Tuesday, May 5, 2009

My Latest Article

Here's a transcript from an article I just wrote. It's a last-minute addition to the upcoming copy of our med student newsletter. Enjoy, and please feedback with your ideas and opinions. :)

In the world of public health, the goal is to benefit the greatest possible number of people. When it comes to blood donations, that means getting as many people to donate as possible, without compromising the safety of the blood supply. To this end, Canadian Blood Services not only screens the blood it receives for pathogens, but also screens out at-risk donors from giving blood in the first place.

In the 80’s, when HIV first burst into the public health scene, little was known about it except that the infection was endemic among gay men. This prompted a blood-donor ban, not just on sexually active gay men, but on any man who had ever had sex with another man (MSM) since 1977. This policy is still in place today. Potential donors are screened via questionnaire.

The obvious purpose of banning MSM from donating blood is to prevent iatrogenic transmission of HIV and other STI’s. However, the donor questionnaire doesn’t ask potential donors if they’ve had unprotected sex recently, nor does it inquire about anonymous sexual partners more than 6 months prior.

To clarify, this means that some guy who got “curious” (yes, including oral) at college once in 1981 but now has been straight and monogamous for 25 years and has 4 kids can’t donate blood. Meanwhile, another guy who had unprotected sex with 3 strangers in Vegas last year can. Somehow, I don’t feel like our blood supply is made safer by this policy.

Think of it this way: since, in Canada, men have a higher prevalence of HIV than women, we should ban men from donating blood, right? Of course not, that’s a ridiculous overgeneralization. The at-risk group can be narrowed down, as it has been. But limiting the at-risk group to MSM is still overly general. There are lots of sexually active gay men who use condoms intelligently with every partner, who get tested regularly, or who have been monogamous for years. These men are no more at risk of contaminating the blood supply than heterosexuals—and are less likely to do so than some!

One obvious remedy to this problem is to ask donors pertinent questions, rather than use a criterion that’s both over-inclusive and under-inclusive. Such questions could include “Have you had unprotected sex or a new sexual partner in the past year?” or “When was the last time you were tested for HIV?” These types of questions would weed out potential donors are at genuine risk for infectious diseases, but allow healthy, monogamous gay men to help their fellow Canadians by donating blood.

Other solutions include improving the reliability of testing and removing monetary incentives. However, the latter has already been implemented in Canada, and current blood screening is already so reliable that only one HIV-positive sample in a million would fail to be detected, according to the US FDA. Surely the best way to solve today’s shortage of donors is to add to the donor pool. The question is: how do we weed out those people who are truly at risk, without turning away healthy donors? Whatever the best answer is, the current policy is certainly not it.

Note: image from slapupsidethehead.com--a wonderfully humourous gay-centric Canadian blog.

1 comment:

Victoria said...

Nice, Chris! I recorded a radio feature in a similar vein for Australia's Blood Donation Day.

I miss you!