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tw101356
Skeptic Friend
USA
333 Posts |
 Posted - 05/08/2005 : 06:51:08 [Permalink]
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I'm not allowed to donate blood because I had tuberculosis when I was three years old. I have no idea if they test donated blood for TB antibodies, but they certainly do screen it out by questioning the donor.
How many different things do they test for in donated blood? It makes me wonder if donor rejection is seen as the cheapest way to raise the
average safety of the blood and/or sperm supply.
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- TW
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Dude
SFN Die Hard
USA
6891 Posts |
Posted - 05/08/2005 : 11:59:59 [Permalink]
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quote:
It is irresponsible to get samples from a group of which you know the risk of infection is very high, especially with infections like HIV of which you know that the effects are so serious.
I'm not arguing that at all. What I'm arguing is the idea that sexual orientation is a factor. Level of sexual activity, number of parterners, use of protection, and IV drug use would seem to me to make more sense as screening criteria.
quote:
How many different things do they test for in donated blood? It makes me wonder if donor rejection is seen as the cheapest way to raise the
average safety of the blood and/or sperm supply.
Yeah. And it isn't a bad thing, if it is based on criteria that make sense.
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Ignorance is preferable to error; and he is less remote from the truth who believes nothing, than he who believes what is wrong.
-- Thomas Jefferson
"god :: the last refuge of a man with no answers and no argument." - G. Carlin
Hope, n.
The handmaiden of desperation; the opiate of despair; the illegible signpost on the road to perdition. ~~ da filth |
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tomk80
SFN Regular
Netherlands
1278 Posts |
Posted - 05/08/2005 : 12:11:38 [Permalink]
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quote:
Originally posted by Dude
quote:
It is irresponsible to get samples from a group of which you know the risk of infection is very high, especially with infections like HIV of which you know that the effects are so serious.
I'm not arguing that at all. What I'm arguing is the idea that sexual orientation is a factor. Level of sexual activity, number of parterners, use of protection, and IV drug use would seem to me to make more sense as screening criteria.
But at the moment that a group on the whole is engaging in that kind of behavior on a large scale, whatever the reason, it makes sense to screen on the characteristics of that group in stead. It's not fair for everybody, but it makes sense. |
Tom
`Contrariwise,' continued Tweedledee, `if it was so, it might be; and if it were so, it would be; but as it isn't, it ain't. That's logic.'
-Through the Looking Glass by Lewis Caroll- |
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Ricky
SFN Die Hard
USA
4907 Posts |
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beskeptigal
SFN Die Hard
USA
3834 Posts |
Posted - 05/08/2005 : 15:24:45 [Permalink]
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quote:
Originally posted by Dave W.
quote:
Originally posted by Renae
I don't think sperm donating is a "right"; rather, it's a privilege granted by the fertility clinic...
Having a job isn't a right, either, but there exist laws prohibiting discrimination in hiring.quote:
...which is obligated to protect its patients. Think of the lawsuits they'd have if a patient ended up with AIDS.
Should hospitals refuse to hire gays, then, too? They've got the same obligations, and employees with unknown HIV status pose a risk to the patients.
No Dave, the ADA prohibits discrimination against a worker with an infectious disease unless it has been shown to be a hazard to clients, patients or co-workers.
This is the point I think is being missed here. There are several cases of health care workers infecting patients with hepatitis B, a few less with hepatitis C and the only HIV transmission in the US was the dentist in Florida who the evidence points more toward purposeful infection of his patients. (If your interested in the evidence there, start a thread and I'll lay it out.) I think there is a suspected case of a surgeon infecting a patient with HIV in Europe but I'd have to check my memory on that. [edited to add I'll have to refresh my memory on the journal article]
On the other hand, there were many cases of HIV from blood transfusions before HIV testing was available that could have been prevented had blood that tested positive for past hepatitis B &/or blood donated by gay men had been discarded early in the HIV epidemic. On a per capita basis, the hep B infection markers &/or having a history of being a man who had sex with men, there was a statistically significant risk for those units of blood.
