Gays, lesbians, bisexuals

[Last Child of Ungoliant]

personally, i dont give blood, and won't likely, but i feel if (and his goes for all issues, not just blood) one sector of society has on set of rules, then the same rules have to be extended to all sectors of society, unless the aim of a government is to create an apartheid society

[inked]

LCoU,

Personally I do give blood. And the selection process is uniform and applied equally. If you do not meet the criteria, you do not donate. No one is creating apartheid. They are creating a safe blood supply for when you need it.

And, in spite of everything that can be done, people who receive blood or organ or tissue transplants will always be at risk of catching some as yet unknown agent.

'Course, if the alternative's bleeding out or uremic poisoning from kidney failure, you'd still like the spare parts to be as safe as possible, right?

[The Wizard from Milan]

I think that the regulations to donate bood at present in the US are discriminatory against LGBT people and they are not suitable for achieving the desired purpose.
I agree with Inked that there needs to be a questionaire test in addition to the blood test before allowing donations. I agree with it because I know that the test is not 100% sure.
Yet the present regulations are discriminatory and are not suitable to achieve the desired purpose because they exclude any man who had sex with men since 1977, a ridiculously long time. Allbeit there is the risk that somebody who contracted HIV back then is still alive now and anaware of his condition, the risk is tiny. Although a tiny risk is still worse than zero, there are many more risky donors who are still allowed to donate blood. So the regulations concentrate on stamping out even the tiniest risk concerned with same-sex intercourse, but are not concerned with extremely risky behavior when it is different-sex intercourse.
The regulation is also blind to the fact that every year many people run a larger risk of dying of blood shortage than the risk they would run of contracting illnesses from blood donated by some low-risk LGBT people.
The regulation is also mean-spirited in as much as it forbids transfusions also among consenting partners (healthy and blood compatible, of course).

Italy used to have the same rules as the US; they changed it and I am not aware of any increase in viral transmission to to LGBT donors

[Insidious Rex]

Why dont they just take all blood but tag blood by liklihood of risk. So that in the event of an emergency they could go into the riskier blood stock rather then let people bleed to death.

[inked]

IR,
Money. Plain and simple. Not only the money to collect, separate, store, and administer the blood and blood products, but the cost of litigation due to transfer of disease from known tainted supplies to patients who do not realize the risk or who are in no position to accept or refuse such questionable blood or products.

Would you take blood that may have malarial parasites in it?

Would you take blood that could transfer syphillis?

Would you take blood from someone who had been exposed to rabies?

etc, etc, etc.

Add to that the remarkable human propensity for making errors and imagine the turmoil from someone who had accepted "no risk" transfusions and who gets "high risk blood" and a consequent disease. The lawyers love this sort of error. Ask anyone who has had a transfusion reaction resulting in Kidney dialysis (acute or chronic) or death (families really believe Uncle Tom never would have died if it hadn't been for that "mistake" and they ought to be handsomely compensated for missing his circumlocutions at annual gatherings, why his wisdom was worth millions of dollars or pounds!)

No. There is no way to ensure a healthy blood supply than the current system. It is not offensive. It is practical. It is effective. It is as safe as we can make it.

I often get requests from patients for family donors. They think that no one in their family would do IV drugs, consort with male or female prostitutes, or engage in risky behaviors. That is patently untrue statistically of course. But it is hard to imagine Uncle Tom as having gone into Town for a weekend of orgiastic behavior and coming home and chatting everyone up about it! So' s Aunt Maud would know?

Directed donations (as these are known) are possible and require preparation so as to allow for proper screening of the blood/blood products. Then they find that it costs them for that. Suddenly, no one wants to pay up for the off-chance that Uncle Tom might need the blood.

Safety first, foremost, and always within the limits of capability. That is what the public wants from its blood supply. And the current system gives it within its capabilities (caveats as noted above).

[The Wizard from Milan]

Originally Posted by inked

No. There is no way to ensure a healthy blood supply than the current system. It is not offensive. It is practical. It is effective. It is as safe as we can make it.

I have just shown exactly the contrary in my previous post

[Nurvingiel]

Great post Inked, thanks. Are both you and TWFM describing regulations in the United States? Because your diametrically opposite positions can't both be right (or can they)? Or are you talking about Italian rules TWFM (What was Chrys's nickname for you? It was much better than this four letter acronym.)

