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Can I donate my gay blood?
February 27, 2010 7:37 PM   Subscribe

Saying that you have had sex with a man ("even once") disqualifies you for blood donation most places. But I know I don't have HIV. Is it ethical to lie on the intake survey so I can still donate?

I think blood donation is great. It is easy and painless and, as far as I know, really, really useful. I've donated blood lots of times in the past and I would like to continue.

On the other hand, I am a man who recently became sexually active with other men. On the red cross intake survey (which is very similar to the ones that I've seen at other donation centers), they will immediately turn you away if you say you've had sex with a man. So that's game over for donating, right?

Well, as part of my job, I have to get regularly tested for STIs. I don't have HIV. Based on my borderline paranoid sexual practices, I don't anticipate getting HIV. Can I continue to donate blood in good conscience? Or is that totally reckless?

Both moral and medical responses are encouraged. Thanks.
posted by anonymous to Health & Fitness (106 answers total) 6 users marked this as a favorite
 
I am a man who recently became sexually active with other men.... So that's game over for donating, right?

Right.
posted by spilon at 7:42 PM on February 27, 2010 [2 favorites]


Lying is lying.
posted by radioamy at 7:45 PM on February 27, 2010 [3 favorites]


What if the timing of your tests and your donation patterns don't line up? What if you do test positive shortly after you've donated blood? Are you willing to risk someone else's life like that?
posted by onhazier at 7:45 PM on February 27, 2010 [3 favorites]


Answer the questions honestly. Your job is to answer the questions, not to interpret the reasons for the questions.
posted by Mr. Justice at 7:46 PM on February 27, 2010 [11 favorites]


Can someone explain this rule? It seems extremely discriminatory and unnecessarily restrictive. The Red Cross tests all their blood donations for HIV, right?
posted by amro at 7:49 PM on February 27, 2010 [2 favorites]


Background info: http://en.wikipedia.org/wiki/MSM_blood_donor_controversy
posted by dfriedman at 7:50 PM on February 27, 2010


I can understand where you're coming from, because I'm ineligible donating blood for an even sillier reason: I spent a year in Wales when I was eight, which apparently puts me at "high risk" for vCJD, aka mad cow disease.

Personally, I would like to be able to give blood, but not badly enough to lie about it. The Red Cross has chosen where to draw the line as far as what constitutes an acceptable risk, and IMO that means they're the ones with the moral responsibility for that choice. So I just donate money instead.
posted by teraflop at 7:50 PM on February 27, 2010 [19 favorites]


Can someone explain this rule?

It's not the Red Cross's rule.
posted by Pollomacho at 7:53 PM on February 27, 2010 [2 favorites]


Blood donation may be great, and maybe you should totally encourage other people to go in your place, "since I can't".

But I don't donate. If they choose to discriminate on this basis, they don't deserve my blood. If the dearth of viable blood is so important, straight people should be up in arms about this issue, because they're just as likely to need the damn blood as anyone else -- it's blood someone will need, but won't have.
posted by hermitosis at 7:57 PM on February 27, 2010 [7 favorites]


When I used to sell my plasma, they also had rules against donating blood or plasma if you've used IV drugs since the early eighties, had sex for money since the 80s, or had male-on-male sex since the eighties -- OR, in the past year you've had sex with somebody who fits those criteria. Yes, if in the past year, you've had sex with somebody who did heroin in 1984, you can't donate blood. Let's hope that girl or guy you dated for a couple months last summer properly disclosed their past thirty years of vices to you.

I agree, stupid rules, but they have a purpose, and lying to get around them is definitely wrong; were I in those disqualification categories, I know I couldn't be happy with myself lying...but I'm that kind of guy. On the other hand, people I know who consistently make a couple hundred bucks every month donating plasma who I'm 99% sure are disqualified by more than one of those rules.
posted by AzraelBrown at 7:59 PM on February 27, 2010 [1 favorite]


If this description of the blood donation process is accurate, then yes, the Red Cross checks every unit of blood for HIV. So yes, at best this policy is outdated (it harkens to the days when HIV testing was more expensive, much slower, and less accurate), and more likely a shameful reflection of the bigoted idea that homosexual people are "dirty".

Unfortunately, ethics demands that you must answer the survey honestly anyways; this process is designed to protect others, not you, and however wrongheaded it may be, you should either abide by the guidelines or decline to participate.

If this were me, I would be infuriated! In fact, it infuriates me anyways! Since you can't donate, perhaps you could see what you can do to change that fact.
posted by Salvor Hardin at 8:00 PM on February 27, 2010 [5 favorites]


If you want to make a difference, which I assume you want to do because you want to donate blood, take a stand and keep making a stink about how you can't give blood for a rule that, though probably a pretty good idea once upon a time, to you and many others now seems pretty back-assward and discriminatory.

