Thursday, June 10, 2010
Should gay men be allowed to donate blood? We speak to the co-author of a study on the "Effects of Lifting Blood Donation Bans on Men Who Have Sex with Men."
TOM FUDGE (Host): I’m Tom Fudge. You’re listening to These Days. If you’re gay man with a sex life, you cannot donate blood. That's been FDA policy for more 20 years. But blood banks and the American Red Cross have begun to question whether that policy is necessary. Today, a federal advisory committee which makes recommendations to the Department of Health and Human Services, will take up the question. They're expected to begin hearings in Rockville, Maryland. Last week, a public policy center at UCLA issued a report that examined the possibility of lifting the ban. They estimated how a change in policy might affect our blood supply, which often suffers shortages. Joining me to talk about that report from UCLA is Gary Gates. Gary is with the Williams – is a Williams Distinguished Scholar at the UCLA School of Law, and he’s co-author of the study which is called "Effects of Lifting Blood Donation Bans on Men Who Have Sex with Men." And, Gary, thank you very much for being with us today.
GARY GATES (Williams Distinguished Scholar, UCLA School of Law): My pleasure.
FUDGE: And, listeners, if you want to join the conversation, you may, of course, by calling 888-895-5727, that’s 888-895-KPBS. Gary, why does the FDA currently ban any man who’s had sex with another man from ever donating blood?
GATES: Well, I mean, the policy is largely dated. It dates back to the mid-eighties and actually the very kind of earliest stages of the HIV and AIDS crisis. And, of course, originally it was an attempt to – the notion was that gay and bisexual men and then very quickly later it became men who have sex with men, are at very high risk for HIV. And at that time, there weren’t nearly as effective ways to screen for HIV even post-donating blood as there are today, and so the decision was made to do a fairly large and blanket exclusion of that group from donating blood.
FUDGE: You say this policy dates from the mid-eighties.
FUDGE: The specific policy also states that no man who has had sex with another man since 1977 may…
FUDGE: …donate blood. Why ’77?
GATES: Well, that was at the time – The idea was that that was when HIV first appeared in the United States. It’s not clear that that’s actually the most accurate date anymore but certainly, like I said, when the policy was developed, the thought was that was when they thought that HIV kind of first emerged.
FUDGE: All right, and I assume this ban applies to gay men and not gay women because gay women are not at high risk for HIV.
GATES: Right. Exactly. I mean, the idea is that lesbians and largely lesbian sexual practices don’t carry the risk of transmission of HIV in the way that gay male sex practices would.
FUDGE: A couple of prominent medical organizations have called for the ban to be lifted, I think.
FUDGE: The American Red Cross and the American Association of Blood Banks. Why do they believe that it’s time to lift the ban?
GATES: Well, the view is that it’s both from a sort of scientific and medical standpoint that the current, very broad-based ban is unwarranted, and it’s for a variety of reasons. As I mentioned earlier, today – You know, when the ban was initially implemented, their ability to detect HIV in blood, there was what they call a window period, so if someone gets infected, there was a period of, at that time, potentially several months before the tests of the blood could detect HIV. The new tests now reduce that window period to a matter of weeks instead of months, so the accuracy and reliability of the testing has changed dramatically. More people know their HIV status and would likely self-screen as well. So for a variety of reasons, they think that this – And the other reason is that this blanket ban isn’t consistent with kind of other high risk behaviors and the period at which engaging in those behaviors would exclude you from blood donation for – And an example would be if you had had sex with a prostitute, you’re not excluded in the same way that men who have sex with men are excluded.
FUDGE: And my guest is Gary Gates, the Williams Distinguished Scholar at the UCLA School of Law, co-author of the study called "Effects of Lifting Blood Donation Bans on Men Who Have Sex with Men." If you want to join our conversation or if you have a question about donating blood in the context of our conversation, give us a call at 888-895-KPBS. Let’s do get to your study, Gary.
FUDGE: What were the aspects of this issue that you tried to analyze?