Originally Posted by The Wizard from Milan

Yet the present regulations are discriminatory and are not suitable to achieve the desired purpose because they exclude any man who had sex with men since 1974, a ridiculously long time. Allbeit there is the risk that somebody who contracted HIV back then is still alive now and anaware of his condition, the risk is tiny. Although a tiny risk is still worse than zero, there are many more risky donors who are still allowed to donate blood. So the regulations concentrate on stamping out even the tiniest risk concerned with same-sex intercourse, but are not concerned with extremely risky behavior when it is different-sex intercourse.
The regulation is also blind to the fact that every year many people run a larger risk of dying of blood shortage than the risk they would run of contracting illnesses from blood donated by some low-risk LGBT people.
The regulation is also mean-spirited in as much as it forbids transfusions also among consenting partners (healthy and blood compatible, of course).

If the above is true for the USA, then I'd say there is pointless discrimination. However Inked's post (which I'm sure is about the USA) says there is no unfair discrimination.

[Last Child of Ungoliant]

Il Milano Mago

[The Wizard from Milan]

Originally Posted by Nurvingiel

Great post Inked, thanks. Are both you and TWFM describing regulations in the United States? Because your diametrically opposite positions can't both be right (or can they)? Or are you talking about Italian rules TWFM (What was Chrys's nickname for you? It was much better than this four letter acronym.)

I am talking about the US regulations.
You can find them by yourself here
As you can see, under "HIV, AIDS" it says clearly that you are excluded if "you are a male who has had sex with another male since 1977, even once;"
But, as you can see, people who have frequent sex with prostitutes, even in (some) countries with a high HIV incidence, are not excluded per se (they fall under the excluded categories only if they have been tested positive for HIV or show simptoms).
That's why I say that the guidelines are concerned in stamping out the smallest risk if it comes from same-sex intercourse, but it is much more permissive if the risk comes from different-sex intercourse.


As I said in a previous post, Italy used to have the same rules at the US in terms of exclusion of gays from blood donation, but we changed it in favour of excluding risky behavior.
The reason why Italy changed its rules is linked to a moving story; I am not 100% sure of all the details, but I am sure it went like this: In Naples, one person had a car accident and was risking to die because of blood shortage. He had the rarest blood type and there was none available. It turns out that his boyfriend had the compatible blood type and was willing to donate, but if was forbidden by law because he was gay; so the head of the section of the hospital just goes ahead anyway as performs the transfusion. Everything is well and everybody would live happily ever after but the police gets wind of it and the doctor is sentenced to 8 months of jail. It took about 4 months before the newspapers got wind of the story and the government decided to act, but finally they lifted the bad as it was written (as I said, there is still an exclusion based on risky same-sex behavior) and freed the doctor.

[The Wizard from Milan]

Originally Posted by inked

I often get requests from patients for family donors. They think that no one in their family would do IV drugs, consort with male or female prostitutes, or engage in risky behaviors. That is patently untrue statistically of course. But it is hard to imagine Uncle Tom as having gone into Town for a weekend of orgiastic behavior and coming home and chatting everyone up about it! So' s Aunt Maud would know?

Directed donations (as these are known) are possible and require preparation so as to allow for proper screening of the blood/blood products. Then they find that it costs them for that. Suddenly, no one wants to pay up for the off-chance that Uncle Tom might need the blood.

My point is more specific than that (Talking about US rules). My point is that the regulations are mean-spirited because they exclude donations by men who have sex with men even when the donation is from one member of the couple to the other member of the couple. I think the discriminatory intent is clearly legible in the absence of the exceptions that make the rules unreasonable. Let's consider the situation in which man A has sex with man B and assume that man B had sex only with man A in all his life. If now B wants to donate blood to A, he can't. I consider it blatantly discriminatory because the rationale for forbidding the donation is not there: if we were in the unlikely case that B has HIV but it is not detected, it can possibly come only from A (and the case of non-sexual transmission does not matter here, because that is the same for gays and heteros).
It is no avail to reply that the rule is not discriminatory because usually B would have had sex with other people too. I am claiming that by excluding cases that are obviously not to be excluded the regulation reveals its own animus against gay people

[inked]

TWFM,

If you like the rules in Italy, why are are you here?

Seriously, I have been excluded from donating blood because of recent travel out of country, possible exposure to a communicable disease other than AIDS, possible latent status for HIV/hepatitis (other than A or B) due to needle stick in surgery (two tests six months apart are required for a complete negative in screening), and for platelet count of 149,000 instead of the minimum 150,000; and for medication use. I have been refused for having a recent vaccination. And I have been giving blood since I was 18 (that's 5 refusals in 32 years, folks).