Answering that question dishonestly -- even if doing it is for a good reason -- is just another version of the closet. Through no fault of your own, you're put in that position, but at the one point in the whole thing where you get to choose -- choosing to donate and to lie -- you're putting your personal stamp of approval on it.
posted by MCMikeNamara at 8:00 PM on February 27, 2010 [8 favorites]


The Red Cross has chosen where to draw the line as far as what constitutes an acceptable risk, and IMO that means they're the ones with the moral responsibility for that choice.

Actually, the Red Cross doesn't really have a choice. It's an FDA mandate, which they have to follow in order to maintain their medical certifications. The Red Cross has recommended that the permanent ban be changed to a deferral period after which donation would be allowed, but the FDA has declined to change the policy.

FDA officials have a rational reason for upholding their policies, and it's a reason that applies to many of their actions. Basically, there are two kinds of errors that a regulatory agency such as the FDA could make when setting policies. Type 1 errors involve approving something, only to have people get hurt by the thing they approved. The agency would be blamed for their deaths, bad publicity would ensue, and people would mistrust the agency going forward, which might harm public safety.

Type 2 errors, on the other hand, involve declining to approve something, only to have people get hurt through a failure to reap the benefits of the thing because they're not allowed to have it. In those cases (blood not donated, drugs not put on the market, medical procedures banned, etc.), people still suffer illness and death as a direct result of the decision, but the agency isn't blamed, and so its reputation is maintained. For example, you'll never hear "this guy died because the FDA won't let gay men donate blood"; people will instead say, "this guy died because of a blood shortage," or even more succinctly, "he bled out." The FDA is responding rationally to incentives by setting levels of acceptable risk very low, even if it's empirically the case that fewer people would die if gay men donated blood and some vanishingly small number of people were infected with HIV.

All of this is to say that I wouldn't fault you for lying if you were absolutely positive that you could not be infected with HIV. However, given the information you've provided, I don't think that's the case for you. I think you're at higher risk than you think you are. If you had sex with a man 20 years ago, haven't done so since, and have been tested for HIV regularly since then, I'd say you're probably safe enough to flout the rule. Hell, if you've been in a monogamous gay relationship for many years and have been tested regularly throughout that time, that's probably safe enough. However, if you are currently non-monogamous, or if you've been monogamous for less than a couple of years, please don't lie. (And yes, I'd encourage straight folks who engage in comparably risky behavior not to donate, too. These tests are not foolproof.)
posted by decathecting at 8:14 PM on February 27, 2010 [22 favorites]


If you engaged in male-on-male sex 30 years ago and are now as certain as possible that you don't have HIV, you might arguably have a case here. I'm not saying that lying would be justified, but it would be a bit more of a gray issue. But that's not the case here, you are, as you say, "a man who recently became sexually active with other men." Even most of those who support loosening the restrictions (and from where I sit, I think they are absolutely right), support deferral for those who have engaged in male-male sexual acts within the past year or more, because there's still a testing window and no tests are perfect.

I know that your goal is to do good here, but you simply cannot know for certain that you won't put others at risk. You are, statistically, a greater risk to the blood supply than a man who takes the same precautions as you but isn't currently having sex with other men. Given that, you have to accept the judgment of the officials responsible for the safety of the blood supply, even though it may well be wrong and quite possibly rooted in bigotry. When it comes to the blood other people are receiving, you don't get to substitue your own judgment here. Sorry.
posted by zachlipton at 8:16 PM on February 27, 2010 [5 favorites]


i come to this issue slightly differently - but still pretty much the same. i have had sex with men who have had sex with men. it is about a decade in the past at this point and my testing is clean. i'm a universal donor. personally, i lie.

the angle argued here is the only one that's ever even given me pause about my lie. especially MCMikeNamara - "Answering that question dishonestly -- even if doing it is for a good reason -- is just another version of the closet." - before i donate again i'll be giving serious thought to that. i can't tell you which side i'll end up on.
posted by nadawi at 8:17 PM on February 27, 2010 [7 favorites]


You are asking if you can ethically lie to an aid organization. What do you think the answer is?
posted by jckll at 8:26 PM on February 27, 2010 [1 favorite]


Lying is lying by tautology, sure, but does a bigoted policy really deserve honest adherence? I'm sure most people here wouldn't say about 1960s era civil disobedience, "law-breaking is law-breaking." Granted, this is slightly different because you're not actually drawing attention to the policy by breaking it, but I don't think the analogy is otherwise far-off.

