Bloody Discrimination

While performing the morning ritual of flipping through my feed-reader, I noticed Andy Towle link this story about gay activists protesting a South African ban on gay men donating blood. Andy (and gay activists) referred to the ban as "discrimination."

Gay men are banned for something, so it must be wrong, no?

Not so fast. In this article in the Advocate, a gay graduate student sets out to uncover the animus behind the ban on blood donations from gay men and discovers there is a valid scientific rationale:

What I found is that there is, in fact, good science to support these policies. According to the Centers for Disease Control and Prevention, in the most recent U.S. study, conducted in 2003, men who have sex with men accounted for approximately two thirds of all HIV infections among men, although only 5% to 7% of men in the United States identify themselves as men who have sex with men. (Obviously their surveys underestimate the true number of men who have sex with men, but even accounting for this error, the data is overwhelming.) The CDC’s statistical models predict that if the criterion was relaxed to exclude only those who have had man-to-man sex in the past five years, the worst-case scenario would mean an additional 1,200 units of HIV-positive blood in the system—a potential disaster.

The entire article deserves a thorough reading for its honesty, concern for scientific facts, and this perfect encapsulation of the issue:

So, as is all too often the case, there’s a slippage between what my emotional gut told me and what scientific evidence suggests is the truth. The lesson there is to get the facts before leaping to conclusions based on our emotional reactions.

Emotionalism is fine sometimes, but not when scientific data are involved. Merely seeing a story and crying discrimination before we even bother to uncover the truth of a matter is bad for gays everywhere. Science must come before political agenda, otherwise we are little different from the ID nutters out there who wish to place their beliefs before empirical data.

Comments

[Sam]

You're using US data in a South African context, but AIDS in South Africa is very different from the US. In South Africa, AIDS has never been seen as a gay disease but is rampant in the general population. Cite some data for AIDS in South Africa instead of an Advocate article about American gay men and your post might have more validity.

[Chad]

Robbie, come on now. Gay men are some of the most rational, level-headed people out there (e.g. DL). Jump to conclusions just to cry "discrimination"?!!?! ... I question your motives sir.

[Robbie]

You miss my point, though. Before declaring something discrimination, it might be good to have all the facts. Reading comments on Andy's blog about U.S. blood policies, you see many gay men uneducated about the issue. They simply believe it to be pure discrimination.

As the article notes, it is not.

I'm currently looking for South African data. Which is what everyone should do before they start screaming at the top of their lungs about the horror of it all.

Facts first, then conclusion.

Not the other way around.

[Malcontent]

I find myself asking this a lot in the comments section, but what exactly is your point, Sam? Men who have sex with men are a high-risk population for HIV/AIDS no matter what country you are in.

South Africa has more people living with HIV than any other country in the world -- more than 5 million -- although India is closing in. In the United States, fewer than one in 200 people in the general population is HIV-positive. In South Africa, it is more than one in five.

How a country where such a holocaust is occurring can be faulted for taking such an obvious and sensible step to protect its citizens is just too stupid and chauvinistic for words.

[Malcontent]

Oops, I should have cited my source.

[Jamie]

The author of that Advocate report was selective in his information. I think there are some relevant facts about the CDC 2003 study (http://www.cdc.gov/mmwr/PDF/wk/mm5445.pdf)that are important to note:

*Included in this analysis are HIV cases reported to CDC
from 33 states† that have conducted name-based HIV/AIDS
reporting for at least 4 years.
(So it leaves out 1/3 of the country.)

*In 2004, the rate of infection
among blacks was 8.4 times higher than among whites. The data on page 3 of the study clearly shows that while 44% of new HIV infections were through male-male sexual contact, 51% of new infectees were black. Statistically speaking, black men and women, regardless of sexuality, should be banned from blood donation before we are. Does that seem right? I didn't think so either.

It all depends on how you spin the data, my friend.

[Dan]

Well, first, let me pick off Mal's argument. It is true that the strain of HIV in the US is more prevalent in homosexuals than heterosexuals. As it turns out, however, the subtype of HIV that's prevalent in southern Africa (HIV-I subtype C) is transmitted just as easily through heterosexual sex as it is through homosexual sex. That's why it's such an epidemic over there. "Luckily" for those folks in western europe/the americas/australia, the strain of HIV here (HIB-I subtype B) does tend to single out homosexual males. So singling out gay men in South Africa is patent discrimination.

