Science, race, homophobia, and 'The View'

A few weeks ago, Slate ran this pointed article about the FDAs refusal to allow homosexual men to donate blood. Quick summary: Yes, homosexual men are 'at risk' for HIV-1 infection. But the majority of HIV-1+ homosexual men are aware of their status, thanks to increased HIV-1 awareness in their social community. African Americans also have an increased risk of being HIV-1+... but very few know they are positive. So if you are going to ban homosexuals for 'being at an increased risk of being HIV positive' (but not people who have sex with prostitutes or IV drug users), why not blacks too? Or why not judge peoples 'safety' at an individual level? Why is a homosexual man who always practices safe sex and regularly gets HIV tests is 'a risk not worth taking', but a straight man who regularly visited prostitutes over 12 months ago and has never been tested for HIV, is fine? Why are African Americans given a pass on being at higher risk for HIV-1 infection (with limited HIV-1 awareness in their social circles) when homosexual men arent?

Race/ethnicity of persons (including children) with HIV/AIDS diagnosed during 2007:

There are certainly bumps in the FDAs logic.

For some reason (race), this was a 'Hot Topic' on 'The View' (videos here). The guest that day, D.L. Hughley, apparently thinks being a black actor makes him an HIV-1 epidemiologist and qualified to dispense information on HIV-1 in the African American community. He decided to use his air-time to dispense a nice bit of misinformation and homophobia-- Black homos on 'the down low', are why black heterosexual women are at such a high risk of HIV-1 infection.

This is not true. Its a scapegoat for the real reasons blacks are at a higher risk, outlined by the CDC:

  • Sexual risk factors include high-risk sexual contact such as unprotected sex with multiple partners or unprotected sex with persons known to have or be at a high risk for HIV infection. People may be unaware of their partner's sexual risk factors or have incorrectly assessed them.
  • Injection drug use
  • Sexually transmitted diseases (STDs)... The presence of certain STDs can significantly increase one's chances of contracting HIV infection
  • Lack of awareness of HIV serostatus
  • Stigma, a "negative social label that identifies people as deviant"
  • The socioeconomic issues associated with poverty

Hughley worsened the stigma of HIV-1+ in the African American community in front of millions and millions of viewers. And thankfully, lots of people are pissed off.

I actually became aware of this story via COLORLINES (we dont watch 'The View' in the lab *sad face*). They bring up the important point that not only did all the people seeing this show 'learn' that its TEH HOMOZ FAULT for HIV-1 prevalence in women, but they had no idea that information was wrong, and no doubt shared that information with friends and relatives, who shared it with friends and relatives, and so on, and so on.

No offense, but this is a lot worse than stupid Sherri Shepherd or stupid Elizabeth Hasselbeck saying something stupid (NEWSFLASH: stupid people say stupid things). This is a very real problem of homophobia, HIV stigma, and public health. So GLAAD, the Black AIDS Institute, and the National Black Justice Coalition joined forces to take out an ad in Variety Magazine, calling on ABC and 'The View' to have scientists on as guests to discuss this issue.

While I commend their call to action, the sad thing is, this wont happen. This just isnt going to happen.

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I thought my opinion of Hughley was initally as low as possible based on his not-at-all-funny "comedy." Then I saw him tell Dan Savage on air that because he (Hughley) was a Christian he did not agree with Savage's "lifestyle." Guess I was wrong. Then I thought that nothing after that could lower my opinion of him any further. I was wrong again.


I dont know jack about Hughley, so I assumed his comments were just the generic homophobia Im used to from the black community.

I didnt think that it was also a strategic 'Christian' thing he has pulled before.

Maybe we don't need to stop the blacks from donating blood... Maybe they could just have their own blood bank - you know, a "Separate" one. But "Equal".

(Important note for persons unable to recognise sarcasm on the internet: this is a joke. Not a very good one.)

Seriously though, don't they screen anyway? What's the deal with discriminating at all?

Btw, you also can't donate if you've ever eaten British beef.

By theshortearedowl (not verified) on 14 Jul 2010 #permalink

My SO is often home when The View is on. I will ask her first, if she saw it and second what she thought of Hughley's schtick. I'll be sad if she fell for it, but then I'll have a better feeling for how her social set reacted as well. It won't be hard to reverse the SO's opinion but harder to reach a wider audience maybe.

Of all the CDC's points, I look at stigma as the biggest hurdle to overcome.

Its unfortunate that these kinds of attitudes still persist. But it isn't too surprising, given that many religious leaders still teach their flocks that HIV is gods punishment for homosexuals...

On the topic of why we still ban homosexuals from donating blood, I think the correct answer is "historical precedent". My wife works for the Canadian version of the USA's blood system, and we have the same rule. This rule comes from the earliest days of the N. American HIV epidemic, when the vast majority of the infected were homosexuals and we did not have an effective lab test to screen the blood. Hence, at the time, this rule made sense - don't allow donations from the known risk groups (at the time, homosexuals and IV drug users).

Today, at least here in Canada, all donations are tested for HIV and a plethora of other pathogens - even if you've donated 1,000 times before. As such, these dated rules are no longer necessary.

The "good" news, at least up here, is that the blood services is being sued over this rule, and they will most likely loose that case. So, with a bit of luck, HIV negative individuals, regardless of their sexuality, should be able to donate...

