Besides, the nation’s blood centers are fully behind changing the policy. I think it’s safe to defer to the REAL experts on this one, not the FDA, which has a far worse record of poor decisions leading to unnecessary deaths than the blood banks.

Though I’d add that all blood collectors do what the Red Cross does. It would be an even larger burden for the smaller, regional ones.

The only real quibble I have is regarding your notion of administering a rapid HIV-antibody test at blood donation sites. I don’t think such a proposal would increase the effectiveness of the blood screening process, but it would add a number of potential problems.

All donated blood in the US is already tested for the presence of HIV antibodies. Testing donors before they donate won’t change the efficacy of this technical screening–it won’t make the blood supply any more or less safe. It will, however, add costs to the donation process and significantly increase the amount of time required for some individuals to donate blood.

Furthermore, the Red Cross already notifies donors whose blood tests positive. This is the case not just for HIV but for other blood-born pathogens that the blood is tested for (syphilis, hepatitis, etc.). Because this is done outside of the donation context it’s not necessary to have staff who are trained to deliver these results on hand at all times. If rapid testing is given at the time of donation it’ll be necessary to have such a person available at all donation sites. You won’t increase the number of people who know that they are HIV+ (because donors who test positive are already being notified), but you will make the entire donation process more expensive and cumbersome.

On top of that, confidentiality is a huge concern. Not only for people who test positive (though this is important) but for the individuals who receive the HIV-antibody test as well. Given the semi-public context of many blood donation sites (imagine an office or campus blood drive) dividing donors into groups of those who are determined to be “clean” and those who are potentially risky (i.e., donors who are being tested) is stigmatizing. How could this be managed in such a way as to not make people wonder about which risk factors the separately-tested individuals might have?

The current system allows individuals who know that their blood should not be used to confidentially identify themselves. This avoids producing public stigma (“why wouldn’t they let you donate blood with the rest of us, Bruce?”), and doesn’t require any additional equipment, skills or time. Any new proposals should emulate the elegance of that example.

Getting people to donate blood is hard enough already. The Red Cross does all it can to streamline the process while maintaining strict safety controls. The technical aspect of screening donated blood (antibody testing) is already as effective as it can be. The issue now is tweaking the social elements: how individuals are determined to be eligible to donate or not, how risks are discerned and measured. Adding a procedure that produces no technical advantage but incurs so many costs and complications just doesn’t seem like a good idea.

As Timothy points out, only about 3% of Americans donate blood. Out-dated and bias-driven prohibitions on the donation of blood by otherwise healthy individuals presents its own risks. If all donated blood is tested, and reasonable deferral periods applied as a function of behavior, the net effect (of diseased donors) on the blood supply would not be measurable—a sudden shortage induced by a large disaster will claim far more lives.

There are also deeper concerns.

The continued ban on gay blood donors is bias driven, plain and simple. That bias may enjoy some science-based justification, but it is indeed tenuous and worthy of wider debate both within the scientific community and society.

The suggestion to allow, perhaps even require an oral HIV antibody test at the time of donation for certain sub-populations of donors seems more scientifically sound than simply concluding that among (the sampled population of) gay men

…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

somehow suggests that truthful answers to a questionnaire are going to protect the nations blood supply from contamination with HIV. Since gay men have been prohibited from donating blood for decades, these statistics seem at least superficially suspect.

While science may be involved, I suspect that politics (and all that comes with it) has a lot more to do with the decision of the FDA.

I wish I could corner an FDA policymaker and pose the following:

Suppose a man gets tested for HIV twice, spaced six months apart, and tests negative both times. Suppose he has had sex with only one other man since the first test, and that the other man has had sex only with him during the same time, and that the other man has taken the same tests on the same dates with the same results. Suppose he brings copies of his test results with him to the test center and affirms on the form that he has met all of these guidelines. Suppose you let that man donate blood. Realistically, how much marginal HIV risk would that man bring to the blood pool compared to your average donor?

This policy isn’t about saving lives; it’s about clinging to an age-old slander that gay men are intrinsically pestilent. It’s somewhat understandable why health care workers might cling to that slander, especially if they were active in the health care industry during the ravages of the AIDS crisis, but it’s not evidence-based, despite their protestations, and it’s not justifiable.

The questionnaire should be changed to specify unprotected sexual contact outside of a monogamous relationship. That is the only scientifically valid question, not breaking it down into specifics and caving to bias.

Another thing is this question causes confusion for transgendered individuals. Do they answer as a man or a woman? It can be quite embarrassing and unnecessary even if the context makes that decision obvious.

In the end the questionnaire is relatively pointless and only causes confusion and frustration in potential donors. HIV testing has a false negative rate of 1 in 2 million. HIV transmission from donated blood is exceedingly rare and it has nothing to do with the questionnaire as almost every case of transmission has come from a heterosexual that genuinely didn’t know they were infected.

Another thing, it’s against the law to knowingly lie on the questionnaire about your HIV status, so only a reckless criminal would attempt that.