not implement this proposal immediately. Dr. James Curran, the director of AIDS activities at the CDC urged the gay community to seize the “political initiative with a call for voluntary withdrawal of all gay men from the donor pool.” He stated, “The thing is, people are dying. The medical problem is more important than the civil rights issue.” Despite Dr. Curran’s recommendations, however, the blood banking agencies in the United States (the American Association of Blood Banks, the American Red Cross, and the Council of Community Blood Banks) expressly rejected pre-donation screening on the basis of sexual orientation, so as not to discriminate against MSM...

* - Gay men were crucial to the donor pool because “[p]rior to AIDS, gay people used to go in together to donate blood, as a community effort.” Melinda Tuhus, Supplies of Blood Fall as Demand Increases, N.Y. TIMES, Oct. 29, 2000, § 14CN (Conn. Ed.), at 3. Few other groups donated with the solidarity that gay men did prior to the mid-1980s.

The U.S. Public Health Service (USPHS) issued these recommendations to comply with federal regulations mandating that blood donors be “free[ ] from any disease transmissible by blood transfusion,” and because there was “no alternative but to treat all members of groups at increased risk for AIDS as posing a threat of transmission.”

... While status-based classifications to exclude donors generally are disfavored because of their lack of specificity, the utility of these classifications “ultimately depends upon the strength of the relationship between status and behavior.” For example, if there is a high prevalence of HIV in a MSM population, the error associated with exclusionary criteria based on MSM behavior is less. An exclusionary criteria based on MSM behavior, however, is functionally identical to a status-based classification. The use of exclusionary criteria closely resembling status-based classifications ultimately was validated by epidemiological data that showed the large prevalence of HIV/AIDS infection in MSM populations in the 1980s...

To public health policy makers in the United States, the risk of harm associated with HIV, of acquiring a fatal or potentially fatal disease from a blood transfusion, far outweighs the costs of pre- and post-donation screening or any consequent infringement on liberty interests or personal autonomy in denying someone the opportunity to donate blood."

- HIV/AIDS and blood donation policies: a comparative study of public health policies and individual rights norms