I might be mistaken here since the only source of knowledge I have on this is And the Band Played On.
Yes, they ought to be screening, but the screening started rather late in the timeline of the AIDS epidemic. It took a long time to persuade the public blood banks (slightly less for the private ones) that there was a problem at all. Even when a few old ladies with hip surgery had already died of AIDS, the blood industry still denied that there was a problem in the blood pool at all!
(Actually, the fact that they were so negligent has a silver lining, I guess. Had they started screening immediately, people in the "socially acceptable" demographic would have lived, and we'd still have next to no funding for research. We ignored the hell out of AIDS in the first five years of the epidemic because it was perceived to be a disease of gays and needle users, and who cares about them!)
One of the things that they did before implementing HIV screening was to prohibit gays from donating blood in the hope that this would save the blood supply so they wouldn't have to fork over the extra $$ to screen.
Yeah. That worked. And now, even though we screen, we still have this stopgap.
My blood bank asks you if you've used prostitutes, needles, or gotten ANY body piercings. They ask no questions about heterosexual promiscuity or practices that I can remember. They might ask about multiple partners.
On one hand, it seems unfair to ban gays if they aren't going to hold heterosexuals to the same standard. On the other hand, anal sex is a high risk activity and while heterosexuals can do it to, it's a bit of a taboo in the heterosexual community, making it more likely that gays spread it this way.
So, I don't know where it is right to draw the line between prohibiting donors donors with a tendency to high risk activities and discrimination. It's a difficult question.

Once again, a trumped-up accusation of bigotry...

From what I remember, the last time I gave blood they asked about BEHAVIOR. They didn't ask "are you gay", they asked if you'd been having sex with men. How is it any different from asking whether you'd had sex with prostitutes or had multiple partners or whatever? People who go to prostitutes use condoms too.

Here's what the Red Cross actually asks:…

You should not give blood if you have AIDS or have ever had a positive HIV test, or if you have done something that puts you at risk for becoming infected with HIV.

You are at risk for getting infected if you:

* have ever used needles to take drugs, steroids, or anything not prescribed by your doctor
* are a male who has had sexual contact with another male, even once, since 1977
* have ever taken money, drugs or other payment for sex since 1977
* have had sexual contact in the past 12 months with anyone described above
* received clotting factor concentrates for a bleeding disorder such as hemophilia
* were born in, or lived in, Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea,Gabon, Niger, or Nigeria, since 1977.
* since 1977, received a blood transfusion or medical treatment with a blood product in any of these countries, or
* had sex with anyone who, since 1977, was born in or lived in any of these countries. Learn more about HIV Group O, and the specific African countries where it is found.

You should not give blood if you have any of the following conditions that can be signs or symptoms of HIV/AIDS

* unexplained weight loss (10 pounds or more in less than 2 months)
* night sweats
* blue or purple spots in your mouth or skin
* white spots or unusual sores in your mouth
* lumps in your neck, armpits, or groin, lasting longer than one month
* diarrhea that wonât go away
* cough that wonât go away and shortness of breath, or
* fever higher than 100.5 F lasting more than 10 days.

What a bunch of bigots, who won't take blood from Nigerians, or prostitutes, or anyone whose has sexual contact with them.

If you accept that gayness is an identity in the same way that blackness is; well, they're not asking "are you gay" and they're not asking "are you black"? They ask about behaviors which have put you at risk for HIV.

But maybe Abbie is right and black people shouldn't be allowed to give blood. I disagree; I think they should ask about behavior. But maybe they should allow anyone who wants to pinky swear that they always use condoms. Or maybe just not ask anyone and screen everybody for everything.

At any rate I think the lot of you owe the Red Cross an apology.

By Gabriel Hanna (not verified) on 14 Jul 2010 #permalink

What I'm annoyed about is that you guys uncritically repeated false claims about the Red Cross without even bothering to try to get their side of the story.

They ask about high risk behaviors, whether or not you identify as gay. They ask if you are a prostitute, ever had sex with a prostitute, or had sex with someone who did, ever shared needles or had sex with someone who did, or if you are from NIGERIA or had sex with someone who was!

No, let's just wade right in and accuse of them of hating gays.

By Gabriel Hanna (not verified) on 14 Jul 2010 #permalink

@Gariel: Do you have a reading comprehension issue? Get off your sanctimonious ass crack and read.

Gabriel I'm not sure which questions are automatic permanent disqualifiers. I've never been to Africa, nor have I had sex with someone from Africa, so I have no clue what happens if you answer yes to those (or sex with a prostitute, or spent x time in jail or UK or the other questions).

I will note in general agreement with what you're saying that they don't ask if you're gay, they ask if "you've ever had sex with another man, even once, since 1979". (I think it's 1979, I've quit paying attention) But why that nets a permanent exemption whereas other actions only win you a year off, is where the problem lies.

On a semi related note, they also ask if you've had contact with someone who's had a small pox shot. I've asked for clarification several times and just get blank stares back. I mean, they don't even ask if you've had one, or put a time frame in there. Nor do they specify "contact". Depending on how stringent the "contact" definition is, I dare say every single person who answers that should be saying yes. I say no because I'm scared of the unknown :p

If you accept (unprotecte) anal sex as a risk factor, why don't they ask *women* if they've ever done it - that's where the homophobia accusations are coming from.

By stripey_cat (not verified) on 14 Jul 2010 #permalink


Sit down. Take deep breaths. Count to ten. Now read the article again.

Now...can you tell me what words never appeared on this page until YOU wrote them? (hint: RC). Can you tell me what word DID appear in the very first sentence as the brunt of the very criticism you projected onto Red Cross? (hint: FDA).

I can't tell you if the Red Cross sticks to the FDA policy, but it has indeed been their policy to defer gays (as defined by "yes" answers to some of the behavioral questions) indefinitely. See below, wherein the Red Cross is credited with challenging the policy. I appreciate your defense of the organization, but you're barking up the wrong tree.

Shortearedowl: To the best of my knowledge they don't ban you for British beef. All I've ever been asked is if I stayed there for longer than a few months, which I have always assumed reflected a broader risk calculation (how likely was I to be exposed by eating it X times). I would assume if eating it once was the threat, then that's what they'd ask.


