Dr. Andy

Reflections on medicine and biology among other things

Wednesday, June 08, 2005

More on gay sperm donation

I am called out as "poorly informed, at best, and downright homophobic at worst" based on this post, by Iatrogenic Causes, an anonymous blogger, who drops the intriguing hint that she has met me personally. Based on certain details in other posts I am 98% sure I know who he/she is, but his/her secret is safe with me.

You can read both posts and decide if I'm really homophobic. I would certainly deny that charge. Iatrogenic Causes goes on to make a fairly convincing case that rules against gays donating sperm are not rational. As I hope was clear from my original post, I am in no way a priori against gays donating sperm, but feel the overriding concern has to be to prevent HIV transmission: if excluding gays helps accomplish that I'm for it, if not I'm against it.

IC notes this article from the American Council on Science and Helath, laying out the case for gay sperm donation. If IV drug users and straight men who use prostitutes are not excluded, as the article claims (I can't find the actual rules anywhere on the FDA site) they should be. I do not however, find the argument that becasue some gay men are at lower risk than some straight men the ban is irrational, convincing

In contrast, here is the argument against gay blood donation, laid out in a publication from Gay Men's Health Crisis of all places(I'm aware this article is in regards to gay blood donation but the issues are similar):
the problem with allowing gay men to donate blood can be considered in a simple arithmetical way: Gay men continue to be at very high risk for HIV and there are relatively few gay men. Depending on which study you believe, gay men comprise certainly no more than 10 percent of the population and probably less than 5 percent.

Of course safe sex works, and many gay men are in monogamous relationships. But HIV prevention is not perfect. Gay men continue to become infected with HIV in substantial numbers, despite the best prevention efforts. Researchers put the annual infection rate for urban gay men in their teens or twenties as 1 to 3 percent annually. This number sounds small, but it is cumulative. In some major cities, like New York, around 15 to 20 percent of gay men are now infected with HIV -- and the prevalence is higher in some regions and ethnic groups. Furthermore, gay men in monogamous relationships still become infected. People cheat on their lovers, whether gay or straight, but the risks of such cheating, especially if unsafe sex is involved, are increased for gay men because of the high prevalence of HIV in the pool of potential sex partners.

I think the best agrument for allowing gay sperm (and blood) donation would be that gay men pose no additional risk of HIV transmission. Unfortunately, that argument is untenable in the face of the above numbers. Statistically, the gay man who thinks he is in a monogamous relationship but whose partner cheats on him is at much higher risk than a similar heterosexual man in the same situation.

So opponents of the ban fall back on the argument of the form "some men allowed to donate sperm under current guidelines are at higher risk of HIV than some gay men," which is a much less convincing argument. Of course no set of guidelines will be perfect and one could come up with exceptions to even very complex critieria for donation. I remain unconvinced by this argument.

The article also points out the potential risk of other, perhaps unknown viruses in gay men and cites that as one of the reasons the FDA declined to loosen blood donor eligibility in 2000.

Note also that exclusion critieria for blood and sperm donation has been changed to only exclude men who have had homosexual sex in the last 5 years; previously it was anytime since 1977, which is clearly archaic.

I think this is a tough issue and resent accusations of homophobia just because I don't toe the politically correct line. My final impression is that the risk from any donor is extremely low, but that excluding gay men may lower the risk even further. I remain receptive to evidence to the contrary.


At 8:05 PM, Anonymous Anonymous said...

Iatrogenic Causes, an anonymous blogger, who drops the intriguing hint that she has met me personally. Based on certain details in other posts I am 98% sure I know who he/she is, but his/her secret is safe with me.

Careful now. You've already told us it's a she... that's already three billion down.

Seriously though, the gay donor issue is ethically challenging, but hardly intractable, or even difficult. I lean on your side in this issue; a look at the freely available statistics on HIV infection will explain all that needs explaining. When less than 2% of your potential donor population gives rise to a disproportionately huge number of infected blood product, a sensible strategy is to stop those 2% from donating, rather than expending resources on catching the infected products inside the system.

At 12:48 PM, Blogger Aggravated DocSurg said...

We must not let political correctness get in the way of proper health care. I agree with you on this one, and feel there is no reason to promote sperm donation from a group that, as a whole, has a higher risk for passing on a dangerous disease. Would it make sense for us to encourage heterosexuals from high risk areas in Africa to donate blood and sperm? Of course not. While the two populations are different, and their absolute risks are different, the analogy is, I think, valid.

At 10:29 AM, Blogger A. said...

Hi Dr. Andy- Thank you for such a nuanced response to my post - it was a pleasure to read. I'm sorry it came across as if I though you were a homophobe - I don't at all. I was trying to make the point that the way that you were originally defending the ban sounded hinky, and danced near that line of speech that sounds 'off' - not that you were a homophobe, as I know you are not.
As for me, I see the issue of blood donation very differently than sperm donation. I agree with the ban on bood donation for MSM is appropriate, and I like the GMHC article you quoted, but I think it should probably be extended to IVDU & people who have recent commercial sex work contact as well, as the risk there for HIV has been shown to be very high. I was very happy about the change to 5-years, once the 1977 issue was gone, I felt that it was an appropriate, evidence-based reccomendation.
As for the sperm ban, I think that since the cost of testing the sperm is 'eaten' by private corporations, and all of the sperm is tested multiple times, the financial argument doesn't hold much water. I also think, that because there has been no cases of HIV-transmission via sperm donation, as a direct result of the expensive and much more intense testing that these samples are subjected to (this would obviously not be feasible for the US blood supply) that it creates something of a different situation.
Sorry for the essay in the comments, and sorry for my poor writing that made it seem like I though YOU were a homophobe.

P.S. Thanks for not revealing my 'secret' - it's mostly to keep it off google for various incriminating names.

At 8:23 PM, Anonymous Anonymous said...

All donors are tested for infectious diseases, the sperm held for a number of months then the donor is tested again. Similiar for other infectious diseases. Would you prevent gays from donating organs, blood too? What else would you screen out? I don't see the medical justification of your argument. What if they wanted to donate but just said "no I'm not gay" --- would that ease your mind?


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