Curious Sanguine


I'm scheduled to give blood tomorrow, and I realized tonight that the last time I gave blood was before I started taking medication. I remembered a long list of medical questions you have to answer to give blood, and was worried that my current medication might prevent me from donating. So, rather than risk hauling myself all the way to the donor station on the Upper East Side only to find I was inelligible, I found the criteria for blood donors.

It looks like I'm fine; my medication doesn't show up on the warning list. But I'm curious about some of the other contra-indications. There's a 12 month ban on donations for getting a tattoo? No one who's spent more than 5 years total in Europe can give blood ever (that is, if you add up all the days of your life spent in Europe, and it's greater than 5 years, you can never give blood again)?

What's really disturbing to me is Question 37, the Ban on Gay Blood Donations. If you are a male and have ever had sex with a man, even if it's only once, since 1977, you're permanently banned from blood donation. If you're a woman and have sex with a man who has ever had sex with another man, you're banned for 12 months. Even if you get an HIV screening, your blood is still verboten.

Now, I understand the thinking that went into this, particularly given that it was likely implemented 20 years ago or more; obviously they don't want any AIDS or HIV positive blood in their blood supply, ever, and it's better to turn healthy blood away than to accept unhealthy blood. Still, though, it seems like you ought to be able to get an exemption if you have a recent screening.

What's more worrisome, though, is the exemption for Question 37. You're allowed to give blood if you are a male who was raped by a man, provided the incident was more than 12 months before the donation. This seems odd; one would think the sort of men who go around raping other men are the sort who would be more likely than average to be carrying HIV or AIDS.

I'm disturbed by the line of reasoning that's used to justify this, which I think goes like this: People who are gay are at a higher risk of carrying HIV/AIDS. This risk is high enough that it's worth excluding the entire class of people who are gay. How do we determine who is gay and who is not? Gay men have sex with men, and we want to have a strict criterion. So if you've ever had sex, even once, with a man, you are officially gay and therefore cannot give blood. However, this is imprecise; we want to exclude gay people, in the sense of people who live the promiscuous gay lifestyle which increases the likelihood of carrying HIV/AIDS. But some people, namely rape victims, have had sex with a man but are not adherants of the gay lifestyle. Therefore, we will give an exemption for men who have been raped by other men, because they are not truly gay.

So the criterion is "have you ever willfully had sex with another man?" But what they want to exclude isn't really gay people; it's promiscuous people. Gay is a cipher for promiscuous, but it's not universally applicable. There are many non-promiscuous gay people, just as there are many promiscuous straight people. Under their criteria, if you've had sex with a man, just once, against you're will, you're fine. If you had sex with a man, just once, willfully, you're banned for life. And, of course, there's the fact that they've gone through the trouble of creating a rape exemption but haven't bothered with something practical like a screening exemption.

Of course, this all assumes they're acting in good faith. There could be a heavy element of prejudice and stigmatization involved, which would help explain the rape exemption. Gay people can't give blood because they are, in some sense, bad: They willfully engage in a wrong act, sex with other men, so we don't want their blood. But rape victims really didn't have a choice in the matter. They committed a bad act, but it was against their will. So we excuse them and allow them to give blood after 12 months.

Or maybe I've just been reading too much Criminal Law and am using a crime and punishment lens when it's inappropriate. Still, this question seems like it could use some refinement, if not a complete overhaul or removal.


Yeah for donners!

We really do appreciate it Zach.

Thanks! It's not really that big a deal; the hardest part is remembering to do it, what with the 8 week break between donations. I've marked my next eligibility date in my scheduler, though, so hopefully I'll remember this time.

What blood type are you? I've given a few times in the Berkeley/Oakland area; maybe you've gotten some of my blood! I'm A Positive.

I've never given blood, as it happens; I've been technically disqualified on one far-reaching basis or another since age 18 1/2 and never got around to donating before that point. I'll admit I find it rather convenient, since I get panicky and childish about needles and would be in for a considerable battle to try to drag myself in to donate.

In fact, I've just realized after looking over the Red Cross guidelines (which are generally similar to the New York Blood Center's) that I am actually permanently disqualified as a blood donor. Why? Not because of my recent tattoos and piercings; those are temporary disqualifiers. No, because I've had (protected) sex with men who have had (protected) sex with other men, and therefore it doesn't matter how many batteries of STD tests they or I have had since then, they are and therefore I am also an unacceptable HIV/AIDS risk.

There is, of course, a definite note of prejudice and paranoia in that reasoning. There's also a major gap through which risks are being missed. In the case of my former sexual partners, those damn dirty libertines were in fact unlikely to be a risk. They were pretty savvy and responsible about regular HIV (and other STD) tests. My emphatically heterosexual ex-boyfriend, on the other hand, lived with his extremely conservative Christian parents and didn't dare seek out STD testing either with or without their permission, so at the time we were sexually involved he had no basis to declare himself STD-free except his previous partners' say-so.