From TFA:

From 1977 to the present, have you had sexual contact with another male, even once? You'll have to answer that question, word for word, on a donor form if you want to give blood in this country. The form, authorized by the Food and Drug Administration and reaffirmed 10 days ago by an FDA advisory panel, offers three possible answers: "yes," "no," or "I am female." If you check "yes," you're done. You're forbidden to donate blood.

In other words, EXACTLY WHAT THE RED CROSS ASKS. And the Red Cross has ALSO been accused of discriminating against gays AND been asked "why not blacks"--this is where I first heard of the issue five years ago when my campus newspaper wrote about it, just as dishonestly as this Slate article does.

I see that the FDA is the target and not the Red Cross as I thought. Mea culpa.

They're using the same set of questions, as you will note if you read the Slate article:

This kind of group-based screening is a long-standing practice in blood regulation. Over the years, we've prohibited donors on the basis of nationality as well as sexuality. There's nothing wrong with such categorical exclusions, according to the FDA, as long as they make the blood supply safer.

So the FDA has rules about Nigeria as well. The same rules the Red Cross has.

So, I think my conclusion stands--you lot charge the FDA with bigotry without bothering to get their side of it. You owe them an apology too.

The FDA's side of the story may be found here, pardon me for quoting a large chunk of it:…

* od & Blood Products
* > Questions about Blood

Section Contents Menu

* Blood & Blood Products
* Questions about Blood
* Donating Blood

Resources for You

* Consumers (Biologics)
* Healthcare Providers (Biologics)
* Industry (Biologics)
* About the Center for Biologics Evaluation and Research

Blood Donations from Men Who Have Sex with Other Men Questions and Answers

What is FDA's policy on blood donations from men who have sex with other men (MSM)?

Men who have had sex with other men, at any time since 1977 (the beginning of the AIDS epidemic in the United States) are currently deferred as blood donors. This is because MSM are, as a group, at increased risk for HIV, hepatitis B and certain other infections that can be transmitted by transfusion.

The policy is not unique to the United States. Many European countries have recently reexamined both the science and ethics of the lifetime MSM deferral, and have retained it (See the transcript of the "FDA Workshop on Behavior-Based Donor Deferrals in the NAT Era" for further information.). This decision is also consistent with the prevailing interpretation of the European Union Directive 2004/33/EC article 2.1 on donor deferrals.

Why doesn't FDA allow men who have had sex with men to donate blood?

A history of male-to-male sex is associated with an increased risk for the presence of and transmission of certain infectious diseases, including HIV, the virus that causes AIDS. FDA's policy is intended to protect all people who receive blood transfusions from an increased risk of exposure to potentially infected blood and blood products.

The deferral for men who have had sex with men is based on the following considerations regarding risk of HIV:

* Men who have had sex with men since 1977 have an HIV prevalence (the total number of cases of a disease that are present in a population at a specific point in time) 60 times higher than the general population, 800 times higher than first time blood donors and 8000 times higher than repeat blood donors (American Red Cross). Even taking into account that 75% of HIV infected men who have sex with men already know they are HIV positive and would be unlikely to donate blood, the HIV prevalence in potential donors with history of male sex with males is 200 times higher than first time blood donors and 2000 times higher than repeat blood donors.
* Men who have had sex with men account for the largest single group of blood donors who are found HIV positive by blood donor testing.
* Blood donor testing using current advanced technologies has greatly reduced the risk of HIV transmission but cannot yet detect all infected donors or prevent all transmission by transfusions. While today's highly sensitive tests fail to detect less than one in a million HIV infected donors, it is important to remember that in the US there are over 20 million transfusions of blood, red cell concentrates, plasma or platelets every year. Therefore, even a failure rate of 1 in a million can be significant if there is an increased risk of undetected HIV in the blood donor population.
* Detection of HIV infection is particularly challenging when very low levels of virus are present in the blood for example during the so-called "window period". The "window period" is the time between being infected with HIV and the ability of an HIV test to detect HIV in an infected person.
* FDA's MSM policy reduces the likelihood that a person would unknowingly donate blood during the "window period" of infection. This is important because the rate of new infections in MSM is higher than in the general population and current blood donors.
* Collection of blood from persons with an increased risk of HIV infection also presents an added risk if blood were to be accidentally given to a patient in error either before testing is completed or following a positive test. Such medical errors occur very rarely, but given that there are over 20 million transfusions every year, in the USA, they can occur. That is one more reason why FDA and other regulatory authorities work to assure that there are multiple safeguards, not just testing.
* Several scientific models show there would be a small but definite increased risk to people who receive blood transfusions if FDA's MSM policy were changed and that preventable transfusion transmission of HIV could occur as a result.
* No alternate set of donor eligibility criteria (even including practice of safe sex or a low number of lifetime partners) has yet been found to reliably identify MSM who are not at increased risk for HIV or certain other transfusion transmissible infections.
* Today, the risk of getting HIV from a transfusion or a blood product has been nearly eliminated in the United States. Improved procedures, donor screening for risk of infection and laboratory testing for evidence of HIV infection have made the United States blood supply safer than ever. While appreciative and supportive of the desire of potential blood donors to contribute to the health of others, FDA's first obligation is to assure the safety of the blood supply and protect the health of blood recipients.
* Men who have sex with men also have an increased risk of having other infections that can be transmitted to others by blood transfusion. For example, infection with the Hepatitis B virus is about 5-6 times more common and Hepatitis C virus infections are about 2 times more common in men who have sex with other men than in the general population. Additionally, men who have sex with men have an increased incidence and prevalence of Human Herpes Virus-8 (HHV-8). HHV-8 causes a cancer called Kaposi's sarcoma in immunocompromised individuals.

