I fully support an abundance of caution...so this is not an argument to let at-risk groups to donate blood. I believe that the standard is also not 'gay men', but 'men who have had sex with other men' over a certain period of time, which casts a MUCH wider net.
It is also important to understand that this policy is made out of a very high abundance of caution and is not reflective of an *actual* high risk.
That gay men are '26x more likely to contract HIV' sound rather ominous...but let's dig deeper:
- The *actual* risk depends upon the baseline risk for contracting HIV. 25x more likely than 1%...0.1%...0.01%...lower? HUGE difference.
- Also, '26x more likely' is the "average global risk"...which fails to account for all sorts of regionall differences, including HIV prevalence, attitudes/behaviours towards safer sex, access to condoms and other preventative measures, access to testing, etc.
The policy fails to account for people taking something like
PrEP, which radically reduces the risk of contracting HIV (by 99% during sex, and by at least 74% for injection drug users,
acc. to the CDC).
It also does not factor in that transmission risk is *critically* dependent upon the viral load of an infected person. If someone has an undetectable viral load, it is virtually impossible to transmit HIV to a partner (
source). Important to note that this relates to sex transmission and not risk related to transfusion, which could be different.
Then blood test sensitivity needs to be considered. Clearly, there is nothing remotely close to a 100% failure rate for testing HIV-infected blood or else the problem would extend well beyond men who have sex with men.
In other words, the *actual* risk of contracting HIV for men who have sex with men is something greater than baseline, but nowhere near 26x greater for most in Western societies...and data on what additional risk this poses to the blood supply is AFAIK lacking because of all of these variables.
So, what we actually have is a policy that is in place out of an *extreme* abundance of caution and for the practical purposes of not having to try and account for all of those relevant variables for any 'at-risk' person seeking to donate. It simply easier to prohibit an entire at-risk group from donating blood altogether, regardless in the within-group risk variance.
I'm fine with that...but from a public messaging standpoint, and to reduce stigma, this is all worth noting.