It's extremely unlikely you're risking anyone's life by donating. As others have pointed out, blood centers test all accepted blood for HIV regardless of how the accompanying questionnaires were answered. Is it possible that you're in the small window where HIV is present but undetectable? Of course. It's also possible for any straight person, especially for those with non-"borderline paranoid" sexual practices.

It is very likely, however, that you're saving someone's life by donating. There are continuous shortages nationwide. The fact that the people who write the rules are homophobic does not give them the right to keep blood from those who need it.

Could you make a stink about the policy instead? Sure. That's a perfectly admirable option, one that doesn't require you to make an unpopular moral decision. I'm just saying that if you're not the activist type and would rather donate your gay blood than take to the streets, I don't think you're doing anything wrong. I don't know about legal/practical consequences should you get found out, but morally, I think you're in the clear.
posted by randomname25 at 8:28 PM on February 27, 2010 [8 favorites]


Is it ethical to lie on the intake survey so I can still donate?

No, it is not. You wish to lie because you feel left out and discriminated against. You are being discriminated against. But you would not be lying because you wanted to help others, you'd be lying to stop discrimination. That's not ethical.

Put another way, the FDA has decided to deal with the AIDS issue regarding blood by banning gay men from giving blood. We can speculate that they are doing this to limit the cost of testing everyone who gives blood for AIDS, or to increase confidence in the blood supply by assuring the public that gay men can't donate, we don't know. But it is not ethical to screw up their system that they are relying on to get blood with full confidence.
posted by Ironmouth at 8:29 PM on February 27, 2010 [3 favorites]


Is it ethical to lie on the intake survey so I can still donate?

I should think the answer to your question lies in its very phrasing: yes, it would be unethical to lie.

I appreciate your disappointment. Four of my friends have been banned from donating blood for a variety of reasons ranging from having had sex with someone who has taken intravenous drugs in the past, to gay sex, to visiting the UK in the early 90s. Each one of them was annoyed and frustrated to discover that they were ineligible; I think that's a common initial reaction. And understandable: I mean, all you want to do is help people, right? That's cool. But you will have to find some other way to help: urging your eligible friends to donate is a great idea. But please don't lie to circumvent the rules because you want to do what you want to do and you think the rules don't apply to you.

Your personal HIV status is not the issue; you simply fall into a statistical group. Yes, it sucks. I discovered recently that although I am completely healthy, and want to be gutted for harvestable organs when I die, I fall into a statistical group that means that my organs probably won't be wanted. It's a bummer. It's a bummer for me. But if there was some way that I could lie, just so my organs would be taken, I wouldn't do so, because it would be completely self-serving; I would be fucking up the screening process in order to satisfy a favoured image I hold of myself. I'm pretty sure my organs are fucking excellent, but unfortunately the decision isn't wholly mine.
posted by hot soup girl at 8:33 PM on February 27, 2010 [4 favorites]


I always lie and donate anyway. I have popular blood, people need it. That's more important to me than being honest on a bureaucratic form.
posted by internet fraud detective squad, station number 9 at 8:33 PM on February 27, 2010 [9 favorites]


I'm sure most people here wouldn't say about 1960s era civil disobedience, "law-breaking is law-breaking." Granted, this is slightly different because you're not actually drawing attention to the policy by breaking it, but I don't think the analogy is otherwise far-off.

Uhh, except the Woolworth sit-in didn't have the potential to transmit a fatal disease to an innocent bystander.
posted by jckll at 8:34 PM on February 27, 2010 [2 favorites]


The criteria for donating are extremely conservative - I've been disqualified for the next year because I visited a major city in India on a business trip.

As a bisexual man, I do lie about my sexual history in order to donate blood. However, I haven't been sexually active with men in many years, have a very low-risk sexual profile (very small number of partners of any gender), and having been tested regularly since then I can say with as close to 100% certainty as anybody who's exchanged bodily fluids with somebody else that I'm STD-free. Were I to resume a more active sex life at some point in the future (ha!), I would stop donating blood immediately. The main reason why I do lie in order to donate blood is because I apparently have some rare factors, and having been a caretaker for somebody who required regular transfusions due to a brutal chemo regimen, I don't have it in me to say "no" when the blood center calls me up and says there's a patient for whom I'm a good match that needs blood.
posted by hackwolf at 8:38 PM on February 27, 2010 [2 favorites]


I'm a woman who has sex with men who have sex with men. I don't lie and don't donate. I'm pretty uncomfortable with the whole thing, and see it as a homophobic and outdated rule, but I'm also terribly uncomfortable with the thought of lying about it. I donate money and time to various do-gooder causes instead.