What is self-deferral?

Self-deferral is a process in which individuals elect not to donate because they identify themselves as having characteristics that place them at potentially higher risk of carrying a transfusion transmissible disease. FDA uses self-deferral as part of a system to protect the blood supply. This system starts by informing donors about the risk of transmitting infectious diseases. Then, potential donors are asked questions about their health and certain behaviors and other factors (like travel and past transfusions) that increase their risk of infection. Screening questions help people, even those who feel well, to identify themselves as potentially at higher risk for transmitting infectious diseases. Screening questions allow individuals to self defer, rather than unknowingly donating blood that may be infected.

Is FDA's policy of excluding MSM blood donors discriminatory?

FDA's deferral policy is based on the documented increased risk of certain transfusion transmissible infections, such as HIV, associated with male-to-male sex and is not based on any judgment concerning the donor's sexual orientation.

Male to male sex has been associated with an increased risk of HIV infection at least since 1977. Surveillance data from the Centers for Disease Control and Prevention indicate that men who have sex with men and would be likely to donate have a HIV prevalence that is at present over 15 fold higher than the general population, and over 2000 fold higher than current repeat blood donors (i.e., those who have been negatively screened and tested) in the USA. MSM continue to account for the largest number of people newly infected with HIV.

Men who have sex with men also have an increased risk of having other infections that can be transmitted to others by blood transfusion.

What about men who have had a low number of partners, practice safe sex, or who are currently in monogamous relationships?

Having had a low number of partners is known to decrease the risk of HIV infection. However, to date, no donor eligibility questions have been shown to reliably identify a subset of MSM (e.g., based on monogamy or safe sexual practices) who do not still have a substantially increased rate of HIV infection compared to the general population or currently accepted blood donors. In the future, improved questionnaires may be helpful to better select safe donors, but this cannot be assumed without evidence.

Are there other donors who have increased risks of HIV or other infections who, as a result, are also excluded from donating blood?

Intravenous drug abusers are excluded from giving blood because they have prevalence rates of HIV, HBV, HCV and HTLV that are much higher than the general population. People who have received transplants of animal tissue or organs are excluded from giving blood because of the still largely unknown risks of transmitting unknown or emerging pathogens harbored by the animal donors. People who have recently traveled to or lived abroad in certain countries may be excluded because they are at risk for transmitting agents such as malaria or variant Creutzfeldt-Jakob Disease (vCJD). People who have engaged in sex in return for money or drugs are also excluded because they are at increased risk for transmitting HIV and other blood-borne infections.

Why are some people, such as heterosexuals with multiple partners, allowed to donate blood despite increased risk for transmitting HIV and hepatitis?

Current scientific data from the U.S. Centers for Disease Control and Prevention (CDC) indicate that, as a group, men who have sex with other men are at a higher risk for transmitting infectious diseases or HIV than are individuals in other risk categories. While statistics indicate a rising infection rate among young heterosexual women, their overall rate of HIV infection remains much lower than in men who have sex with other men. For information on HIV-related statistics and trends, go to CDC's HIV/AIDS Statistics and Surveillance web page.

Long story short, learn to read news articles critically.

By Gabriel Hanna (not verified) on 14 Jul 2010 #permalink


The FDA doesn't screen blood based on your identity. You can be gay, straight, bicurious, whatever; the only question they ask is did you have sex with a man since 1977 if you are a man? Just like they ask if you ever had sex with a prostitute or anyone from Nigeria or with anyone who shared needles.

They screen by behavior and national origin, and the homophobia charge is trumped up. The FDA says if they had a better rule they'd adopt it, and that Europe has the same rule.

Men who have had sex with a man since 1977 have HIV at 60 times the rate of the general population. Someday that will change, or screening will get better. Until then, the rule will stay in place, and it is always getting reviewed.

By Gabriel Hanna (not verified) on 14 Jul 2010 #permalink

I donate regularly in the UK and the screening check here also excludes all men who have ever had sex with men. There are also exclusions around drug use and prostitution. It's pretty clearly unfair that, for example, a gay man in a monogamous relationship who always practices safe sex is excluded whereas a heterosexual anyone can have multiple partners and not practice safe sex and not be excluded.

Gabriel, please read for comprehension: people are not accusing the FDA or Red Cross of hating gays, as you put it. People are pointing out that the current policy seems discriminatory against gay people in that it lumps all gay people together as a high-risk group.

By Stephen Wells (not verified) on 14 Jul 2010 #permalink

@ Gabriel Hanna:

I don't think that the fact that gay people are identified on the basis of a behavioral question is terribly significant to the moral question as to whether it is right to exclude people on the basis of their sexuality when this is nearly as crude a manner of grouping high-risk individuals as using race.

Also, I don't think that anyone here had accused the red cross (or FDA) of bigotry - did I miss something?

@ Stephen Wells - darn it Stephen. If I'd refreshed the page before typing my reply I'd have noticed you had made me entirely superfluous.

woah. Did you realize you were having an argument all by yourself? You're not talking, on point, about what others are discussing --- why is this??

This was about Hughely making claims that are not substantiated by facts, and not the articles you quoted. Did you realize that you quoted, verbatim, off the FDA website? Cuz, the conversation wasn't about the FDA's defense of the FDA's policy (and not about the red cross - they adopt the FDA policy, but this conversation was not about them until you brought it up - nice job)

You wrote:
"The FDA doesn't screen blood based on your identity."
That's true - they screen blood indiscriminately. As in, all blood, regardless of who donates it, or what they say, their blood is screened for two reasons.

(1) They may, unknowingly, have HIV for any of the reasons people posit (though some are more likely than others).
(2) They may, knowingly, have HIV and have some sort of drive to harm others.