So in the former case above, there are certain "exposure prone procedures" that certain infected health care workers should not be doing. I'll spare you the details but they are evidence based. In the latter case, the discrimination is very much evidence based as well. |
| Edited by - beskeptigal on 05/08/2005 15:42:31 |
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beskeptigal
SFN Die Hard
USA
3834 Posts |
Posted - 05/08/2005 : 15:27:16 [Permalink]
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quote:
Originally posted by Dude
quote:
Of course, because of the possibility of lying, asking this is not foolproof.
Nope. And the issue is that the donated product (blood/plasma/sperm/organs) needs to be screened, not the actual doner/s.
It makes no sense to screen people out based on sexual preference, and makes all the sense in the world to actually test the content being donated.
Let me put it another way, blood tests are not fool proof either. Using both screening methods is preferred as double protection. |
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beskeptigal
SFN Die Hard
USA
3834 Posts |
Posted - 05/08/2005 : 15:39:00 [Permalink]
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quote:
Originally posted by Dave W.
Are there any statistics on nurse-to-patient transmission? Or janitorial staff-to-patient transmission? Or am I supposed to assume that those two cases represent the only two documented cases of health-care workers spreading HIV?
Actually there are no cases of HIV transmission from the workers to patients you speak of. I'll have to review the journal article re the doctors. The known risk is as close to zero as the risk of getting HIV from the guy who cuts his finger and spills blood in the salad he is making at a restaurant or the barber who nicked one client then used the clippers on the next.
Just so you know, neither HIV nor hepatitis C are a significant risk to health care workers nor from them to patients. It takes a sufficient dose of virus from either of those two diseases to infect a person. There are cases but they are so rare as to not warrant any special intervention such as screening workers for disease. But for a whole unit of blood or a fair amount to be infused or for a sperm donation, you are talking about a potentially very large dose of virus being transmitted directly into another person. It is very different.
quote:
The debate here is not about whether or not this represents a case of discrimination, but whether or not the discriminitory "line" is drawn in the correct place.
It has been drawn based on evidence not politics in this case.
Did I mention this is the specialty I practice in? |
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beskeptigal
SFN Die Hard
USA
3834 Posts |
Posted - 05/08/2005 : 16:01:03 [Permalink]
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Here is the list from our local blood bank of quote:
...individuals at a higher risk for acquiring this illness and/or transmitting the virus should not donate blood. These individuals are:
* Persons with clinical or laboratory evidence of AIDS virus infection.
* Any male who has had sex with another male since 1977, even one time.
* Present or past users of intravenous drugs.
* Individuals with hemophilia or a related clotting disorder who have received clotting factor concentrates.
* Men and women who at any time since 1977 have engaged in sex for money or drugs.
* Individuals who have had sex within the last 12 months, even once, with any person meeting the above descriptions.
* Individuals who have had a positive test for syphilis in the last 12 months.
* Individuals who were born in or lived in any of the following African countries since 1977: Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, or Nigeria.
* Individuals who have traveled to any of the above countries listed in (8) since 1977 who have received a blood transfusion or medical treatment with a product made from blood.
* Individuals who have had sexual contact with anyone who was born in or lived in any of the above countries listed in (8) since 1977.
It is behavior specific. While gay men obviously would be the ones who had sex with men, I believe a few heterosexual men may have experimented as well. The list is very restrictive and perhaps could be changed. But better to be over restrictive than not restrictive enough.
BTW, I see no TB exclusion and I hadn't heard of that one before. Perhaps it was an older exclusion? |
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Dude
SFN Die Hard
USA
6891 Posts |
Posted - 05/08/2005 : 21:17:48 [Permalink]
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quote:
Let me put it another way, blood tests are not fool proof either. Using both screening methods is preferred as double protection.
I agree. 100%
But the pre-donation screening should be based on real evidence.
At the outset of HIV in the 80's, yes, gay men were the primary carriers. Why? Because they didn't use protection, because they weren't worried about getting anyone pregnant.
