B is for Blood

Or, A Bloody Disgrace

It’s 9:30 on a Thursday night and halfway through a supernatural TV show, a man’s throat is split open and he bleeds to death. On three other stations, seven nights a week, medical dramas and crime shows portray gory deaths and attacks even more frequently than this. On this same evening, half a dozen movies in theatres nationwide are rated PG-13 or R for excessive blood and gore. And at night before bed, most of the viewers of all of these programs curl up with lovely books full of even more bloodshed between the many mysteries, thrillers, and vampire novels circulating bookstores today.

Seems like there’s blood in excess everywhere.

Unfortunately for too many people, there just isn’t enough blood where it’s needed most—circulating their veins and arteries, nourishing the organs that keep them living 24/7.

According to the American Red Cross, five million Americans need blood transfusions in a single year, which taken day by day, accounts for nearly fourteen thousand people in need of blood every twenty-four hours. Second by second, another American needs a blood transfusion every two seconds. That means in the time it has taken you to read this paragraph, twelve more people have become in need of blood right now.

These five million people are not just nameless faces that we’ll never meet. They’re friends, coworkers, students, teachers, even family. Twenty years ago, when my grandmother was in the hospital, she fell into a coma from which she would never awake. The doctors believed giving her blood would help her come out of it, but because of the blood shortage—which persists today—her transfusions were delayed, and almost not given at all. Although by the time she was given the blood she needed, it was too late to save my grandmother’s life, the blood she did receive gave her body the strength it needed to breathe on its own, unassisted by machines, a small miracle that made her death five days later easier to bear on everyone: Instead of suffering with wires and tubes throughout her body, she was able to die peacefully at rest.

For most people, however, blood is the answer, and it does save lives. The Australian Red Cross breaks it down simply and succinctly, naming more than fifteen different causes that result in patients requiring blood transfusions, including, but by all means not limited to, cancer and blood diseases; open heart surgeries; burns; treatments for heart, stomach, and kidney diseases; orthopedic procedures; obstetrics, including treatments for pregnant women, new mothers, and young children; as well as victims of trauma, including motor vehicle accidents and other emergency situations. The list does not end here, and for many people, even a single illness can keep a person on transfusions throughout life. For these people and the many others in need, a shortage in blood—and blood donors—can mean the difference between living a long and healthy life, or living their last days waiting in agony for a miracle to happen. Not only does this hurt the patients themselves, but also their families and their friends.

All of this life-sustaining blood is provided solely by blood donors throughout the United States and has been exclusively donor driven since 1970, twenty-nine years after the Red Cross began its first blood donor program in 1941 to collect blood specifically for the military (blood donations only became available to civilians seven years later in 1948). According to the Red Cross’s estimates, only thirty-eight percent of the American population is eligible to donate blood, but only eight percent of these individuals actually do so. To put these numbers in perspective, that’s only three donors for every hundred people in the US today.

To compound this already tragically low donation rate, an entire category of people are banned from donating blood solely on account of who they are: Gay, bisexual, and even straight men who have ever had sexual contact with another man, even once, are banned, by law, from donating any blood for their entire lives, regardless of how healthy they might otherwise be. Not only does this jeopardize the lives of millions dependant on donated blood, it also wrongfully discriminates against an entire class of people solely because of their sexuality. By adjusting the current donor regulations, we can open the path for these men to become blood donors without sacrificing the safety or the good standing of the United State’s present blood supply.

According to a study by the Williams Institute at the UCLA School of Law, there are an estimated 8.8 million gay and bisexual men and women in the United States as of 2005. If we assume that half of these people are men, and if we take into account the estimation from the American Red Cross that only eight percent of eligible donors actually donate blood, if the ban on donations were lifted today, there would be 352,000 more men waiting on line to donate blood right now. If a single donation can save three lives, more than a million lives will be saved at once. If all four million of these men donated blood throughout their lifetimes, more than four trillion lives could be saved—and since the present ban extends to all males who have had sexual relations with other men, even once, regardless of their sexual orientation or self-identity, these estimates are conservative at best!

To understand why this untapped source of life-giving blood has been banished from donating, we must take an extensive look at the causes of the present donation ban, which will then also allow us to discuss possible solutions that can ease the burden of blood supplies while maintaining, if not enhancing, the safety and reliability of our national blood reserves.

The root of the problem comes down to an illness accredited to a few chimpanzees native to west equatorial Africa whose blood most likely infected hunters in the mid-1950s, according to the Centers for Disease Control and Prevention. From there, this illness slowly seeped throughout the world population until it reached the United States in the late seventies and was first detected in 1981, primarily afflicting men who had sex with other men. In 1983 when scientists first identified the virus causing this disease, they called it HTLV-III/LAV, although this was later changed to its present and much more recognizable and infamous name: HIV, human immunodeficiency virus.

Until early 1982, all of the known victims of HIV/AIDS in the United States were gay men and men who had sex with other men, which would later become the preferred descriptor used by the United States Food and Drug Administration. When finally women and heterosexual males were infected, the idea of AIDS being a gay man’s disease slowly began to dissipate through decades of fear of and hostility towards the illness, but even then, the deep-seated stigma would still remain.

Within the first four years of the AIDS epidemic, over 12,000 people had died because of the disease, and since then, more than twenty-five million people have died from HIV/AIDS worldwide. Since HIV is transmitted not through water or air, but through bodily fluids such as semen, vaginal fluid, breastmilk, and especially blood, it is no wonder that laws and regulations would be put into place to protect the blood supply that is intended to save lives from inadvertently taking them. It was for this reason that in 1983 the U.S. Food and Drug Administration began deferring gay men and other males who have had sex with men. In 1992, the FDC adopted its current and presently final position on blood donors, that all men who have had any sexual relations with another man, even once, since 1977 (the beginning of the epidemic) are deferred for life from donating blood.