Screening all blood prevents tainted blood from reaching the blood supply.

They screen people, preemptively, because some individuals are at a higher risk factor than others. You seem to be okay with this policy - that's fine, but if you follow the logic that this thread is actually discussing, then you should be in favor of black women also not being allowed to donate blood, right?

See, that would be consistent logic -- since you're fond of quoting statistics off the page, please tell me how much more likely it would be for a black woman to be HIV positive than the general public?

Now, what others here are saying is that HIV+ men are likely to know they have HIV and thus are unlikely to donate. But a much higher proportion of the HIV+ black women, which is the largest growing population of new patients, is much less likely to know their HIV status. Thus, they are more likely to donate when they shouldn't.

So, instead of barring "men who have had sex with men" but likely know their HIV status, why not just screen everyone, anyway, and let them donate. Or ban black women. The position to ban MSM and not black women is not an internally consistent position to hold.

You're failing on reading comprehension Gabriel. It is not being denied that homosexual behaviour is high risk. It is questioning the consistency. You seem to be completely avoiding the question of whether having sex with prostitutes is also high risk behaviour. The Red Cross seems happy to take my blood as long as I verify that it's been over a year since I had sex with a prostitute. IIRC, it also asks if I have had sex with someone who has tested positive for HIV (It'll be another 40 days before I can confirm that).

Thus the question of consistency arises. It seems that either they are being too harsh w. homosexual behaviour or too lax w. other behaviours. Can you come up risk profiles on the other behaviours to justify this differential?

I second your WTF, Abbie. I THINK Gabriel's beef is accusations of bigotry in general, though I'm not sure. Which I think Stephen Wells covers... Might also be confusing the bulk of the article, concerning Hughley, with the FDA.

Haven't donated in a while, since I'm pumped full of drugs, but the Danish questionnaire specifically singles out homosexual behaviour. As well as intravenous drug abuse and tattoos within the past year. I don't recall any questions about prostitution, though.

I did kind of go off half-cocked about accusations of bigotry--I was expecting to hear them (because I had heard them before) and so I interpreted comments in that way which may not have been intended in that way. And I am sorry for that, and will be more careful in the future.

As for the comparison of black women and gays with HIV, it doesn't even compare. "Fastest growing" or not, the prevalence of HIV among men who've had sex with men is many many times higher than for anyone else, except maybe women from the hardest-hit parts of Africa--who also get screened.

Being black is not a behavior which increases your risk of HIV. It's an identity. Being gay is an identity which does not increase your risk of HIV. Being a man having sex men IS, and that is all the difference.

Until that changes, or until blood screening gets so good that the rate of a false negative from a man having sex with men becomes negligible, the rule is simply common sense in a way that forbidding black women to donate is not.

By Gabriel Hanna (not verified) on 14 Jul 2010 #permalink

instead of barring "men who have had sex with men" but likely know their HIV status, why not just screen everyone, anyway, and let them donate.

They already test everyone's blood for everything. No test is perfect, is the problem. When people engage in a behavior that makes them 60 times more likely to have HIV, the consequences of a false negative are correspondingly higher.

Being black is not a behavior. Being a prostitute or an IV drug user is a behavior.

We know all about correlation != causation, don't we? If blacks as a whole are more likely to have HIV, it is because blacks as a whole are more likely to engage in high-risk behaviors. The high-risk behavior is the sensible thing to evaluate. Evaluating the race is just a way to score debating points.

If one of the questions were "Are you gay", it would be discriminatory not to screen black women. But the questions are about specific behaviors, not about identities.

By Gabriel Hanna (not verified) on 14 Jul 2010 #permalink

The reason why blacks have a higher HIV incidence is because they have to deal with generational poverty. Sexuality is a behavior also race is a social construct.

Of course it couldn't be that blacks face institutional racism on many fonts and instead of arguing on gay men giving blood you argument is that "niggers" shouldn't get to donate blood.

These niggers don't even deserve HIV treatment

WHITE POWER!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

/\/\/\ The above is ironic racism if you can't tell. The foolish argument that the CDC shouldn't allow blacks to give blood because they don't allow gay men is incredibly foolish.

Guess what gay men can be black OMG LOL NOWAAYYYZZZZZ!!!!! So gay black men can't donate blood but no one cares its when we the mighty whites get somewhat disadvantaged then there is a problem.

Also tell me the gene that makes one black? Oh wait you can't race is a social construct not a biological one.

On it is written:

" African-American blood donation may be the best hope for the needs of patients with sickle cell disease, 98 percent of whom are of African-American descent."


"Do blood types differ between ethnic groups? Yes. For example, about 57 percent of the Latino population is type O, the blood type in greatest demand. That share is 51 percent for African Americans, and only about 45 percent for white Caucasians. As certain population groups continue to increase, so does the need for type O blood. It is critical that more Latino and African American donors, give blood regularly to ensure that patient needs can be met."

Also 69% of all HIV cases in 2007 came for male to male sexual contact. And about 20% came from IDU but the RedCross doesn't ask if people use drugs intravenously...oh wait.

I'm not sure if this was noted, but the blood banks notably do NOT ask about promiscuous sexual behavior, do not distinguish between promiscuous and non-promiscuous male-male sexual behavior, do not distinguish between protected and unprotected sexual contact of any sort, and ignore the ramifications of their date cutoff and the passage of time (hence, I guiltlessly lie to them about the few sessions of experimental fumbling I engaged in with a couple of friends in my early teens - I would literally be more likely to catch HIV from a glassware accident in chemistry lab than those encounters, and they don't ask about THAT either).

These omissions make very little sense if the MSM blood ban is motivated by fear of blood recipients catching AIDS.

