FDA Reduces Lifetime Ban On MSM Blood Donations To 1 Year

The Food and Drug Administration (FDA), the federal agency responsible for protecting the United States blood supply has finally issued regulations on changing the discriminatory (and patently offensive) policy on preventing any man who has said sex with another man (MSM) from donating blood. The decades-old policy of a lifetime ban was replaced with a "1-year deferral" for men who have had (any kind of) sex with another man.

From the FDA press release issued today:

As part of today’s finalized blood donor deferral guidance, the FDA is changing its recommendation that  men who have sex with men (MSM) be indefinitely deferred – a policy that has been in place for approximately 30 years – to 12 months since the last sexual contact with another man. These updated recommendations better align the deferral period for MSM with the deferral period for other men and women at increased risk for HIV infection – such as those who had a recent blood transfusion or those who have been accidentally exposed to the blood of another individual. The FDA examined a variety of recent studies, epidemiologic data, and shared experiences from other countries that have made recent MSM deferral policy changes. 

“In reviewing our policies to help reduce the risk of HIV transmission through blood products, we rigorously examined several alternative options, including individual risk assessment,” said Peter Marks, M.D., Ph.D., deputy director of the FDA’s Center for Biologics Evaluation and Research. “Ultimately, the 12-month deferral window is supported by the best available scientific evidence, at this point in time, relevant to the U.S. population. We will continue to actively conduct research in this area and further revise our policies as new data emerge.” 

Several countries, including the United Kingdom and Australia, currently have 12-month deferrals for MSM. During the change in Australia from an indefinite blood donor deferral policy for MSM to a 12-month deferral, well-conducted studies evaluating over 8 million units of donated blood were performed using a national blood surveillance system. These published studies document no change in risk to the blood supply with use of the 12-month deferral. Similar data are not available for shorter deferral intervals.

The website fivethirtyeight.com and Williams Institute conducted an analysis on the numerous proposed changes to the lifetime blood ban on MSM donations and these are summarized:

There should be an estimated 2 million more people eligible to donate blood, with 190, 000 of them likely to do so.

However, as the New Civil Rights Movement blog points out, the revised policy still continues the stigma of homosexuality, since a married gay couple who only have sex with each other (even with condoms!) is technically barred from giving blood for a year while a straight guy could be having sex every day for a year with sex workers or other high-risk individuals and the straight person is not bared from donating blood under this policy. This communicates the message that homosexuality is inherently more "dangerous" than heterosexuality.

I applaud the progress from the ridiculously stigmatizing lifetime ban on men who have sex with men but would urge the FDA to consider a policy that is neutral based on the gender of the person the potential blood donor has sex with.

CDC Announces $185M To Combat HIV In Gay Men and MSM

The CDC announced a substantial investment of $185 million in HIV prevention among gay and bisexual men and men who have sex with men. This is a huge endorsement in the efficacy of PrEP (Pre-Exposure Prophylaxis) in combating the HIV/AIDS epidemic.

Up to $125 million of the funding will be provided over three years to state and local health departments to scale up two new, powerful HIV prevention strategies:

• Increasing PrEP uptake: Numerous studies have shown that people who take PrEP daily can reduce their risk of contracting HIV by more than 90 percent.

• Health departments will be funded to provide PrEP information and referrals and to conduct outreach and training to increase the number of health care providers who are knowledgeable about PrEP and offer it to their patients.

• The primary objective is to increase the knowledge about and uptake of PrEP among MSM and transgender people at greatest risk of infection.

• Twenty-four health departments in areas where MSM are severely impacted are eligible to apply for these funds.

• Using routinely collected data to increase engagement in HIV care: A recent CDC study showed that more than 90 percent of new HIV infections in the U.S. could be averted by diagnosing people living with HIV and ensuring they receive prompt, ongoing care and treatment. Only about half of MSM diagnosed with HIV in the U.S. are engaged in regular care.

• Health departments will be funded to expand the use of HIV surveillance data to help connect and reengage people diagnosed with HIV but not in care with needed services, prioritizing MSM and transgender people.

• Twelve health departments in areas where MSM are severely impacted and that have sufficient clinical data are eligible to apply for these funds.

“Science tells us that increasing PrEP access and engaging more HIV-positive people in care and treatment could prevent tens of thousands of new HIV infections, but these strategies remain underused,” said Eugene McCray, M.D., director of CDC’s Division of HIV/AIDS Prevention. “This new funding will drive wider adoption where it’s urgently needed and provide lessons on how to improve uptake nationwide.”

Finally some good news about the HIV/AIDS epidemic in the United States.

FDA Proposes Reducing Lifetime Ban On Gay Blood Donors To One Year

The Food and Drug Administration (FDA) released a statement today which indicates that it will propose changing the current lifetime ban on blood donations from any man who has had sex with another man since 1977. The proposed policy will be that gay men who declare that they have not had sex with another man in over a year shall be allowed to donate blood.