Mom's a pathogenic microbiologist. Who knew?

[Jeff]

Well, I have the stoopid ol' virus so I guess I have a say... Just a brief lil' minute ago, I got off the phone with a Dentist, I just moved to this area (a kind of upper-middle, where's my E500? double Chai Latte, little hamlet) And she told me she had NEVER treated anyone with HIV, and she wasn't sure she wanted to...and she gave me the name of a clinic in NEWARK! Now, THATS discrimination.
I indulge anyone their fear, but do your job. Universal precautions are universal precautions. OTOH, to suggest we open up a nations blood supply to high risk groups is just mathmatically stupid, its not discrimination. Instead of screaming discrimination, hows about acknowledging the reality of the virus, and do whatever it takes to prevent the next infection. Its a VIRUS, it doesn't know or care about PC bullshit. I don't understand some "activists" mindset. If you have ever lost anyone to AIDS, I would imagine you would do anything to make sure some one else doesn't get it.
And we don't need to waste resources screening out a threat that is easily avoided. And what if the activist get their way, and the accept gay men into the system? It is a statistical certainty that some one, some where will get infected through contaminated blood, no matter how thorough the screening process. How do you justify that?

[Jamie]

I also don't care for the fact that if I want to store my own blood for use in the event of an emergency, even THAT is illegal per FDA guidelines. That's just patently ridiculous.

[Sam]

I've done AIDS work in South Africa and am well aware of the holocaust occurring there. As Dan said, the disease in South Africa is very different from that of the US. I'm hardly an expert and maybe the ban in SA will be a good thing, but I doubt it.

[Queer Conservative]

I agree with Jeff. Gay men are a high risk group, the smart decision is to ban us from donating. Of course if you really, really feel discriminated against and feel like your world won't be complete if your blood isn't accepted into the donor pool - just lie and donate anyway.

[North Dallas Thirty]

I'm still trying to figure out why it's so important to the "gay community" that an additional 1200 units of contaminated blood make their way into the system.

[Dan]

Jaime leads me into my second argument. Are gays in the US more likely to have deadly STDs than the general population? Well, yes. But if we follow your logic we should go ahead and ban african americans from donating blood as well. From a strictly statistical standpoint they're much more likely to have HIV than the general population. Granted, their infection rates aren't quite as high as gay men, but they do constitute a larger proportion of the overall population. A completely logical, unemotional review of the data shows that barring african americans from donating blood would make the blood pool safer by statistically significant amount. But even if barring them only saved one human being, wouldn't it be worth it?

And while we're at it, why don't we bar homosexuals from professional sports? I mean, it's a physically vigorous game. People often get cut and bleed. It's totally unfair to expose those clean, virtuous straight players to somebody who engages in such risky behavior. And what about the children? I'm not prejudiced... I just think that those gay boys should be kept out of shop class, track or anything where there's a risk of blood spilling. This is just for safety reasons, nothing to do with discrimination.

The error you're making, Robbie, is allowing people to automatically equate sexual orientation with sexual behavior. That's a bad path to go down. These surveys should be focusing on genuinely risky sexual behaviors, rather than automatically assuming gay sex is risky. I know you're just trying to be pragmatic. So am I. So how about this: rather than bar homosexual men completely, why not just submit their blood to more extensive screening? Sure, it's technically discriminatory. But it's certainly better than having the government say "fuck off, we don't need your hiv-ridden blood".

[Robbie]

Jaime - you also need to look at concentrations of infection within populations. While transmission rates are now higher among the black population, statistically speaking, they still account for much lower percentage of infections per capita according to the demographics.

If blacks started showing concentrations at the same levels as gay men, then yes, I think a ban would be justifiable.

Naturally, that's unPC as hell. But I'll take public health concerns of a vicious virus over someone's delicate sensibilities any day of the week.

I mean, is that what it's going to come down to? We have to begin accepting more infections and deaths in order to kowtow to a minority group's feelings?