On the other hand, they make perfect sense if it's motivated principally by fear of catching "Faggot."

@26: since people very rarely climb down gracefully in online arguments, kudos to you for doing so on the homophobia issue.

I still disagree with you on the screening issue- I think "being a man who has sex with men" is far too broad-brush a criterion to identify the relevant high-risk group that should be excluded from donation.

@Joseph: that is the wrong end of the stick that you have got there. Read Abbie's post again.

By Stephen Wells (not verified) on 14 Jul 2010 #permalink

If you want not well thought out policies on blood donation then you need to look at the restrictions around geographic residency. I work in a rather prestigious institution that has a hospital attached to it. They had a blood drive last year and seeing as I have some of the good stuff (O neg) I asked a simple question: Are the restrictions regarding living in Europe still in place? That is, I lived in Germany from 1983 to 1988, and there is some fear that I picked up mad cows and ate their brains. And guess what - it still is in place, they wouldn't take my blood.

By Onkel Bob (not verified) on 15 Jul 2010 #permalink

As someone who donates blood very regularly, I have been through the Red Cross question gauntlet many times.

I was once rejected from donating blood because of a "test" on an earlier donation, and it being on the weekend couldn't find out what that "test" was for several days. Turns out it was for elevated liver enzymes, back when they tested for such things as a marker for hepatitis. At the time, that was a permanent rejection. They later changed their criteria and I became eligible again.

As has been mentioned, all blood is tested, but the tests are not accurate for some period of time after infection with HIV. One can have infectious levels of virus, but not have yet seroconverted. This is the source of most cases of HIV transmission by blood transfusion. A donor has been infected with HIV in the recent past, has an HIV infection, but doesn't have the immune response yet to show positive on the tests. Being in prison for more than 72 hours is a deferral too.

There is not just the issue of false negatives, there is also the issue of false positives. For a false positive you have to discard the unit that tests positive. If you test for 10 things and each of them has a 1% false positive test rate, then you have to discard ~10% of the blood you collect just for false positives. Making a test more sensitive to get fewer false negatives means you will have more false positives.

There are not tests for everything that can be transmitted, and the costs associated with testing for everything that can be tested for would be very high. Malaria for example is very easily transmitted by transfusion, but if you have been to a region where malaria is present you are deferred for a year. If you get malaria you are deferred permanently. They don't test for malaria. By excluding people who have been in regions where malaria is endemic, they exclude people who might have malaria even though most people who have been to an area where malaria is endemic didn't get infected.

If they did allow people who had been to malaria endemic areas, they might get 1% more donations (these are all made up numbers). If they needed to test for malaria, and the test had a 0.01% false negative, a 1% false positive, and if 1% of the people who had been to the malaria endemic area actually had malaria, then for an initial 1,000,000 donations, by adding 1% they would get 1,010,000 donations, but would have to test 1,010,000 units, rejecting 10,100 as false positives, 99 as true positives and would let 1 false negative through. They would end up with 999,801 units and one case of malaria transmission. The blood supply has been reduced, has cost more, and has become less safe by allowing people who had been in malaria endemic areas to donate. I used made-up numbers, but getting ârealâ numbers would not be cheap, at $5 per test, a million tests is $5 million.

The goal of the blood supply is to have âenoughâ blood that is safe âenoughâ and is cheap âenoughâ. They only accept blood that is donated, so the cost of the blood is âfreeâ, but the storage containers, the testing, the labor to draw the blood and test and store it are not âfreeâ.

What they do now when they are running short of blood is to call up previous donors. I have been called multiple times, often just after I have become eligible again (after 8 weeks). The âcostâ to increase the blood supply now is to have people make phone calls to known eligible donors until they have âenoughâ. That way they also get to target specific shortages by blood type.

The case of living in Europe during the mad cow exposure event is not clearly not well thought out. There is no way to test blood for prions. There have been a couple hundred vCJD in the UK from probable beef exposure and 5 probable vCJD from transfusions. With there being a known risk factor, and no known test, the liability of accepting blood from people with known risk factors could be very high.

I just realized there is a calculation error in my example. It would be 0.01 cases of transmission, not 1. This doesn't change the gist of the example.

People do lie about their risk factors, or don't know the actual risk status of their partners. A MSM may be in a monogamous relationship, but if his partner is lying to him and is having sex outside the relationship, he might have been infected without knowing it.

I think that men are more likely to lie about sex with men because there is stigma attached to it by some. They don't ask about lesbian sex because there is negligible risk associated with it.

If you have been raped, there is a one year deferral. My understanding is that this is to give you time to seroconvert if you were infected.

Nice lessons daedalus.

I'll remake the point that the categories may not be coherent (maybe everyone's convinced, but I worry) with an example of a married male, who's had just 1 partner since 1984, but a few homosexual relationships before then, been HIV tested, and has no other risk factors. Maybe they could have Hep B, but HIV risk comes from the wife only. I claim I could find many categories of people that give blood who pose higher risk, far higher. It's possible the risk from this person is below the median of the actual donors. (I'd like to make a stronger statement, but have not the data.) 1977 or 79 is a hell of a long time ago.

On average folks who have ever had male homosex may be 60 times the risk or whatever, but that is ignoring other factors, inviting Simpson's paradox-related failure.

Maybe I want a system where I can be tested and vetted to prove I am low risk, even if I have to pay for it.

I'll remake the point that the categories may not be coherent (maybe everyone's convinced, but I worry) with an example of a married male, who's had just 1 partner since 1984, but a few homosexual relationships before then, been HIV tested, and has no other risk factors.

Okay, but they're not trying to come up with a rule that covers every possible situation. They are trying to come up with a rule that requires throwing away the least amount of blood and money.