The reaction to the proposed policy change was decidedly mixed:

Slate’s Mark Joseph Stern wrote: “…the FDA remains trapped in the 1980s—terrified of gay men and their diseased, untrustworthy ways. Perhaps in another 31 years, we’ll see the FDA move to a sensible, nondiscriminatory rule. For now, we’re stuck with this embarrassing, unscientific half-measure. 

U.S. Senator Patty Murray (D-WA) told her constituents, “Today’s announcement is a welcome step in the right direction. However, I am disappointed that low-risk gay men are still being discriminated against with this outdated policy. Healthy Americans who don’t engage in risky behavior, regardless of their sexual orientation, should have the opportunity to donate blood and help in the effort to save lives. I look forward to working with Secretary Burwell to build on the step taken today by removing this discriminatory ban while keeping our blood supply safe.”

I think my position is somewhere closer to Senator Murray's than Mark Joseph Stern's although I would agree that this is a half-measure. That being said, you can still acknowledge that a change has been made, and the change is in the right direction even if it is not as much change as one would prefer. I also agree that the proposed policy change would STILL be discriminatory and is unacceptable public policy, but it is still better than the current policy which was completely irrational and rooted in homophobia.

REPORT: Lifting Ban On MSM Blood Donation Would Increase Supply By 2-4%

The Williams Institute at UCLA Law School has released a report that analyzes the impact of changing the current lifetime ban on blood donation by any man who has had sex with another man (MSM) since 1977.

In "UPDATE: Effects of Lifting Blood Donation Bans on Men who Have Sex with Men" authors Ayako Miyashita and Dr. Gary Gates estimate the number of men who would donate blood if the "gay blood ban" was relaxed at over 300,000 leading to an increase in the blood supply of 2-4%  (600,000 pints) per year which could potentially save the lives of 1.8 million people.

The way the estimate is done is that Miyashita and Gates look at three different scenarios in which the current lifetime ban is changed in three ways: removed entirely, changed to a "deferral" lasting 12-months after sexual contact with another man and changed to a 5-year deferral.

In the US, 8.5% of men (10 million) say that they have had at least one male sexual partner since age 18. GSS data show that 4.1% of men (4.8 million) have had a male sex partner in the last five years, and 3.8% of men (4.5 million men) reported having a male sex partner in the last twelve months.

[...] 

If the current MSM ban were completely lifted, we estimate that an additional 360,600 men would likely donate 615,300 additional pints of blood each year. If MSM who have not had sexual contact with another man in the past twelve months were permitted to donate, we estimate that 185,800 additional men are likely to donate 317,000 additional pints of blood each year. If MSM who have not had sexual contact with another man in the past five years were permitted to donate, we estimate that 172,000 additional men would make an additional 293,400 blood donations.

To me it appears as if the report buries the lead! 8.5% of American men say they have had sex with another man since age 18 (i.e. as an adult). Does that mean that this percentage of the population is "gay"? Not really, since being gay is a complicated combination of identity, self-realization and  resistance to social stigma. However, in my mind the significance of this figure is the demonstration that same-sex sexual attraction among men is more common than is usually reported to the general public.

NYT Spotlights HIV Crisis Among Young Black and Latino Men Under 25

Well, this is a surprise! Today the New York Times has a front page, above the fold (most prominent placement), story entitled "Poor Black and Hispanic Men Are the Face of H.I.V." by Donald G. McNeil Jr. The key point is that 25 percent of new infections are in men who are either Black or Latino.

Here's an excerpt:

Nationally, 25 percent of new infections are in black and Hispanic men, and in New York City it is 45 percent, according to the Centers for Disease Control and Prevention and the city’s health department. 

Nationally, when only men under 25 infected through gay sex are counted, 80 percent are black or Hispanic — even though they engage in less high-risk behavior than their white peers. 

The prospects for change look grim. Critics say little is being done to save this group, and none of it with any great urgency. 

“There wasn’t even an ad campaign aimed at young black men until last year — what’s that about?” said Krishna Stone, a spokeswoman for GMHC, which was founded in the 1980s as the Gay Men’s Health Crisis. 

Phill Wilson, president of the Black AIDS Institute in Los Angeles, said there were “no models out there right now for reaching these men.” 

[...] 

According to a major C.D.C.-led study, a male-male sex act for a young black American is eight times as likely to end in H.I.V. infection as it is for his white peers. 

That is true even though, on average, black youths in the study took fewer risks than their white peers: they had fewer partners, engaged in fewer acts of sex while drunk or high, and used condoms more often. 