Honestly, I wouldn't fault you for lying. I don't think it's a huge moral pit of evil. But I think that protesting loudly is the better tactic here, and sturdier moral ground all around.

That said, in an emergency situation where they start calling desperately for donation, or if you have a particularly rare and needed blood type, I think you're in the clear to go ahead and lie about it.
posted by Eshkol at 8:39 PM on February 27, 2010 [4 favorites]


"Lying is always wrong" is very simplistic ethical reasoning, as easy as it is to say "oh that's obvious, lying is wrong" it does not hold up as a universal ethical rule.
posted by internet fraud detective squad, station number 9 at 8:41 PM on February 27, 2010 [10 favorites]


Isn't the highest rate of HIV infection at this point in the African American community? Is that going to be the next mandate, that no black people can donate blood? It is ridiculous, especially with the lack of people willing to donate.

I understand the moral problem you are facing. But, if in need of blood one day, I would not give a shit if a gay man lied in order to be able to donate the blood that saved my life. I'd be grateful. Anyone can contract HIV, so I guess anytime you donate blood you are risking your infection being undiscovered in testing, and potentially infecting another person. Life is pretty risky for us all. But in the end, you have to do what you think most fits with your own personal morality. Thanks for being willing to donate regardless!
posted by afton at 8:47 PM on February 27, 2010 [6 favorites]


It's not totally reckless, but it is lying. Don't do it.
posted by Dasein at 8:50 PM on February 27, 2010 [1 favorite]


I'm banned from donating because I'm British and apparently CJD is still a 20-year old ticking time bomb. It's stupid, xenophobic and outdated but it's their rule and their loss.
posted by poissonrouge at 8:58 PM on February 27, 2010 [6 favorites]


I'm disqualified from donating because I have heart disease. Doesn't make much sense to me, but since I'm not a medical professional, I'm going to defer to experts who have knowledge I don't have and who are qualified to make decisions I am not qualified to make.

Admitting I'm not qualified to make these decisions, acknowledging that these decisions were taken by a body of experts appointed by a democratically elected government, it seems to me it would be breaking the social contract to attempt to duplicitously subvert my disqualification.
posted by orthogonality at 8:59 PM on February 27, 2010 [1 favorite]


You would certainly have no justification at all in lying in the absence of an immediate and desperate shortage of your blood type. Not "The Red Cross has announced a shortage," but people currently dying because there isn't enough blood for them -- if people aren't dying for lack of blood, they don't need yours. This level of need seems very unlikely in the US absent a severe natural disaster or large-scale attack.

It is very likely, however, that you're saving someone's life by donating.

Is it? How many people in the US die annually because there isn't sufficient stored blood for their needs?

I have to admit that I find the frequency with which people admit lying to donate blood positively chilling. Not because gay people are icky, but because I want a blood supply that's not just safe, but that's so absurdly safe that I could not reasonably have any fears about the anonymous stranger's blood going into me. Which means multiple and independent screening mechanisms, which you're subverting if you lie.

Well, as part of my job, I have to get regularly tested for STIs.

I don't think I'd need testing to know if I'd come down with a Subaru.
posted by ROU_Xenophobe at 9:00 PM on February 27, 2010 [8 favorites]


Lying is always wrong" is very simplistic ethical reasoning, as easy as it is to say "oh that's obvious, lying is wrong" it does not hold up as a universal ethical rule.

No, "lying is wrong" is not a universal ethical rule, but it's a pretty good starting point. In this example, we can certainly, if we try hard enough, imagine a set of circumstances that would justify lying on the form. For example: someone is holding a gun to his head, telling him to lie. But the original poster's reasons are far less compelling: he would like to circumvent a screening process because he thinks that his personal evaluation of the risk he poses is more accurate than the statistical evaluation of the organisation he is trying to help.

He could be right. He could be wrong. Certainly, no one here on the green can evaluate the risk he poses with sufficient certainty to be able to, in good conscience, exhort him to lie in order to donate.

If he should lie on the form, who else should lie? Should my friend who ate beef in London in 1992 lie? She's pretty sure she doesn't have vCJD. If it's okay for some people to lie on the forms, who are those people?
posted by hot soup girl at 9:05 PM on February 27, 2010 [6 favorites]


Isn't the highest rate of HIV infection at this point in the African American community? Is that going to be the next mandate, that no black people can donate blood? It is ridiculous, especially with the lack of people willing to donate.