GATES: Well, there’s – Basically, there’s several proposals out there in terms of how you might change the current ban. One is to completely lift the ban and, in fact, change how they screen for who’s eligible. And, you know, the current screening, as I said, would say any man who’s had sex with a man since 1977, even one incidence, would be excluded. The idea would be to eliminate that restriction and instead ask very specific questions about high risk sexual behaviors and create exclusions based on those limited, you know, high risk behaviors as opposed to the blanket ban. And we found that if you eliminate broadly that restriction that it would create probably about 2.6 million eligible donors and that would result in annually about 219,000 more pints of blood into the blood system, which is about a 1.5% increase. And then we also looked at it, whether you restrict it to only if you haven’t had sex with a man in the last year or the last five years. And in those cases, you have a substantially less – substantially lower pool of newly eligible donors down to like one million and from, say 70,000 to 90,000 pints of blood.
FUDGE: Well, of course it gets, you know, you get into a lot of numbers…
FUDGE: …it gets a little complicated.
GATES: Sorry about that.
FUDGE: But I think you said if the ban were to go away altogether if they took…
FUDGE: …out the question ‘do you have sex with men?’ Oh, okay, you can’t give blood. If they got rid of that entirely, you would see about a 1.4% increase in blood donations…
GATES: In the annual blood donations.
FUDGE: In the annual blood donations. Now, is that a lot, 1.4%? Is that good news?
GATES: Well, I mean, I think the truth is, we have chronic blood supplies – blood shortages that, you know, crop up periodically so, you know, I’ll let it to policymakers to decide whether they think that amount of increase is high or low. What I will say is that in terms of thinking about what does 219,000 pints of blood mean, one thing is that blood is divided into three component parts when someone donates. And so those 219,000 pints of blood could potentially be used in something like 650,000 separate medical procedures, you know, using that blood.
FUDGE: Well, one question I should ask because I don’t think we’ve made this clear, Gary, when a person gives blood, they are asked about their HIV status, right?
GATES: Yes, of course. And our estimates in terms of these newly eligible donors, we take into account so we’re arguing that there would be about 2.6 million new HIV negative donors as a result of the policy change.
FUDGE: Well, we do have a call from Chris in San Diego. Chris, go ahead. You’re on the show.
CHRIS (Caller, San Diego): Hi, thank you for having me. My question this morning is for the officer of the study. I’m curious to see or to hear your opinion on whether or not the potential benefit from allowing men who have sex with men to donate blood outweighs any potential risk from sort of any disease entering the blood supply?
CHRIS: And in addition to that, what is the implication from continuing the ban from a civil liberties perspective?
FUDGE: Well, I guess you’re a law professor, Gary. Is this a violation of civil rights, telling people you can’t donate blood?
GATES: Well, first I’m not actually a law professor, though…
FUDGE: Oh, sorry.
GATES: …although I’m playing one on radio. I’m actually a demographer by trade…
GATES: …even though I work in the law school.
FUDGE: All right.
GATES: But to answer that question, I mean, I think – In this study, we don’t really attempt to do a kind of cost benefit analysis. I mean, again, our idea is to put these numbers out and let the policymakers do that kind of analysis. What I will say is that, again, I think it’s important to remember that the best science and medical studies suggest that the blanket ban just is not warranted, that it doesn’t protect the blood supply in the way that people believe it is protecting the blood supply, and lifting the ban won’t have any observable effects on the safety of the blood supply. I think the civil rights issue is an interesting one. You know, I think where this comes down, you know, where this plays out often is, you know, many of us are employed in companies or organizations that do these periodic blood drives and in some cases it’s a fairly high profile event within the office. And the problem with this blood ban is that it can be, one, very stigmatizing for gay and bisexual men, and even in some respects, too, almost a mechanism to out people because, you know, they just consistently don’t donate blood. And their option is to either say I’m not donating because I’m – I don’t care, which is unappealing, or they have to say it’s because I’m not permitted to donate because I’m gay or bisexual. And so…
FUDGE: Well, I have – Yeah, I have to imagine going to donate blood and then having somebody ask you about your sex life…
FUDGE: …is a little bit – must be a little bit embarrassing. And I can imagine why people would just avoid it for that reason.