Although it is true that gay men and other men who have sex with men account for 53% of HIV/AIDS cases according to the CDC, we must temper this figure by taking into account that this represents the percentage of HIV/AIDS victims who are gay or have sex with men, not the percentage of this group who has HIV/AIDS. We must also realize that HIV/AIDS now affects as many women and heterosexual males as it does gay males and other men sexually active with men. Although these groups are equally as likely to contract the virus, they are not deferred for life, but are only deferred for a year after being considered high-risk, which includes such factors as having an STD or STI and visiting certain countries.

Furthermore, since it is impossible to know every facet of a partner’s past sexual endeavors, at-risk individuals may not themselves know of their at-risk status and need for deferral. Additionally, since anyone can lie on the questionnaire that precedes blood donations, the safety of the blood supply can be further jeopardized by dishonest individuals who may wrongly believe that they, although high-risk, are healthy and well enough to donate blood. Thankfully, for both of these accounts, the Red Cross tests all donated blood for multiple diseases, including Chagas disease, Hepatitis B and C, West Nile Virus, Syphilis and—of course—HIV-1 and HIV-2, the two dominant strains of the virus.

The lifetime deferral on gays and other men must also be compared to one other figure: HIV incidence by race. Although it’s been shown already that male-to-male sexual contact accounts for 53% of HIV/AIDS cases, 45% of HIV/AIDS victims are African-Americans, male and female. This difference of eight percent is statistically obsolete when we realize that no African-Americans are deferred for life based upon the color of their skin, even though the data clearly shows that they are nearly as high risk as men who have sex with other men. How can a double-standard such as this be justified when the lives of millions are on the line? Certainly, the only conclusion that can be drawn from this is that, if allowing African-American men and women to donate blood is no more dangerous than allowing white men and women to donate blood, then allowing gay men and other men who’ve had sex with men to donate blood is no less dangerous than allowing heterosexuals to donate blood as well.

Now let’s consider a time when all healthy people, regardless of their partners, are able to donate blood. Imagine how many people will have access to the life-saving blood that they need. Imagine that people like my grandmother, desperately in need of blood, won’t be denied what could otherwise save their lives. What steps can we take to get here? What must we do?

I propose a three-step solution that would allow gay, bisexual, and other men who have had sex with men to donate blood while simultaneously enhancing the overall safety of the blood supply by adding additional easy-to-implement safeguards to donor requirements.

The first step, intended to quickly and effectively increase the blood supply while allowing a transitional period between the present and future donor restrictions, would be to reduce the lifetime deferral on these men to only twelve months, the equivalent of deferrals for other persons engaging in various high-risk activities. According to an article in The Advocate entitled “Blood, Sex, and the FDA” written by Steven Thrasher, Argentina, Austria, Hungary, Japan, and Spain have all adopted this one-year deferral policy and none of these countries have experienced any increase in HIV in their blood supply; incredibly, the HIV-infection rate from donated blood has actually decreased in Spain since their policy was changed.

The second step would not only allow many of the men presently barred from blood donations to donate but would also simultaneously further protect the blood supply by requiring that all donors provide up-to-date information on their current STD status, such as the printed results of tests conducted by physicians or STD status cards with the results of tests conducted at nonprofit clinics. Not only would this quickly show the sexual health of the donor during his or her pre-donation examination, allowing for quick deferrals of those unable to donate, it would do this equally for all individuals, not merely those presently considered high-risk.

The use of STD status cards would also set the grounds for a more accurate and affective way of determining donor eligibility by adjusting the current regulations accordingly, leading to the third step of my proposed solution: Instead of deferring men who’ve had sex with other men, the policy would defer only those who have had unprotected sex outside of a monogamous relationship or have had multiple sexual partners since their last set of STD tests. This regulation would also help eliminate potential risks from the heterosexual community, successfully completing the promised results of more eligible donors and safer donation practices.

Of course, to implement the second step of this solution to allow the adoption of the third step would require funds, and probably a lot of them: Not only would everyone wishing to donate blood be required to have multiple STD tests at appropriate intervals, up-to-date and accurate records of these tests would have to be available on easy-to-carry STD status cards. However, the pay-off of this policy would certainly outweigh the costs: Not only would a sustainable blood supply result in faster transfusions that would lead to quicker treatment and faster recovery times, thereby reducing healthcare costs, testing more people for STDs would inevitably reduce the incident rates of STDs, once again lowering healthcare costs.

Undoubtedly a difference would still remain, but this difference could be made up through various private donations currently aimed at HIV/AIDS research and prevention as well as through other nonprofit organizations that also sponsor blood donations and collections. Additionally, gay rights groups would also be likely to donate to allow such a plan to be implemented as it would directly relate to allowing gays to donate blood equally with others.

As we can see, the present ban on donations from men who’ve had sex with men has not always been unfounded, but due to the current accuracy of blood testing, is no longer necessary to ensure the safety of the United States’ blood supply and serves now only to diminish the already critically low supply of blood available to those in need. By reducing the deferral period and by implementing a system requiring STD statuses to be disclosed during the examination process preceding donations, we can both increase the blood available to patients while safeguarding the present supply of blood. Through simple changes that would open blood donations to more people, thousands, if not trillions, of lives can be saved in our lifetimes alone.

Class: ENG 112 Argument-Based Research
Grade: A
Date: May 2010

Worked cited list available on request.

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