The National Blood Service [damerell]

The latest LJ meme seems to be a petition to repeal the rule prohibiting men who have sex with men from donating blood. I'd like to have a rant about that; normally I just do it in comments, but this idea seems remarkably widespread.

Context: I have sex with men - well, one man. Hell of a way to out yourself, but it seems pertinent.

The incidence of HIV amongst men who have sex with men (which is what is actually banned; people are banned on the basis of activity, not sexual orientation) is twenty times that which is typical of the population at large. It is obviously considerably more so than that amongst the portion of the population who aren't MSMs, don't have sex in West Africa, don't take IV drugs, etc. Half of all new HIV infections detected are amongst MSMs. The idea that the rising infection level amongst heterosexuals renders the risk assessment outdated is just wishful thinking.

The screening technique used for HIV in blood is not 100% reliable; no 100% reliable screening technique exists. Every year, a small number of people are infected by blood transfusions. Therefore, taking blood from high-risk groups will result in HIV infections. Presently blood supplies do not run out [1], so taking this extra blood would not save lives.

It is not practical to quiz people extensively on their sexual histories. Each additional question causes a drop in donations; people find these questions intrusive. A significant drop in donations would cost lives.

Furthermore, because the incidence of HIV amongst MSMs overall is so much higher, extensive questioning would be necessary; only the very least sexually active MSMs represent a lower risk than the population at large. This also implies that the quantity of blood you gain by this extensive questioning is rather small.

What they are proposing to do would, literally, kill people for the sake of an ideological point.

Furthermore, an observation; giving blood is not some kind of privilege. It's tedious except when it's painful, and the purpose of the exercise is not to make the donor feel smug. I can't do something tedious or painful which I would otherwise feel obliged to do? Lucky me. You can't either? Lucky you.

Comments screened if you ask me to or if they reveal someone's sexual history and they don't ask me not to.

[All figures from Department of Health website.]

[1] They might, though, and if you don't donate purely because you think the policy's homophobic you're an idiot. Even if you were right, the people you'd be penalising are not the people who wrote the policy.

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This also implies that the quantity of blood you gain by this extensive questioning is rather small.

The figure I've seen quoted is about 2%.

It's also worth noting that there are about 50 reasons why people are asked not to donate blood, and in total they cover about 40% of the adult population. Various other restrictions are also designed to block transmissible diseases, and exclude people based on where they've lived or what they've done. These are not considered controversial.

The other large source of HIV infections amongst Britons (meaning British residents and therefore potential blood donors in this case) is infection in sub-Saharan Africa. This is also covered by a restriction, whether it involved sex between two men or not.

The standard paper to cite on this topic is this one by Kate Soldan and Katy Sinka, which estimates a rise from 0.45 to 0.75 donations a year slipping through into the blood supply (a 60% rise) if the MSM criterion were relaxed to only cover sex within the last year, or a 500% rise if it were dropped altogether. This is a large relative change to a small absolute risk, but I don't see how it's possible to meaningfully discuss matters without (as is often the case) making any reference at all to the fact that the risk exists.

This paper (also one of Soldan's - busy woman, clearly) is also interesting. It doesn't directly address the MSM issue, but is available in full rather than just as an abstract, and shows the figures and what sort of factors are taken into account.

Feel free to paste bits of this into public view if you think it'd be more useful than just unscreening it.

[link] [reply]

Interesting. You're the first commenter, actually, I'll see how it goes.

I note that no-one gets uptight about the Africa restriction being racist, even though I imagine it affects black people far more than others.

[link] [parent] [reply]

As to "Racist", well, sometimes reality and skin colour coincide. Correlation does not imply causality.

Not quite: sex tourists tend to be white. However, they are definitely not all male: West Africa (Gambia in particular) is a popular destination for unaccompanied middle-aged women.

They get uptight about this one, perhaps, because it is assumed that the HIV test is wholly reliable, with possibly the only variable being the window of infection versus test. I would also question whether the other restrictions are as widely known as this one.

Besides, if white, searching under the street lights is easy. Statistics are always useful.

Since I'm at work and can get at it, I've put a copy of the paper here - I'll take it down in a couple of weeks.

Interesting cost-benefit analysis.

Yes, "are you a man who's had sex with other men?" is a good question to ask in risk assessment. However, for the process to be fair there have to be no better questions they might ask instead; is that really the case?

Why are men who have sex with men such a particular risk? Presumably it's some combination of number of partners, type of partners, simultaneity of partners and anal sex. I would therefore expect that "Have you ever given or received anal sex?", "How many sexual partners have you had?" or "Have you ever had sex with someone who was not the only long-term partner you had at the time?" could do better. (The web's not being forthcoming with statistics, alas.)

Context: For me, the answers would still be "yes", "more than average" and "yes" respectively, but there are plenty of other reasons I can't give blood anyway.

The problem is that a) "men who have sex with men" is such a strong indicator relative to the donating population overall, it's much better than (say) ever having anal sex (but probably with someone low-risk) and b) just how many men who have sex with men would you free up by asking enough of those questions to get the risk down to comparable levels? How does that compare with the resistance to the intrusiveness of additional questions?

Having, once in the distant past, worked in the healthcare and having had the opportunity to discuss these things with the men working in a (possibly the, at the time, premier) HIV ward in Sweden, the reason they ban men having (or in given past timeframe, had) sex with men from donating blood ISN'T because of HIV (specifically). It's to stop the NEXT blood-borne disease to get a solid foot-hold.