Do you suppose anyone's tried suggesting that it might make more sense to screen people out by asking things like,

-Have you had more than 1 sexual partner in the last six months (or whatever numbers make you happy)?
-Have you been tested for HIV/AIDS in the last six months?
-Have you switched sexual partners since your last HIV/AIDS test?
-Have you had sexual contact in the last year with someone whose infection status you didn't know?
-Have you ever had unprotected sex with someone whose infection status you didn't know?

Because a) the responses to those questions would be much more helpful in identifying STD-risky behavior and b) it seems like the responses of the blood-collecting agencies to the suggestion of changing the questions would tell you whether their current questions are being asked on ideological grounds or practical ones.

Damn. I meant to say "far-fetched", not "far-reaching".

Actually, you're not permanently inelligible; if you parse the guidelines closely, there's only a 12 month deferral for women who have had sex with men who've had sex with men. I think that supports the point that I believe both of us are making. That is, I'm not quite sure why a guy having sex with another guy should permanently disqualify, whereas a woman having sex with that guy should be disqualified only for 12 months. Presumably the waiting period for the woman is based on the theory that, if she'd contracted HIV, she'd probably have noticed by now. But can't the same thing be said about the guy? Why not ask guys if they've had sex with other men in the last 12 months?

Unless, of course, they're not worried so much about HIV as they are about letting The Gay pollute their blood stream and infect real (you'll pardon the expression) red-blooded Americans.

What's really stupid about the whole thing is that the question is, ostensibly, designed to determine whether you are at risk for HIV. So how do they determine if you're at risk? 1. Are you gay? 2. Have you used dirty needles? 3. Have you had sex for money or drugs? 4. Have you had sex with anyone who's done the above? Not a single question about protected sex or number of partners. So the only sexual risk behaviors for getting HIV are being gay, being a prostitute, or having sex with the above. Huh.

The more I think about it, the more I think that these questions were written in the era of "AIDS is a gay person disease and you can't get it if you're straight/a woman" and they haven't bothered to revise it.

Also, I think these are national standards, though I don't know who sets them. It may be the Red Cross, or some other umbrella organization, or it may be the Federal Government through the National Institute of Health/Surgeon General or some such.

As I think about it, it'd be interesting to see if you could file a discrimination claim against whoever sets this standard. You could argue that it discriminates arbitrarily against a broad category of donors (gay men). I can't imagine the organizations don't get Federal funding, which would subject them to Federal non-discrimination laws (though it could be different for non-profits, especially with the whole faith-based initiatives thing). And you could probably make a strong case that the discrimination is arbitrary, given that it's a pretty poor screen for HIV risk level and they haven't even tried to implement a more precise set of questions.

A hypothetical: Suppose they did a study and determined that Asian Americans were at heightened risk for carrying HIV, and that the risk level was unacceptable. Suppose they then banned blood donations by Asian Americans. They justify it, not on racial grounds, but because they "live a lifestyle that puts them at heightened risk of HIV infection." They would be in court before the press conference announcing the new policy was over. And rightly so. So why shouldn't the same apply to a blanket ban on donations by gay people?

You know, it just occurred to me that I'm sitting here jabbering about a topic I know very little about, when my father, whom I could just call and talk to, is not only a hematopathologist (a doctor who studies diseases of the blood) but also spent a few years as a director of the San Diego Blood Bank. He just might have some genuine information on this subject. I'll call him tomorrow and report back anything interesting.

Alright, I mentioned it to my dad, and this is how he explained it:

Basically, the blood bank is extraordinarily conservative, in the sense of taking unnecessary precautions to ensure the blood supply isn't infected. He feels they reject a lot of donors and a lot of blood that's prefectly healthy, on the basis of pretty imprecise questions.

Further, the blood bank is very conservative in terms of the structure of the questions they have on the test. If a new dilemma arises that may compromise blood, they add on new questions to deal with it. But they never, ever go back and revise their questions.

So, he believes that they probably instituted a task force in the early 80s to figure out how to keep HIV out of the blood supply. They devised the set of questions on the test, declared the HIV problem solved and the issue closed, and on that basis refuse to re-examine the questions.

The problem, as my dad explains, is that we knew very little about HIV/AIDS when they wrote the questions, so the questions are oriented towards excluding gay people and needle users, the only people it was believed could get AIDS at the time. Also, at the time tests for HIV/AIDS were speculative and unreliable, so there's no provision for screenings.

Of course bear in mind that, as someone who helped run a local blood bank, my dad has come to the conclusion that the folks who run the national blood bank are a bunch of morons. So you might take his assessment with a grain of salt. Nonetheless, he believes that it is the opinion of the Red Cross that just because medical science has advanced doesn't mean they should go around adapting to it willy-nilly. If our HIV screener questions worked last year (in the sense of not causing the entire organization to collapse in on itself) there's no reason they shouldn't work this year, and on into the future.

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This page contains a single entry by Zach published on February 18, 2006 1:15 AM.

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