GATES: Right, and as I said, in some offices if you avoid donating blood, that act in itself can be somewhat stigmatizing and people might, you know – It prompts questions as to why you’re doing that. So, you know, I – again, I’ll leave it up to the lawyers to really make a determination of, you know, how that plays in the civil rights argument but it’s certainly true that it’s – it can be highly stigmatizing.
FUDGE: Let’s take one more call. Melissa is in Carmel Valley. Melissa, go ahead.
MELISSA (Caller, Carmel Valley): Hi. Yeah, what’s funny is I was on my way to donate blood when I turned on your radio program. I listen to you all the time.
FUDGE: Oh, wow.
MELISSA: And I’m a regular donor. I donate every 58 days or whatever the time is that I’m allowed to donate. And I think what the, you know, crux of the matter boils down to is by the time you’re ill enough to need a blood transfusion and to really need some medi – the blood that’s going to possibly potentially save your life, you don’t care if it comes from a gay man, you don’t care if it comes from, you know, whoever. You want it to be clean. And so politics aside, you know, whatever – anybody should be able to donate as long as their blood is clean. And, you know, that means I don’t want, you know, dirty blood coming from a guy who just had sex with a prostitute or someone who has tuberculosis. You know, we just want the blood to be clean so that by the time the people are getting it who could be saved, it works and doesn’t kill them from some HIV side effects.
GATES: And to kind of respond to that, what I would say is that that’s one of the reasons why I think the effort to reform and change these policies, one of – much of it is focused on improving the screening questions such that you get at exactly what the caller’s talking about. So you really try to get at asking people about the specific behaviors that really potentially create scenarios for the blood. You know, having problems with the blood, instead of just a, you know, this kind of blanket question which is really very imprecise at determining your actual risk behaviors.
FUDGE: Melissa, thank you very much for calling. And I’m talking with Gary Gates with the UCLA Law School, co-author of the study called "Effects of Lifting Blood Donation Bans on Men Who Have Sex with Men." Before we wrap this up, let me ask you a couple of questions about what’s going on on this issue. Gary, I think you testified before the state Senate’s Health Committee about this issue just yesterday, right?
GATES: That’s right.
FUDGE: Now, what was the purpose of that?
GATES: So that’s a bill in the California legislature to – it’s a resolution basically pushing the federal government to revisit this ban and to reform the policy.
FUDGE: Okay, to revisit the ban but is it an issue that the state can address? I thought that the FDA was the one that was imposing the ban.
GATES: No, exactly, the state can’t address this so it’s really just a reso – basically saying this is the thinking of the California legislature, and we are saying to the federal government we’d like you to reconsider this issue.
FUDGE: And speaking of the federal government, the Department of Health and Human Services is holding hearings or one of their advisory committees is holding hearings on this issue today and tomorrow in Maryland. What do you think – what could come out of these hearings?
GATES: Well, I think, again, I think – I hope what will come out of it is that they – that it does create serious consideration about, you know, reconsidering the ban. It’s not – I think this is just a very, very beginning step in that process but it does suggest that, in fact, Health and Human Services and potentially the Food and Drug Administration do have this kind of on their agenda in the relatively near future.
FUDGE: Well, finally, let me ask you to predict the future. What do you think’s going to happen? Do you think we’re going to see a change in policy?
GATES: I suspect there will be some kind of change. I think it’s a little hard to predict how they’ll change the policy. Again, you know, they could go with a blanket removing the restriction or these kind of other kinds of deferral procedures, and it’s not clear which way they’ll go. Certainly many other countries have moved to change the ban. Many that had these very restrictive bans have begun to change that and I suspect the U.S. will follow in that regard.
FUDGE: Well, Gary Gates, once again, is the Williams Distinguished Scholar at the UCLA Law School, even though he’s not a lawyer, and he’s co-author of a study on the "Effects of Lifting Blood Donation Bans on Men Who Have Sex with Men in the United States (sic).” Gary, thank you.
GATES: My pleasure.
FUDGE: I’m Tom Fudge. You’re listening to These Days. And coming up next we will hear from the producer of “Antiques Roadshow,” which is coming to San Diego this weekend, so stay tuned for that.