The rules about MSM, IV drug use and high risk contacts (having heterosexual sex with someone who has sex with men or uses IV drugs) covers the vast, vast majority of black HIV cases, so I don't think your point makes the sense you think it does.

reference
posted by rr at 9:07 PM on February 27, 2010 [4 favorites]


The ethics of lying in a situation where you can be absolutely sure you aren't carrying anything, or similar situations - such as the references to 30-year-old exposures to people who may or may not have been exposed to risk factors themselves - is pretty knotty. Of course, it would still be lying.

However, if you are continuing to be sexually active with men, I don't believe you can be absolutely sure there is no chance of trasmitting anything, due to the difference between testing windows and potential exposures. I think that would be a reckless action, and ethically wrong.
posted by Nabubrush at 9:11 PM on February 27, 2010


The issue is the policy states you can not donate blood if you have had EVEN ONE sexual encounter with a man since 1978. For a sexually active gay man with multiple partners, it might make sense to exclude their donation because of the 3 month window period in testing for HIV. However, let's say you had sex with a man in 1985, you have been tested multiple times for HIV and tested negative, and have been celibate for the past 10 years. Your blood is excluded as well.
posted by hworth at 9:15 PM on February 27, 2010


The point of the screening questions isn't, really, as I understand it, so much to put anyone into a "suspect" category, as it is to identify those who have been in situations where blood products are at higher risk of being contaminated. And not, I might point out, just by diseases or conditions we now know about.

More importantly, interview screening questions are asked, because it may be some time yet, before a disease vector we have yet to identify, but that is, or will become virulent in the future, can be recognized. After all, we're still unsure of who was Case 0 in the AIDS epidemic, and that's to some degree, because interview questions and donor screening procedures were much more lax in the '50s, '60s, '70s, and '80s. Being truthful with your answers to screening questions, is, in a real sense, a moral contract with epidemiologists of the future, who, if it comes to that, may, on the basis of the greater amount of information being collected, be able to back trace and identify as yet unknown disease, much earlier than they were able to do for AIDS.

If by being truthful in answering screening questions you consider socially loaded today, you could help, in even a small measure, to stop or slow the next AIDS epidemic, wouldn't that be worth whatever indignation those questions provoke, today?
posted by paulsc at 9:16 PM on February 27, 2010 [5 favorites]


The Red Cross has chosen where to draw the line as far as what constitutes an acceptable risk, and IMO that means they're the ones with the moral responsibility for that choice.

As another person excluded under the "oh noes, British people have little mad cows running through their veins!" criterion, I take the same view, though slightly less charitably; I give my money to MSF. Their rules, their loss. When I return to the UK, I'll look forward to exchanging my blood for tea and biscuits.
posted by holgate at 9:27 PM on February 27, 2010 [1 favorite]


I don't see a big problem with it.

By the sheer fact of being tested for STDs regularly (though it depends on how regularly), you can make yourself far less of a health risk than the average donor who rarely, if ever, gets tested. And they still accept those persons' blood.

And to all the "lying is lying" zealots: put down the Kant and read some Mill. Not all lies were created equal.
posted by astrochimp at 9:40 PM on February 27, 2010 [5 favorites]


You get to decide what risks you're willing to take for yourself but you can't ethically impose those risks on other people however small those risks might be.

Instead of thinking of lying to the Red Cross imagine that you're standing in front the blood recipient and that you're explaining to them that you are regularly tested, engage in safe sex, and that as far as tests can tell you're HIV negative. Then take the next step and explain to them that you felt justified in lying about your history but that they should believe everything else you say.
posted by rdr at 9:42 PM on February 27, 2010 [3 favorites]


I personally have never donated blood and know of people who do. I admire people who do. Here, after reading all the above opinions, In my humble opinion I agree with rdr. All said and done, the final call is your own.
posted by VickyR at 10:03 PM on February 27, 2010


I don't know that it is ethical to lie. I do think it is unethical for the Red Cross to be homophobic, given the HIV infections are mostly coming from other groups, and have been for a while.
posted by Blazecock Pileon at 10:08 PM on February 27, 2010 [4 favorites]


A follow-up on my earlier point:

The lie is beside the point: any sexually-active person who donates blood regularly but rarely/never gets tested for STDs acts far more immorally than the poster would, even if no lies are involved.

This is because the real concern is the quality of the blood.

And if, statistically, a particular person's blood -- gay or not -- is less likely than the average donor's to be carrying a virus at any given time, that fact should carry all of the weight. This, of course, presumes that we can know the relevant statistics; but if we do know them, any other concern is irrelevant, and likely betrays an underlying homophobia, or simply misses the forest for the trees ("it may be clean blood... but he had to lie to give it!")
posted by astrochimp at 10:35 PM on February 27, 2010 [6 favorites]


For the time being, accept that you're ineligible. Yeah, this system may be broken since they are screening out risks that probably aren't significant.