I'm not screaming discrimination, am I? I also don't get to fly the Space Shuttle. Reason? I am not qualified. This is the same sort of thing. Not all pilots are astronauts; not all astronauts went to the Moon. Not all donors can give. Plain, simple, unvarnished good public health practice. Period.

If you want to minimize the risk of disease transmission, you exclude donors who have risks. Period. They are not all sexually-related risks. So don't feel picked on because you are gay. Accept the fact that it is excluded from donor status! So is IV drug use and tattooing and fever of unknown origin!

Latency for HIV to full-blown AIDS was last-I-knew about 10-12 years at most, so far as was known. But that isn't a guarantee because there may be variants that hide longer or are more lethargic. Until we have a good handle on the natural history of HIV in the human population (and that will be at least a generation of observation), the current guidelines are correct. The latency of HIV was a big factor in the transmission of infection to patients receiving transfusions or blood products in the late 60s - 70s. When identified in the early 80s, no one had any idea what the latency period was.
Blood samples held at various facilities from the early 70's were tested and suggested an 8 - 12 year period of latency. But no one knows yet for sure the natural history of this retrovirus. There may have been folk with it longer who were not in the sample pool. (If this were Ebola and had an 80 - 90% mortality within 7 - 10 days, we wouldn't be having this discussion. Or Lassa fever, for that matter. HIV/AIDS is endemic in chimpanzees and great apes so it qualifies as a zoonosis that made the jump to human pathogen successfully.
Recent studies of the virus and its genetic fingerprints have suggested that it arose spontaneously from perhaps 5 different loci in those carriers. It has been isolated from dead gorilla carcasses. The question is whether it has a latent period of ? duration. Since the Africans hunt and eat these animals, the transmission from infected carrier could occur via contamination of non-intact skin, mucosa, or insufficiently cooked meat. It could be emerging again even as we converse. And the great apes and chimps and other monkeys may not be the only carriers or reservoirs of the retrovirus HIV.)

Yes, Nurv, my comments are on the USA situation.

[The Wizard from Milan]

inked, it seems to me that you are avoiding my point.
My point is that there are groups of people who are more at risk than some gay people, yet all gays are barred and these other riskier people are not. Examples of risker people who are not barred (according to the list to which I link in my post #189) are regular clients of prostitues who had unprotected sex
My point is neither of the ones to which you answer: 1. my point is not that gay people are at zero risk 2. my point is not that gay people are the only ones excluded

[The Wizard from Milan]

Originally Posted by inked

TWFM,

If you like the rules in Italy, why are are you here?

To bring my wisdom to the barbarians

[inked]

TWFM,

Yes, about those barbarians: they sacked Rome 5th Century, recurred in a purely nationalistic native form in the 1930's allied with Hitler(known as Fascists, IIRC), and were driven out by the Allies when the Italians were unable to do it themselves!

Seriously, I understand your complaint in the sense that I can relate. When I was denied the ability to donate because of trips to Chile to adopt my daughter in 1991, it seemed unfair. After all, I had only been in Santiago, not the wilds or hinterlands. And again in 1996, after returning from a week's holiday in Mexico which had included hiking around Chichen Itza and insect bites, it made more sense that time. Finally, after a long weekend in Porta Vallarta in 1998, when I never left the resort area except to travel by bus to the airport and back.

So I was refused the opportunity to donate because of my classification as a "traveler" to regions with endemic diseases and an "arbitrary" exclusion. I have managed to recover from the blow to my altruistic self! Also, last year, when I voluntarily undertook smallpox vaccinations to be on emergency response teams, I couldn't donate for specified periods. Again, "arbitrary" time lines were the culprit.

That's the way it was and it is and it should be. Had I acquired Dengue fever at Chichen Itza and been in a latent phase...well, too bad for the recipients, eh?

Recent research relating animal viruses to human viral infection have established some fascinating concerns. Simian ImmunoVirus (SIV) infections (related to HIV-2) have been shown in the blood of zoo workers with monkeys and great apes to have been present for 26 years with no apparent effects. Thus far none of the tested spouses or family members of these folks show evidence of infection. Until workers became ill in European and American labs with a variant producing a characteristic foamy appearance in ill individuals, no one had thought to test for this.