That'd be awful.

[Jamie]

NDT, that's disingenuous and you know it. The desire is to be able to donate our safe blood to fill the constant demand and recurring blood shortages, not contaminated blood. I happen to have O+ blood and would love to donate it. Of course, I could just LIE on the form and it'd all be peachy-keen, because they'd never no the difference, so the policy is basically ineffectual anyway.

Wouldn't a more effective measure of which blood to accept be how many risk factors a person engages in? The FDA policy effectively equates homosexuality with promiscuity, which is simply not true. That's like saying black people should be banned because they statistically use more illegal drugs. So please, anyone, address the question I posed in my first comment: shouldn't black people be banned accordingly as well? Black men statistically engage in high risk drug use and at-risk sexual activity at a higher rate than white men. (BTW, please don't think I'm being racist--I'm making a point using the same study the Advocate article's author cited.)

[Jamie]

Robbie, black people are also statistically less-likely to be tested than gay men, so the whole concentration argument is a wash. There isn't an accurate number. And I think the most potent point I made, really, is that this is all based on the "honor system" of self-reporting sexual activity when you donate. I highly question the scientific efficacy of a policy that you can circumvent by merely lying. So what real purpose does the policy serve except to discriminate?

I know someone's gonna brand me a lefty-liberal for all of this, when I'm really pretty middle of the road, but whatever.

[Chad]

Jamie, if you could lie about your sexual orientation, why couldn't you also lie about what activities you engage in? Are we to expect the screeners follow the donor around for 6 months like Big Brother, watching his every move to make sure he's telling the truth?

[Dan]

That's kinda Jamie's point, Chad.

[Jamie]

You make my point for me. The policy is not effective beyond the point that donors honor it themselves. So WHAT PURPOSE DOES IT SERVE?

[Robbie]

Dan - See, you sort of make the article's point here. By making the leap between blood donation and professional sports, you're letting your emotions over-ride your logic. There is a vast difference between contact sports and directly injecting pints of blood into a person. Logic (and science) dictate contact sports hold a far, far lower risk of transmission, but your mind still went there. That's specifically what the article warns against. (And I concede, when Magic Johnson played, heterosexuals' minds went there, too, with attitudes based on emotion. We, gay or straight, must always be concerned with the science, not the emotional impulses).

Jaime - The CDC and others are concerned about statistical data. You make the emotional impulse against gay men = promiscuity. Well, for a start, I'd be very hard-pressed to believe anyone who told me gay men are no more promiscuous than heterosexuals. Come on, that assertion is laughable on its face. Statistically speaking, gay men are promiscuous. Not all gay men, no. But more than heterosexuals? Oh god, yes. Shouldn't we be interested in statistical truth, and not "labels" here? You may not be promiscuous, nor I, nor many others. But, statistically speaking, as a group, we most certainly are.

Another note on the black transmission rates - Remember, the problem with HIV in the black community often surfaces about what is called "The Down-Low." I know Keith Boykin has written on this extensively. Many gay black men decide they "aren't really gay," and have secret homosexual sex and then transmit it to heterosexual partners. The problem with the statistic you cite is that black is not mutually exclusive of male-to-male sex. How much of that 51% transmission rate is attributed to homosexual activity?

Gay men are also far more statistically likely to engage in high risk behavior, including unprotected anal sex. So, again, you have a group that engages in a certain behavior at a disproportionate rate. No, not all gay men have unprotected anal sex, or even anal sex at all, but as a group, they most certainly do.

I find the arguments in this thread against the CDC's policy to be far more concerned with "how we feel to be categorized" and "they're not talking about me" than the statistics, science, and methods involved in protecting the blood supply.

Last point - Sure, people could lie I suppose. But why would they? I mean, honestly, why would anyone lie about these things in order to donate blood? To feel better about themselves? Breaking the rules of blood donation for a minor boost in self-esteem? How self-involved do you have to be?

[Aatom]

I'm conflicted on this one. I am HIV+, which solidly removes me from consideration for blood-giving. But it seems to me that in S Africa, based on the disturbing stats that Mal has given us, combined with the logic that Robbie is using, NO ONE should be able to give blood.