Take your married male who did some "experimenting" back in the day. Suppose that instead of hot man-on-man action, he was experimenting with IV drug use.

People sharing needles have a high rate of HIV infection partly because what they do makes HIV transmission very easy, but also because the IV drug community is very small (Is there anyone besides IV drug users who share needles? If you are sharing a needle with someone, you are almost certainly both IV drug users, unless there is some kind of widespread needle-sharing fetish with which I am unaware). If one person gets infected and people are sharing needles the disease will spread rapidly through the population. So, should we allow IV drug users to donate blood if they pinky-swear that they never shared needles?

Likewise, men having sex with men are, for the most part, having sex with other men having sex with men; though there are people who experiment or not exclusive to men, we all know that. (If you have sex with a man, and it's only a one-time thing, what are the chances that it's only a one-time thing for him too? Of course it can happen, but it's not likely.) Like the IV drug community, this community is also much smaller than the general population. According to CDC, about half of people who have HIV are men having sex with men 20% are IV drug users), and this works out to about 530,000 people:…

If 3 percent of Americans are men who have sex with men, this works out to about six percent of all men who have had sex with men having HIV.

If you accept blood from one of these men, there is a six percent chance it has HIV in it, if we know nothing else about this particular man. If he tests negative, there is a significant chance the test is wrong--and you will find this out for yourself when you get tested for HIV. If you don't engage in high risk behaviors they don't retest you unless you test positive; if you do engage in high-risk behavior, they retest you if you test negative (and the same for your six-months-late test). This is common sense.

Female prostitutes are not having sex mostly with each other. A prostitute might spread HIV to other people, but not directly to other prostitutes, except in very rare cases. Likewise an IV drug user is sharing needles with other IV drug users. One community is relatively closed and the other is relatively open.

It's the high risk behavior coupled with a small and relatively closed population that leads to the high prevalence. If men who have sex with men were not counted, the rate of HIV in the general population would be almost half, and if IV drug users were not counted the rate in the general population would be about a quarter or a third of what it is. You can't just wave that away by saying "let's count black people oh they disproportionally have HIV you gonna ban them too?"

And making people swear they always use condoms or are monogamous could be tried, but people--gay straight whatever--lie about that.

Maybe there should be some kind of certification process that people could pay for if they want to donate blood and have sex with men; that is a very humane and fair solution.

Someday, if all the men having sex with men are monogamous and using condoms, their rate of HIV will drop to something approaching what it is among other populations. Until then, the rule is common sense, in the absence of some kind of voluntary certification such as rork describes.

It's not that I want gay people prevented from donating blood--it's just that that right now the cost-benefit analysis doesn't work that way. When it does the rule will be changed and I will cheer.

By Gabriel Hanna (not verified) on 15 Jul 2010 #permalink

Joseph asks: "Also tell me the gene that makes one black? Oh wait you can't race is a social construct not a biological one."

Actually Joseph, skin color is determined by genetics. The gene in question is the melanocortin receptor 1 gene. Mutations leading to non-funtioning MCR1 receptors gives rise to red hair and very fair skin, for instance.

So, actually racism is a social construct not skin color/race which would appear to be a biological construct after all.

So anyway, why does anyone care what D.L. Hughley says about anything? He's just an idiot with a mic and camera....sort of like the hosts of the show in question.

No race is a social construct. Phenotypes are determined by genetics (mostly) but how dark does skin have to be to be considered black? Obama has a skin complexion equal to some "whites" yet he is considered black even though his mother is white.

Race is just determined on the arbitrary pigmentation of your skin especially since I've known some people who have children that have lighter skin than their parents. Is this a different race?

Does having a mutated MCR1 receptors mean that person is in a different race?

Joseph, you're getting a bit off topic--can't say I didn't do the same--but you know who believes that race is biological? Forensic anthropologists. They can tell you all about differences in bones, teeth, and hair and they can determine the race of a person well enough to identify a murder victim.

How we treat people of various races is of course social.

By Gabriel Hanna (not verified) on 15 Jul 2010 #permalink

The many words of #37 about average behavior did not address when the behavior was happening, which was my main point, though I admit it is a rather small detail in this discussion as a whole. I'm asking, and have no data, whether changing 1979 (or 77) to 1989 (or 86, or 82, or 92), would make sense. When that date should be set is hardly considering "every possible situation" - it's an incredibly prominent part of the decision rule. It's saying "common sense" and "cost-benefit analysis" but it's all fuzzy, and I've not seen it demonstrated that 79 is optimal. I suspect it's just stuck there for other reasons. Maybe it'll still be stuck there in 2029, eh? For a nerd like me, this is just an optimization problem, where experts have pretty good handles on the loss function, and may have fairly big data. I admit that it may cost too much money to obtain better data to make it worth altering the date, if it will only increase the donor pool by a small amount. That question can be attacked analytically too.

PS: The right data would permit a more careful calculation telling people when they would be doing more good than harm by simply lying, and then they might feel ethically compelled to lie. People are probably already lying based on seat-of-the-pants computations, without full knowledge of the loss function (it's messy, involving more than just HIV), which is not a perfect situation.
Emphasis: I've not done that and I don't advocate that.

rork, I want to disabuse you of the notion that people are "doing more good than harm by simply lying". That is simply not the case. If there is a crisis shortage of blood, the word goes out, more people are contacted and more people who are within the guidelines donate blood. If there is such a crisis shortage of blood that the guidelines need to be modified, let the experts who know the trade-offs make that call.

When people lie about their status and donate, it does increase risks of infected blood entering the system, they can't catch everything, they don't know everything that is important and they don't even test for lots of stuff that they know is important. If the experts don't know what is important, how can the random joe schmoe know enough to second guess the guidelines and lie about them? He can't. It is the arrogance of ignorance that makes him feel that he does.