With the current state of this disease in modern/western nations, I don't think you can continue to say that gay men (because of their sexual orientation) are higher risk to have HIV than heterosexual men. Is there any recent evidence (surveys/studies/etc) to back up the claim that they are higher risk to have the disease?
The screening questions should focus on behaviors like number of partners, use of protection, IV drugs, etc.
Look at the sub-Saharan areas of Africa where 70% of the population is infected. That has nothing to do with the orientation of the people who have it, and everything to do with their level of sexual activity.
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Ignorance is preferable to error; and he is less remote from the truth who believes nothing, than he who believes what is wrong.
-- Thomas Jefferson
"god :: the last refuge of a man with no answers and no argument." - G. Carlin
Hope, n.
The handmaiden of desperation; the opiate of despair; the illegible signpost on the road to perdition. ~~ da filth |
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Valiant Dancer
Forum Goalie
USA
4826 Posts |
Posted - 05/09/2005 : 07:28:27 [Permalink]
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quote:
Originally posted by Dude
quote:
Let me put it another way, blood tests are not fool proof either. Using both screening methods is preferred as double protection.
I agree. 100%
But the pre-donation screening should be based on real evidence.
At the outset of HIV in the 80's, yes, gay men were the primary carriers. Why? Because they didn't use protection, because they weren't worried about getting anyone pregnant.
With the current state of this disease in modern/western nations, I don't think you can continue to say that gay men (because of their sexual orientation) are higher risk to have HIV than heterosexual men. Is there any recent evidence (surveys/studies/etc) to back up the claim that they are higher risk to have the disease?
The screening questions should focus on behaviors like number of partners, use of protection, IV drugs, etc.
Look at the sub-Saharan areas of Africa where 70% of the population is infected. That has nothing to do with the orientation of the people who have it, and everything to do with their level of sexual activity.
CDC have a few recent studies from 2001 which indicate that homosexual men are far and away the leader in new cases of AIDS/HIV.
Here's the 2003 numbers.
http://www.cdc.gov/hiv/stats/2003SurveillanceReport/table1.htm
http://www.cdc.gov/hiv/stats/2003SurveillanceReport/table18.htm
http://www.cdc.gov/hiv/stats/2003SurveillanceReport/table19.htm
Causality for this has to do with several factors.
1) The medical field has implemented universal bodily fluid barrier protocols which have severely decreased the instance of new HIV cases in healthcare workers.
2) The nature of the homosexual male sexual act is more likely to facilitate transfer of the HIV virus through anal tearing and propolactic failure.
3) A fringe group of homosexual activists have claimed that AIDS does not exist and urge people not to use barrier infection prevention methods. The mainstream homosexual community has redoubled their efforts in education and are appalled at the fringe group.
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Cthulhu/Asmodeus when you're tired of voting for the lesser of two evils
Brother Cutlass of Reasoned Discussion |
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beskeptigal
SFN Die Hard
USA
3834 Posts |
Posted - 05/09/2005 : 08:39:55 [Permalink]
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Another point being missed here is HIV isn't the only blood borne disease. The blood bank has only been able to test for hepatitis C since 1991 and a more reliable test has only been available since 1993. IV drug users have infection rates, (~70-80%), so having used IVDs even once is considered a reason to recommend a person get tested. (BTW, just being a health care worker is not a risk and doesn't warrant suggesting a patient be tested.) The idea a gay person is monogamous only addresses the current situation for that person. Again, the per capita risk in gay men means that unless both partners have only been with each other, ever, there is a potential risk for an unknown disease emerging. In other words, that single sexual encounter carried more potential risk than a single sexual encounter in a heterosexual relationship just as a single use of an illicit IV drug does. It comes down to evaluating actual risk. While the blood banks might not be excluding enough groups when it comes to those born in other countries, it is excluding gay men for known risks not perceived risks. Gay women can donate.