The point is that SIV has a latent state of 26 years. This particular infection appears benign at present and, except in certain cases, nontransmissable to close contacts. But the operative words are "appears benign" and "latent".
No one truly knows.

Since the retrovirus is related to HIV-2, it may well be that the latter can be latent for 26 years. NO ONE KNOWS. So, rather than have the extension of disease by erroneous assumptions or unknown assumptions based on the little we know about HIV, it is good public health policy to err on the side of caution. Much better than extending yet another round of retroviral infections to persons receiving blood or blood products when we cannot detect the agent's presence or absence.

You see, there are good reasons that lie behind the exclusions from donation status. I refuse to allow you to make political what is a matter of life or death. It may be that Italian science is so far ahead of that in the rest of the 1st world, or it may be true that political pressures have been better established and organized there to remove "obstruction", or it may be that Italians are unaware of the risk they run in getting blood, or the government may not fee it need concern itself with the apparently small risk of undetected/undetectable HIV transmission, or... . I do not know. That is their lookout.

But here in the USA the policy is not sexually discriminatory per se, unless you wish to argue that it also discriminates against persons with wealth and leisure to travel on the same political basis. The allegation is absurd. And no amount of yowling from travellers or gays is going to change the scientific basis of the exclusions. WE DO NOT KNOW THE NATURAL HISTORY.

If you feel the need so strongly, may your altruism return you to Italy where you may so donate. Though, I rather doubt that will happen!

[Embladyne]

Originally Posted by inked

Embladyne,

If you said Dorothy L'amour was a soccer mom, folks would know what you meant and what it meant about the lady's lifestyle. Similarly, if you said Betty Boop led a flapper lifestyle, or Arwen an elven lifestyle until she changed for a mortal lifestyle.

You acknowledge the existence of a gay lifestyle op cit. What's the problem

Soccermom, flapper, elvish, mortal, gay...all accurate within their scope!


omnia munda mundis...

There are MANY gay lifestyles. It depends on the person. I don't think an Elven lifestyle is comparatively similar. They are a race of beings. Homosexual people are part of the human race. Therefore, they participate in the Human lifestyle.
Your mixture of concepts does not aid your argument. I agree that lifestyles exist, but they are not as definitive of their members as people seem to expect.

[inked]

Embladyne,

You missed the qualifier "within their scope".

There is a distinguishing characteristic within the gay community. It is the nature of sexual behavior which carries a quantifiably elevated risk of the transmission of specific diseases. It is true that heterosexual engage in some of the same behaviors. The persistently ignored fact is the statistically elevated risks of of MSM particularly, then bisexuals, then WSW. This is a direct correlation phenomenon. It is world-wide. It is no respecter of persons or status or wealth.

I realize that apart from sexual venues there is a great variety of behaviors not incorporated per se into a gay lifestyle. Just as in the heterosexual transmission of the same diseases there are behaviors ranging from tribal life in Africa to jet-set westerners and all in between. In fact, the use of beasts of the jungle as an ancillary food source in times of reduced availability of other foodstuffs (correlated with the European Unions take of fish off the coasts of Africa, by the way, in recent studies - sciencenews.org March 5, 2005 for a summary of the report) may account for the jump from zoonosis to human infection. Of course, some Africans continue to utilize this food source even in Europe and the USA, perhaps due to nostalgia or a desire for "home cooking". The latter are lifestyle variants of course. They still have an underlying basic factor - the use of game as a food source.

In the USA, apart from the concerns over "mad cow" disease in cattle, is the transition of that viral entity into deer and moose and elk. So whether heterosexual or homosexual, all persons who various lifestyles (however defined) incorporate the consumption of these game animals are at some risk.

So what I am driving at is that howsoever differentiated otherwise, persons who lifestyles incorporate a defining activity may be descriptively identified by the behavior under question which leads to the specific exposure. As in the "mad cow" problem in GB. Persons who consumed suspect lifestock are at risk. Other than "beef-eaters" their lifestyles undoubtedly varied much from one to another.

So, one cannot ignore the one behavior which in fact places a group of persons at risk in regard to individual distate for categorization or even a particular categorization. Despite your obvious distate for such, in the practice of medicine, particularly public health and epidemiologic aspects, one cannot ignore the realities. To do so is fool-hardy and exposes others to risks - some quantified and some still nebulous.