However, even given its flaws, the screening process has integrity. This isn't a matter of all lying being bad. This is just a lie you shouldn't make. The receiving public--any of us, potentially--is relying on the system that in turn relies on donor honesty. Even though you know for a fact that you don't have HIV or another STI, it might be less certain for someone else who is donating. If it's well known that people can play fast and loose with the truth when screened, that integrity--and therefore, safety--just won't be there.

BTW(and this goes for all of us), you probably have a lot more than blood that you can donate to the Red Cross. Give them money, time and your skills.
posted by The Potate at 10:36 PM on February 27, 2010 [2 favorites]


Lie hard with a vengeance.

I'm a bisexual man in a monogamous relationship with a woman. Like you, I've been tested; I'm HIV negative. This is why I would donate blood with the utmost confidence. Countless gay men donate regularly. If blood is required from HIV negative heterosexuals, it's required from HIV negative homosexuals too. Gay men donate blood after telling this perfunctory lie with no moral hangups. It's not a matter of pride when the intention is to save lives and do it safely.

I know I'm HIV negative because I have been tested numerous times. But how many heterosexual women use hormonal birth control and forgo condoms -- even with multiple partners? How many heterosexual men forgo condom use citing any multitude of unjustified excuses? That's beyond irresponsible. I call it a public health hazard.

A heterosexual donor who has had sex with a knowingly HIV-positive partner 366 days ago would be eligible for donation...yet a man who has had sex with another man is ineligible to give blood no matter the frequency (or infrequency) of sexual encounters, safe sex practices involved, or how long ago the sex occurred.

Some unusually ignorant commentary has shown up in this thread. Let's clarify:

There would be severe cause for alarm if every sample wasn't being tested (not just screened using questions) before going into the supply. More like public outrage.

WHO recommends that, at minimum, all donated blood to be used for transfusion should be screened for HIV, hepatitis B, hepatitis C and syphilis.


Red Cross explicitly states: A dozen tests are performed on each unit of donated blood – to establish the blood type and test for infectious diseases.

The choice is yours.
posted by xndr at 10:42 PM on February 27, 2010 [27 favorites]


Sit tight, make a stink about it every chance you get, educate people in your vicinity about this vile (and frankly stupid) discrimination, and wait to donate until you can do so honestly and openly.

But mostly OP, don't let this policy or the people supporting it get you down. Thanks for being a good person (and that's what you are whether you choose to lie or not).
posted by greekphilosophy at 10:45 PM on February 27, 2010 [1 favorite]


Depends on how you look at ethics.

A utilitarian view would say that it doesn't matter if lying is absolutely wrong, or even if you believe that it's wrong as long as you can show that the good you create by donating is greater than the harm you cause by lying. A deontological / Kantian view would say that it doesn't matter if you could save a million crying puppies from a furnace by lying; it's always wrong, and you should never do it, no matter the ends. A virtue or character ethics view would ask whether lying to donate makes you a good person.
posted by obiwanwasabi at 10:48 PM on February 27, 2010 [1 favorite]


I am ineligible to donate blood not because of sexual activity, but because of international travel. I've considered lying about it, but haven't. My thought is that the benefit of my giving blood is very marginal, but the potential cost (were my blood to turn out to carry something nasty) is very high.

So my suggestion is to not lie, but instead to make a stink if the rules you object to are based on bias, rather than hard science. As a potential blood recipient, however, I do hope that the current rules are meant to protect recipients both from current diseases (eg HIV, CJV) and diseases that we don't yet know to watch out for. The rules and procedures surrounding transfusions in the 1980s turned out to be inadequate for many people -- I am willing to accept some over protection in exchange for better controls for the next virus or disease that will use blood as a vector.
posted by Forktine at 11:26 PM on February 27, 2010 [1 favorite]


Sorry. I thought of more that should be said.

The screening process doesn't really exist primarily for safety. It couldn't, since, if the blood supply relied on truthful answers, it would simply be "safety theater." The screening process is really in place for thrift. Accepting blood from any donor costs the Red Cross resources in manpower, time and cash. Since it costs resources just to get the needle in your arm, if they can't use your blood, they've incurred a net loss.

They figured out years ago that some peoples' (and not all people who are ineligible are for reasons as socially charged as HIV/AIDS and sexuality) blood is inherently more likely to earn the Red Cross (a not-for-profit that wants to give safe blood to anyone who needs it!) negative resources.