We have, twice, been bitten by this and spread it around rather wildly before we even knew the disease existed. First it was Hepatitis Non-A Non-B (now known as Hepatitis C), prevalent in needle-sharers and men having (unprotected) sex with men (more prevalent amon needle-sharers, mind you; but they're not allowed to give blood either) and the second was HIV. Essentially anything taht is blood-borne is more than capable of using shared needles or semen injected anally as a vector (there's trace blood in semen, there's almost always microtears during anal intercourse). Men having unprotected oral sex or men using sufficiently good condoms aren't at risk.

That the current blood-tests for what-have-you are non-reliable is NOTHING compared to the one we don't know about. From it starting to spread to "we know what it is, we have an N% chance of detecting it in screening tests" is, well, about 2-3 years. If it, as is not uncommon, there is a long incubation time, that's quite a few people at risk.

Obviously, a balance between "possible lives saved by blood collected" and "possible lives at risk from chronic diseases spread through blood collected" must be weighed. I honestly don't know that "no men having sex with men allowed" is on the RIGHT side of the paranoia barrier, but I'd say that it is close to that barrier, no matter what side it is.

hrm. i actually wasn't aware of the stats behind it, and it seems a lot more logical when i do.

I think that much of the irritation which leads to the MSM criterion comes from people on blood-drives who seem to demand an explanation as to why you don't give blood, lest they think you simply insufficiently altruistic.

Personally, I don't fancy revealing my sexual history to someone just because they approach me with a pin and a smile, and don't appreciate them taking umbridge if I refuse to do so. Knowing a fair few people who have volunteered on such recruitment campaign, I'm confident that this disingenuousness is reasonably common.

I think that much of the anger may stem from this attitude.

This comment neither indicates support nor non-support of the criterion.

I think that's unfortunate, but the answer is obviously better recruiters, not laxer restrictions. If people want to petition the PM for better-mannered recruiters, go for it. I wouldn't mind myself.

The last time I answered their questions I would have been unable to give blood because of not weighing enough anyway, aside from any sexual history.

Here's the thing: as a culture, we know how to deal with diseases we don't know how to treat, we have no real problem doing it, we have done it a bunch of times and it's standard operating procedure these days even for relatively low-fatality diseases such as SARS and bird flu. I myself, as well as a lot of other people, have received basic training in operating on both sides of this procedure. I am referring of course to quarantine, and I can see no reason other than an irrational fear of being labelled a homophobe in The Grauniad that it isn't employed in the case of AIDS. We are the same age you and I and I can barely remember a time before mass-media AIDS awareness - there should be no new cases of AIDS in this country, and there shouldn't have been for decades, everyone knows that they ought to take basic precautions, and those precautions are even free on the NHS, there's no excuse really. Frankly, all other measures have failed, it is time action was taken before it gets out of hand.

I just want to say I agree with you entirely.

What worries me in all of this is issues becoming 'rights' issues rather than looking at the consequences of what is proposed.

Context: I have sex with men - well, one man.

Don't most men?

Oh, one other man. I see now.

Hell of a way to out yourself, but it seems pertinent.

It's as good a way as any other.

ISTM that if you've had a clear HIV test you ought then to be able to discount risk factors that predate it by more than six months. They could implement this by telling people it when they give them a clear HIV result, rather than in the blood donation bumf, to keep the bdb straightforward. That way, people who know themselves to be clear could donate with a clear conscience.

They won't let you donate if you have a headache either. I think this is discrimination against people with small children.

What I worry about are the people who decide they are low risk and lie to give blood, because they think that's more important than the rules. And I think the oral sex prohibition is a bit odd too, since as far as I'm aware that's extremely low risk. While the risk of contracting HIV is higher, and yes it might miss the screening, I do wonder why these people are banned for life, when women who are sleeping with them are only banned for a year after they stop. I wonder if it would be possible to give a similar or possibly longer period of time after people have stopped taking part in risky activities.

I note I signed this petition, but not as a result of seeing an LJ meme encouraging me to do so. In fact this is the first I heard of any such meme.

I will admit that I might not have signed it if I had stopped to think about it in complete detail, because I think it was written quite badly. I think the petition site is possibly dangerous in this regard, because you tend to scan down the list and look at all the ones that seem like even vaguely a good idea.

I would like to know that they do review the policy regularly though, and make sure it is statistically still the most sensible one.

I would like to know that they do review the policy regularly though, and make sure it is statistically still the most sensible one.

http://www.theyworkforyou.com/wrans/?id=2006-03-08c.53528.h

(no subject) — (anonymous) [screened]

I seem to be revisiting this one.

The reason why there are different rules for bone marrow is that there aren't enough donors and if you need a donation and don't get it the odds of you dying are on average quite high - 100% in many cases. Many people in need of bone marrow donations would greatly improve their life expectancy even if the only donor available was absolutely guaranteed to be HIV positive.

happy birthday!

Thanks. What, no blood drama?

To compile these statistics you need two pieces of data from some representative sample a)do they have HIV b)are they a MSM (other 'high risk' group).

Given that they collect these stats if you go to a clinic to discover if you have HIV I require better evidence than 'the DoH believes these stats' to be convinced that they are not using a *horribly* self selecting sample and infact have functionally no idea atall what the incidence of HIV is in the general population (especially given that HIV has no symptoms).

At least in the case of sub-saharan Africa you can say 'we have a population of N and M people have presented with symptoms of AIDS' and then go 'omg the AIDS infection rate is waaaaay too high'. In this country we have no idea what the population of MSM *is*!

Ah, ah, you can't go from "the statistics may be inaccurate" to "the truth must be an error in the direction I suppose it is". You've got to do the best you can with the figures you've got.