Note, I am discussing blood donations but think sperm donations pose the same disease transmission risks for blood borne diseases. |
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tomk80
SFN Regular
Netherlands
1278 Posts |
Posted - 05/09/2005 : 13:40:51 [Permalink]
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quote:
Originally posted by Dude
quote:
Let me put it another way, blood tests are not fool proof either. Using both screening methods is preferred as double protection.
I agree. 100%
But the pre-donation screening should be based on real evidence.
At the outset of HIV in the 80's, yes, gay men were the primary carriers. Why? Because they didn't use protection, because they weren't worried about getting anyone pregnant.
With the current state of this disease in modern/western nations, I don't think you can continue to say that gay men (because of their sexual orientation) are higher risk to have HIV than heterosexual men. Is there any recent evidence (surveys/studies/etc) to back up the claim that they are higher risk to have the disease?
The screening questions should focus on behaviors like number of partners, use of protection, IV drugs, etc.
Look at the sub-Saharan areas of Africa where 70% of the population is infected. That has nothing to do with the orientation of the people who have it, and everything to do with their level of sexual activity.
But the problem is that they really are at a higher risk in America and Europe. Around half the infections of HIV occur with gay men, while they make up less than 10% of the population. Those are not statistics for the '80s, they are recent statistics. By screening for man-on-man sex, as beskeptigal indicated (so gay women are included and straight man who experimented with homosexuality are excluded from donation), you are screening for high risk behavior. |
Tom
`Contrariwise,' continued Tweedledee, `if it was so, it might be; and if it were so, it would be; but as it isn't, it ain't. That's logic.'
-Through the Looking Glass by Lewis Caroll- |
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Dave W.
Info Junkie
USA
26022 Posts |
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Dude
SFN Die Hard
USA
6891 Posts |
Posted - 05/09/2005 : 17:30:13 [Permalink]
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quote:
CDC have a few recent studies from 2001 which indicate that homosexual men are far and away the leader in new cases of AIDS/HIV.
What those tables show is that male/male sexual contact is the second most likely way to contract HIV in 2003 (32%). Other/non-specified takes the top honors(35%). With heterosexual contact falling in at 18%.
Nothing in there indicates level of sexual activity or number of partners. I suspect (no evidence to back this one up) that if they broke it down into monogomous relationships vs non, then the numbers from male/male and hetero sexual contact would be very close to one another. That is my hypothesis anyway. Not sure if there is any evidence out there to support it or not. Will look.
Anyway, I am not suggesting that there be no pre-donation screening, just that the screening should be based on a solid analysis of the evidence. If my hypothesis bears up, then the questions should be more concerned with level of sexual activity, number of partners, and use of protection... as opposed to who your partner is.
If the idea is to protect recipients, then the questions should be as effective as we can make them yes?
Then there is the issue of honesty. Especially with the ammount of anti-gay sentiment being feuled by the neocon and fundamentalist rightwing. People want to donate blood for many reasons. To help others, to return a little to the community, etc. If they feel they will be discriminated against they may well just lie on the questions.
Our specimen screening process for blood and tissues seems to be pretty good. Only 87 cases in 2003 of transmission.
The pragmatist in me says if it isn't broke, don't mess with it. And from the view of protecting people it seems we are doing fairly well.
But. We always have a shortage of blood. If the system could be improved to safely introduce more safe donations, then it is something we should do.
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Ignorance is preferable to error; and he is less remote from the truth who believes nothing, than he who believes what is wrong.
-- Thomas Jefferson
"god :: the last refuge of a man with no answers and no argument." - G. Carlin
Hope, n.
The handmaiden of desperation; the opiate of despair; the illegible signpost on the road to perdition. ~~ da filth |
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beskeptigal
SFN Die Hard
USA
3834 Posts |
Posted - 05/09/2005 : 23:41:30 [Permalink]
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quote:
Originally posted by Dude
....
But. We always have a shortage of blood. If the system could be improved to safely introduce more safe donations, then it is something we should do.
That would be developing a blood substitute. |
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