Pur Autre Vie

I'm not wrong, I'm just an asshole

Wednesday, June 15, 2016

The Ban on Blood Donations by Sexually Active Gays

I just want to give some context for the ban on donations of blood by sexually active homosexuals.  I don't have an informed view on whether the ban makes sense today, because I think that depends on medical facts that I'm not competent to assess.  But I think that such a ban could make sense, however bad it may make gay people feel.  The following account comes largely from And the Band Played On by Randy Shilts.

For many years, probably for most of human history, the leading cause of death for hemophiliacs was uncontrolled bleeding.  This is because hemophiliacs suffer from a condition in which their blood doesn't clot properly, so what would be a very minor injury for most people can be life-threatening for a hemophiliac.  This is tremendously limiting.  The most famous hemophiliacs in history were nobility, but obviously today the vast majority of hemophiliacs are working-class people.  But think of how difficult most jobs would be if even a minor cut or bruise were life-threatening.  And think how you would live your life if a simple stumble, or a fall off a bike, were basically a death sentence.

The response has been to develop treatments that involve injections of concentrated platelets (actually it's a little more complicated than that, but for our purposes it's close enough).  This requires a large amount of blood, meaning that a single dose must come from multiple donors.  So a hemophiliac who is receiving this treatment is getting blood from dozens of strangers.  (As I said, it's concentrated, so the recipient isn't getting gallons of blood, he or she is getting platelets from gallons of blood.)

Anyway for a period in the 1980s the leading cause of death for hemophiliacs wasn't uncontrolled bleeding.  It was AIDS.  Think about that for a minute.  The leading cause of death.  Obviously this is a result of the practices used to manufacture the clotting factor that hemophiliacs need.  In surgery you might get a few pints of blood, coming from a few donors.  A hemophiliac regularly, and for the entirety of his/her life, needs injections of platelets coming from dozens of people.  If you allow HIV-positive blood to be donated, then it's nearly inevitable that hemophiliacs will contract HIV.  Today HIV isn't a death sentence, but it's certainly not something that people want to get.

For a long time, the blood banks resisted any effort to screen blood for HIV or to restrict donations.  This is why hemophiliacs started getting AIDS in such high numbers.  The blood banks benefited from a law that Congress had passed that made it nearly impossible to sue them.  Their incentives were mostly in the direction of keeping their donors happy so that they could keep the blood coming in.  The hemophiliacs fought bitterly to get safe platelets, and for a long time they were rebuffed.  And as noted, they started dropping like flies.  It was deemed more important to be nondiscriminatory than to give hemophiliacs safe blood products.  Ultimately that changed, of course, and for a long time homosexuals couldn't give blood at all.  Recently homosexuals who aren't sexually active have been removed from the ban.

So anyway that's the context.  Today we presumably have better screening tools, and sexually active homosexuals aren't nearly the risk that they once were.  As a result, it may make sense to relax the prohibition (apparently this was done in Orlando in the wake of the mass shooting).  But the ban wasn't some hysterical overreaction to an imagined threat.  It was imposed so that hemophiliacs could receive their life-enhancing treatments without dying of AIDS.


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