They've decided to screen for these circumstances at minimal cost at the very beginning of an attempted donation. This screening, like I said in my reply above, relies on donor honesty for its integrity. Your blood is fine, even though you lied. An unintended consequence of that lying could be an increasing perception that it's okay to lie to the Red Cross at screening. This increasing perception will statistically lead to an increase in well-meaning but useless "donations."
posted by The Potate at 11:29 PM on February 27, 2010 [4 favorites]


You get to decide what risks you're willing to take for yourself but you can't ethically impose those risks on other people however small those risks might be.

This right here. If you were doing some sort of directed donation the situation would be totally different, or if you were donating blood for your own future use or something, but you don't have the right to impose your judgment and ethical framework on someone unwitting person down the road, who is making the choice to use donated blood based on procedures that you're subverting. Even if you think those procedures are stupid, it's not your call to make.

Don't donate, or better yet go in and let them refuse you to your face over and over, make a stink to your elected representatives (who can influence the FDA) if you think the standards are wrong. If the need for blood gets great enough, and everyone knows that there's a pool of willing-but-denied donors out there, the policies will change. But they'll never change if you and other excluded people just lie.

Also … it's worth pointing out that although the Red Cross likes to emphasize blood-supply shortages, it's very, very unlikely that your decision to donate or not donate is going to result in any sort of change in life-or-death outcome. This isn't to say that they're exaggerating, exactly (although I've known people in the medical industry who would go that far), just that the people who are couching this decision in absolute, personal life-and-death terms are going a little far.

I think you could actually come up with a good argument that, in the long run, you would be doing more good by refusing to lie and working to change the system — opening up the pool of eligible donors — than you could ever do by lying, perpetuating the system, and donating at most a couple of extra pints of blood.

I think you're better off, both practically and morally, not lying and not donating. You can do some other charitable activity if you want, or you can rest easily knowing that you tried, and your attempt at Doing The Right Thing was turned down. If the blood supply ever gets really short, then the eligibility criteria will, out of necessity, be changed. If and when that happens, and you can donate without lying, then I hope you'll do so — but until that happens, they're effectively saying that your donation isn't necessary or needed. You can go on with your life with a clean conscience, without having to lie.
posted by Kadin2048 at 11:41 PM on February 27, 2010 [7 favorites]


If he hasn't got any STD's then there isn't any risk. So I'm not advocating doing anything illegal...but fuck it.
posted by Not Supplied at 11:47 PM on February 27, 2010 [1 favorite]


So my suggestion is to not lie, but instead to make a stink if the rules you object to are based on bias, rather than hard science.

If you're pissed off, yell at the WHO and FDA, but don't get shitty at the Red Cross. They can't/won't let you donate anyway, and you would just waste ten minutes of probably several workers' or volunteers' time that could be spent sticking needles in eligible donors' arms.
posted by The Potate at 11:50 PM on February 27, 2010


imagine that you're standing in front the blood recipient and that you're explaining to them that you are regularly tested, engage in safe sex, and that as far as tests can tell you're HIV negative. Then take the next step and explain to them that you felt justified in lying about your history but that they should believe everything else you say.

I would take the OP's blood over some unknown donor whose conscientiousness and sexual practices I didn't know about. I agree that it's overly simplistic to say "lying is lying."

Personally, though, I wouldn't feel qualified to make the decision to lie. I would probably call up blood donation efforts in gay-friendly neighborhoods to see if they rigorously adhere to this rule or quietly overlook it.

It looks like Gay Men's Health Crisis just last week released a report on alternatives to an MSM blood donation ban and may be ramping up a campaign to urge the FDA to change the law. From another source, here is a sample letter asking that the MSM rule be changed.
posted by salvia at 12:01 AM on February 28, 2010 [2 favorites]


There would be severe cause for alarm if every sample wasn't being tested (not just screened using questions) before going into the supply.

True, but you're not giving proper weight to the fact that testing the blood costs resources. Up to that point, any unusable blood that makes it to testing costs pretty much the same as blood that can be used.

However well meaning the donor, an unusable donation isn't really a donation at all.
posted by The Potate at 12:15 AM on February 28, 2010 [1 favorite]


Yes to holding the Red Cross accountable. You shouldn't kill the messenger. But not because he isn't culpable - because he's the one who has to carry back your reply.
posted by greekphilosophy at 12:30 AM on February 28, 2010 [5 favorites]


Blazecock Pileon: It is the Red Cross that collects blood and carries out this policy without questioning it. The actions and policies of the ARC are not grounded in science or reason. I hold the ARC accountable for their continued, homophobic course of action.