They had other risk factors. Lacking health insurance, they were less likely to have seen doctors regularly and more likely to have syphilis, which creates a path for H.I.V. 

But the crucial factor was that more of their partners were older black men, who are much more likely to have untreated H.I.V. than older white men.

The fact that the HIV epidemic is becoming browner and younger has been known by HIV activists for quite awhile but it is useful that the mainstream media is starting to pay attention and send the message to the wider population.

I'm somewhat surprised that my friend Phill Wilson is quoted saying there are "no models" for reaching young Black and Latino men who have sex with men (MSM), when he runs the Black AIDS Institute which is a national organization focused on creating, studying and promulgating such models.

In Los Angeles, In The Meantime Men is an organization which focuses on HIV prevention in young Black men and Bienestar focuses on HIV prevention and treatment in the Latino community.

I think what Phill meant to say was that there are no widely adopted or generally accepted models for reaching the communities the article is focused on.

Shame! Gov. Brown Vetoes Bll Allowing Condoms In Prison

There is bad news to report today on the status of the progressive goal to improve the lives and health of people in locked facilities in California.

Governor Jerry Brown has finally completed his work on the 900+ bills the Democratic super majority in the California legislature sent him this session. He has taken some action that progressives applaud and some that we can only shake our head at and wonder "What was he thinking?"

Overall, the Governor vetoed 96 bills in total and signed into law 805.

However, some of his more controversial legislative actions took place at the end, which occurred this weekend. On Saturday October 12th, Governor Brown vetoed AB 999 (Prisoner Protections for Family and Community Health Act) which would have eventually allowed condoms in state prisons. The Governor's Office released his veto message:

To The Members of the California State Assembly: 

I am returning Assembly Member Bill 999 without my signature. 

This bill would require the California Department of Corrections and Rehabilitation to develop a plan to expand the availability of condoms to all California prisons. 

The Department currently allows family visitors to bring condoms for the purpose of the family overnight visitation program. While expansion of this program may be warranted, the Department should evaluate and implement this expansion carefully and within its existing authority.  

Sincerely 

Edmund G. Brown, Jr

This is disappointing news. As readers of the blog may know, I have been on the board of directors of the Center for Health Justice for years. Health Justice has the mission to eliminate disparities between prisoner health and public health and one way it does this is by distribution of condoms in Los Angeles County jails.

The point of the legislation was to give CDCR the authority (and political cover) to consider the availability of condoms in prisons (we're talking about a condom machine, people). This is because people in prison have sex with each other, and people who are in prison often have sexually transmitted infections. Officially, sex between prisoners is against the law, so making condoms available is viewed by some as an enticement to break the law. Most public health advocates strongly support actions that will "reduce harm" and they agree that increased access to condoms in locked facilities will improve the health of prisoners (and the public) and will not reduce safety for those who work in locked facilities.

It is unfortunate Gov. Brown had to use AB 999 as an example to show less progressive members of the political spectrum his conservative bona fides. He now joins his predecessor, Republican Governor Arnold Schwarzenegger in vetoing a measure that would have allowed condoms in prison.

Shame on you, Governor!

STUDY: Gay Men Having Fewer Sex Partners

There is a new report out indicating that men who have sex with men, i.e. MSM (which is a larger set of people than self-identified gay men), are reducing the number of partners. In "Temporal Trends in Sexual Behavior among Men Who Have Sex with Men in the United States, 2002 to 2006-10," researchers from the Centers for Disease Control and Prevention analyze results of two telephone surveys of Americans (ages 15-44) reporting their sexual behavior from 2002-2006 and 2006-2010.

A nice summary of the results presented in the article is:

Between the two polls, the mean number of reported male sexual partners dropped significantly from 2.9 to 2.3, and fell from 2.9 to 2.1 for men younger than 24. The drop reached statistical significance, meaning the finding was not the result of chance, among men whose incomes were below 150 percent of federal poverty level, who reported a respective 3.0 and 2.1 partners, as well as among men in suburban metropolitan areas (3.2 to 2.1). Those living in urban areas reported 2.6 male partners in both surveys.

Condom use remained unchanged, with 57 percent of the men in the first survey reporting they had not used a condom for the last time they had sex, and 58 percent in the second.  

The proportion reporting an HIV test in the past year also remained unchanged, at a respective 41 percent between both surveys.  Thirty-eight percent of the men reported receiving a sexually transmitted infection screening in the past year in the 2002 survey, compared with 39 percent in the 2006 to 2010 survey. However, the rate of those who reported never having had an HIV test dropped from 25 to 15 percent.

The average number of approximately 2-3 sex partners per year seems sort of low to me, doesn't it? Apparently there were 197 MSM surveyed in the first survey and 272 in the second. That would mean the margin of error on the percentages are  quite large.

hat/tip to Queerty