[Rían]

Originally Posted by inked

After all, I had only been in Santiago, not the wilds or hinterlands.

*smiles to see Santiago and "hinterlands" together - just struck me funny mixing Spanish and German*

So I was refused the opportunity to donate because of my classification as a "traveler" to regions with endemic diseases and an "arbitrary" exclusion.

Obviously people that leave the good 'ol USA to consort with furriners are up to no good and engage in practices that will probably taint their blood!

That's the way it was and it is and it should be. Had I acquired Dengue fever at Chichen Itza and been in a latent phase...well, too bad for the recipients, eh?

But they won't mind dying, because they have the cheering knowledge that they weren't being discriminatory!

So, rather than have the extension of disease by erroneous assumptions or unknown assumptions based on the little we know about HIV, it is good public health policy to err on the side of caution. Much better than extending yet another round of retroviral infections to persons receiving blood or blood products when we cannot detect the agent's presence or absence.

Absolutely.

I refuse to allow you to make political what is a matter of life or death.

*cheers loudly*

[The Wizard from Milan]

Responding to inked #194
How comes that all those viruses and latency periods makes you so worried about gay men's donations, but does not worry you at all when it comes to heterosexuals' donations?

The point is not whether I would want to donate blood or not; the point is that when heterosexuals are free to donate regardless of their sexual practices and gay men are barred from donating regardless of their sexual practices, then these rules stigmatize the gay community with no scientific basis.
I would be more understanding of your position if strict rules were to apply to heterosexuals too

[inked]

TWFM,

Didn't I specify that the number of sexual partners (regardless of homosexual or heterosexual) was a criterion for refusing donors?

It is not true that there is blanket ignoring of heterosexual sexual activity in the donor evaluation.

What there is in terms of restriction is the best devised (to date) screening of all potential donors to exclude on the basis of rational, scientific evidence those that are at risk. All comers. No exceptions.

My suggestion to you and all concerned is that you go to your local blood bank and attempt a donation. Assuming you read the entire questionaire, you will see the criteria are quite extensive in regards to policy; and, stop whining about sane public health practices.

The scientific evidence is that a closely related virus has a known 26 year longitudinal persistence. That ought to throw up red flags rather than caution to the wind. Science learns from the data available and makes reasonable approximations and inferences from data. It has no political ax to grind. Public health concerns trump individual political machinations, or they should. Individualism must bow to the common good.

Current estimates of undiagnosed and probably apparently healthy individuals carrying HIV of either sex are in the hundreds of thousands in the USA alone:

http://www.retroconference.org/2005/...acts/24468.htm

http://www.retroconference.org/2005/...acts/25729.htm

Public health is about more than clean water and sanitation. It is about those measures that maximize helath for the greatest numbers of persons. It really is that simple. A safe blood supply is one of those items. It is just as pragmatic as sewage disposal and water treatment. It is no more or less an area for contention on the grounds you suggest. It applies equally to all potential donors. It protects (within current capability and understanding of disease agents) the common good.

[The Wizard from Milan]

Originally Posted by inked

Didn't I specify that the number of sexual partners (regardless of homosexual or heterosexual) was a criterion for refusing donors?

I provided a link in my post #189 to an official red cross website that does not make any reference to heterosexual activity (other than prositutes themselves), but if you have a list of exclusions which is more specific than that, I'll be happy to read it and compare it.

Moreover in my post 03-12-2005 11:59 AM I point out a case to which none of your objections apply.

Originally Posted by inked

What there is in terms of restriction is the best devised (to date) screening of all potential donors to exclude on the basis of rational, scientific evidence those that are at risk. All comers. No exceptions.

Well, that is your opinion; be it that you are a doctor, I am not going to take your opinion for good without a second opinion.

Originally Posted by inked

My suggestion to you and all concerned is that you go to your local blood bank and attempt a donation.

I instead strongly argue against this strategy. The red cross has the policy of recording the reason for the exclusion of donation. Albeit after Lawrence vs. Texas, in the US, this practice has smaller potential legal consequences than before there are still cases in which it matters (e.g. employment, in most states...)

Originally Posted by inked

Current estimates of undiagnosed and probably apparently healthy individuals carrying HIV of either sex are in the hundreds of thousands in the USA alone

That is not a surprise to me. And you will also know that not all of them are gay men. But still nothing is done to review the guidlines to see wether these new groups (e.g. African American heterosexual women) should be barred from blood donation or not.