It also distorts the apparent size of the actual eligible donor pool. If 20% of the actual donors are actually ineligible but are lying about it, those doing the collecting think that the pool of eligible donors is 25% larger than it actually is. If they get contaminated blood from those lying donors, they might think they need to make the guidelines more restrictive.

The real reason I am always completely straight with the guidelines is to protect myself. If someone gets infected through my blood, it won't be because I lied about it. I will feel badly about it, but because I didn't lie about my status I won't feel guilty.

I found this general article to be quite interesting:

Social factors play a role in U.S. HIV/AIDS epidemic among black women.

Two factors caught my eye: prevalence of STDs and food insecurity.

STD infections altering membrane integrity (increasing inflammation), that made sense.

Food insecurity: I wonder if the high rate of obesity among black women is associated with an increased inflammation response. Does it increase the odds of contracting an STD which then vastly increases odds of HIV infection, even at low dose exposure rates?

Is STDs is also a factor for the rate of HIV diagnoses among white heterosexual women?

The rate for black women is 3.5x that for black men (heterosexuals). Something is a tad odd here.

Source. June 2010, graph: Estimates of New HIV Infections, 2006, by Race/Ethnicity, Risk Group, and Gender for the Most Affected U.S. Subpopulations.

I could not find HIV diagnosis annual data for white heterosexual males. Interesting.


@Gabriel Hanna:

Do you ever read before writing?
"Europe" do not have the same rules as the US.
The rules vary between every european country. Europe is first of all not a country dim-wit, it is a rather loose federation of countries.

The rules for me are (boiled down): Prostitutes and their visitors and drugaddicts (which incidentally means that most americans and dutch are banned from giving blood) have a lifelong ban. Those who have HIV, malaria, hepatitis and Chagas are banned for life.
New partner, wait for 6 months. Tatoo, piercing and soforth, wait for 6 months.
All potential donors are tested for the above mentioned deceases, and the blood is screened.

For those who became annoyed by the coment on americans and drugs? Check the statistics on drug-use... US and Holland (where the dutch people live) are far in top of that list.

daedalus @42: I am agreeing with you. (I hope the paragraph and sentence you mined the quote from makes that clear, but maybe it was not fool-proof enough, and I appreciate you writing the warnings again.) I do question the calculations of the experts though, cause I haven't seen them, and it's common to find poor applications of decision theory in the wild. It's hard for experts, so don't try this at home.

British beef? Srsly?

I spent a summer in the UK in '78. Had some Wimpy burgers (gak!). Does that count as "British beef"?

They're fairly specific about the mad cow disease/vCJD issues. I do not recall a question specifically asking about eating beef in England :p

"From January 1, 1980, through December 31, 1996, you spent (visited or lived) a cumulative time of 3 months or more, in the United Kingdom (UK), or

From January 1, 1980, to present, you had a blood transfusion in any country(ies) in the (UK). The UK includes any of the countries listed below."

The countries are: Channel Islands, England, Falkland, Islands, Gibraltar, Isle of Man, Northern Ireland, Scotland, Wales.

Their stated justification for Anglophobia is:

"There is now evidence from a small number of case reports involving patients and laboratory animal studies that vCJD can be transmitted through transfusion. There is no test for vCJD in humans that could be used to screen blood donors and to protect the blood supply. This means that blood programs must take special precautions to keep vCJD out of the blood supply by avoiding collections from those who have been where this disease is found."


For those who became annoyed by the coment on americans and drugs?

You'll have to clarify the rules first:

Postitutes and their visitors...

This is 15% of all men in the USA that have used one. Jolly-good.

Only 23 of every 100,000 of the population are prostitutes (that's .023% of the population... that's nearly negligible).

...and drugaddicts (which incidentally means that most americans and dutch are banned from giving blood) have a lifelong ban.

Does this mean if you've used drugs even once you're excluded? Does this include marijuana use?

Seems a little odd that you'd use the term "most" if refering to actual addicts of drugs because only 9.4% of the population is actually classified with past year substance dependence or abuse. And of that 9.4%, 75% of those was for alcohol abuse only.

6% are said to be current (within the last 30 days) users but not all are addicted, and most of this is marijuana use.
A little bit more than 33% of the population have used an illicit drug, but more than 90% of that was marijuana use.

Source: Substance Abuse and Mental Health Services Administration, and others (I can give you the list if you want).

So, if even if you assume absolutely no overlap between prostitution and illicit drug addiction (which is being far too generous), and we include single time users INCLUDING that which was just marijuana, that's still only 45% of the population.

If you exclude marijuana, that drops the number down to about 18% of the population assuming no overlap between prostitution and illicit drug addiction.

Not exactly "most" Americans is it?

Maybe it's increased dramatically since 2002-2004 (when the statistics I stated were gathered), but they were showing a downward trend in drug use...

You think you could provide a source for your "most" claim, Carl?

By Kemanorel (not verified) on 23 Jul 2010 #permalink

Almost off topic:
There was some discussion i read some years ago that because all of Europa today descendt from people who survived "Black Death" - the Plague, we might have a better resistance against HIV than africans. Anyone knows if this has been proven true or just speculation?


You are referring to CCR5 delta 32. A deletion mutation found as two copies in one percent of the Northern European population. It is believed, by some, to be much older than the Bubonic Plague epidemics and may, originally, be a form of selected resistance to small pox.

In answer to your question the resistance has been demonstrated and reproduced. The downside is not fully understood but there is some indication in double deltas of a greater susceptibility to West Nile.

A study in engineering the deletion mutation using mice and stem cells was released early this month. I have not yet read it.

By Prometheus (not verified) on 26 Jul 2010 #permalink