And that's obviously not right.

On 9/11 (oh yeah, I'm going there), one of the more inspiring/disturbing things I witnessed was a man running up 8th Avenue screaming at the top of his lungs for people to get to the nearest hospital to give blood that was absolutely crucial. Blood is one of those medical necessities that we never have enough of, yet it is surprisingly easy to get from people. The system needs to be streamlined somehow and a public education program wouldn't hurt. But we should probably be erring on the side of gettig as much blood as possible, and pouring research money into figuring out how to minimize the risks of tainted blood. Wide bans on entire subsets of the population are simply unacceptable, regardless of your view of their lifestyle.

In the end, in about a decade we will probably have the technology to screen every single person that gives blood for contaminants quickly, cheaply, and easily. Then we will find out if the ban on gay men is lifted or not. Anyone wanna lay odds on it?

[Malcontent]

Jamie, you talk abuot "desire" to donate blood, which is laudable, but the construction Andy Towle is using -- "discrimination" -- implies that there is some "right" that everyone should be able to donate their blood and that it should be accepted into the system, and such talk is just pathologically dangerous. It is this reflexive and casual talk of "discrimination" that I think Robbie and I (and others) object too.

It kind of goes to the question of whether I would prefer to prefer to be rescued from a burning building by a 90-pound woman or a 200-pound man. Statistically speaking, it is no question.

I feel completely comfortable arguing in favor of gay marriage because it is endagering no one -- nothing, nobody, no institution.

However, while we can carp all we want about the "unfairness" of not being able to do a good turn by donating blood, there is no denying the statisical soundness of denying the blood of gay men or intravenous drug users. If somebody would like to compare prevalence rates among ALL the high-risk groups, perhaps there would be an argument to make about specific racial groups, but to simply lump African-Americans into the discussion because their prevalence rate is higher than Caucasians is just a red herring, IMO.

If it is that important to us to help promote the availability of blood for transfusion, then until gay men can credibly argue that our HIV (and blood-borne STD) prevalence rate is comparable to that of other groups, we should instead write checks to the American Red Cross.

[Robbie]

But it seems to me that in S Africa, based on the disturbing stats that Mal has given us, combined with the logic that Robbie is using, NO ONE should be able to give blood.

Pretty much. I've been googling the hell out of South African stats, but I haven't found much data in the way of per capita male to male transmission. Until I can pin that down, it's a fuzzy area.

Re: stream-lined testing. Absolutely. Once there is a test that can quickly, cheaply, and efficiently screen the blood system to the point they can catch virtually all infected blood, all this will become moot. But given modern methods, at this point in time, I think the CDC is fairly justified, and I'm unwilling to cry discrimination. The safety of the blood supply should come before my delicate sensibilities.

[Chad]

But are there really people out there that are so hell-bent on donating blood that they will do anything necessary to do so?

And who really wins in that situation? You're gay, you can't give blood, so you lie, say you're straight, they accept you, and.... what? You gave blood as a "straight" guy. Kudos to you! Power to all my gay peeps!!

But I think that's getting away from the original point of the gay community once again jerking the knee in their typical "oppressive" fasion. Yeah, if gays are banned because our lifestyle suggests a risk, then maybe blacks should be for the same reason.

I mean... we are talking about a disease with no cure yet, right? Feelings... meet the back burner.

[Jamie]

Robbie: The very "down-low" men that you talk about are the ones who are most likely to lie on the donation form. They don't consider themselves gay, and are most likely NOT going to be tested for HIV for the same reason they aren't going to say they has same-sex intercourse on the form. Shame.

What if they grew up in a family like mine where blood donation is a family tradition (that we ALWAYS did together)? I had to make excuses to not go with MY family once I was out to myself, but not anyone else.

I'm well aware that I have a visceral reaction to this, but I'm diligently trying to take a logical tack rather than an emotional one.

I still do not subscribe to your belief that gay men are more promiscuous than heterosexuals, and not because I think I'm surrounded by gay men of "higher morals" or some bullshit, but because all of the straight people I know are just as promiscuous as the gay people I know. In small towns, all the have to DO is fuck each other. I think EVERYONE is too damned horny for their own good.