As has been said many times in this thread, the American Red Cross has proposed changing the rules along with many other medical experts. Ultimately, these are the FDA's policies, and while I believe them to be generally overboard and homophobic, they are grounded in caution and safety and there's a lengthy process involved in changing them, one which you may well wish to get involved with.

It's one thing to go all Rosa Parks on the ARC when they are doing something that is outright morally reprehensible. But what you're doing here is demanding that the ARC unilaterally ignore the law as set by the FDA because you believe it to be unjust. The result would be that the ARC would become unable to fulfill its mission to collect and distribute blood, the nation's blood supply would be severely crippled, and everyone would lose faith in the FDA, the ARC, and the blood donation system. This helps nobody. The ARC has made their position quite clear and asked that the relevant regulations be changed to something far more reasonable. Should they go farther and ask for no exclusionary period? Perhaps.

The ARC isn't blindly following the FDA's orders to engage in unspeakable horrors, they are following misguided regulations intended to preserve the safety of the blood supply. They've encouraged the FDA to change these regulations to be more rational and fair and joined with others in their industry to do the same. I'd say they are doing their part here within the system we all live in, which is how something like this needs to work.

It can be courageous to exercise civil disobedience over laws you believe to be wholly unjust, but it's also an incredibly drastic action not to be taken lightly. When you do it over anything but the most pressing of issues, you tend to look foolish, and when you do it in a way that not only affects others, but may well expose them to involuntary risks, you're being outright irresponsible. The blame here isn't on the American Red Cross, and it's silly of you to keep insisting that we ought to blame them instead of the true source of these policies.
posted by zachlipton at 12:33 AM on February 28, 2010 [8 favorites]


As has been said many times in this thread, the American Red Cross has proposed changing the rules along with many other medical experts.

That link suggests the ARC would still equate the risk profile of any act of sex between two males with IV drug use with dirty needles, which is a comparison not supported by science or reason.

You don't have to agree with me, but the ARC conducts itself in a homophobic manner. It's up to individuals to decide whether to be a part of that regime of dishonesty.
posted by Blazecock Pileon at 12:40 AM on February 28, 2010 [1 favorite]


It is the Red Cross that collects blood and carries out this policy without questioning it.

This is factually incorrect, and provably so.
posted by Tuesday After Lunch at 1:00 AM on February 28, 2010


This is factually incorrect, and provably so.

The fact is that the FDA does not collect blood.

The fact also remains that the ARC does not question the policy decision to identify the blood of all gay donors as a public health risk.

In light of those facts, one can create an ethical case for telling the ARC where to go. In any case, I apologize for contributing to this derail.
posted by Blazecock Pileon at 1:07 AM on February 28, 2010


It's interesting that such a stringent rubric has been so internalized. In my opinion, it's a good thing that as someone who's considering lying about this, you're considering the potential recklessness of this scenario. It sounds like you yourself are putting yourself under some rigorous tests. You're probably questioning the viability of your blood more than most donors do.

Knowing that you are, personally I wouldn't hold it against you if you forgot your blood was gay once in a while.
posted by inkytea at 1:14 AM on February 28, 2010 [2 favorites]


Ethics are just what the majority of people think. They do not have to be moral. The ethics of some past societies were pretty ghastly. Judging by people's responses here, you ethically shouldn't donate. That said, if you do lie, there will probably be zero negative repercussions for you or anyone else, so you'd morally be in the clear.
posted by malp at 1:54 AM on February 28, 2010 [3 favorites]


I can understand where you're coming from, because I'm ineligible donating blood for an even sillier reason: I spent a year in Wales when I was eight, which apparently puts me at "high risk" for vCJD, aka mad cow disease.

I'm ineligible because of a year in Wales as well, and I was (and am) a vegetarian. I've lied about it in the past, but I haven't donated in many years. This is because I've come to this realization: they can't possibly need blood as badly as the Red Cross claims that they do if they're going to exclude people for such marginal reasons.

They don't want your blood so don't give them your blood.
posted by Mayor Curley at 3:10 AM on February 28, 2010 [3 favorites]


The fact also remains that the ARC does not question the policy decision to identify the blood of all gay donors as a public health risk.

Here's the thing: on average, blood from gay donors is statistically more likely to carry HIV than blood from heterosexual donors. That's not homophobic, it's reality. Would I rather have the OP's blood than blood from a heterosexual man who engages in risky sex without protection and never receives testing? Of course, I would. But the system doesn't work that way; it's a massive public system that has to work on averages to function.

Now the goal of the blood donation system and the FDA regulations governing it is more or less to do three things:
1. Ensure the safety of blood transfusions for all parties involved
2. Have suitable quantities of blood on hand in order to satisfy reasonable levels of medical need
3. Do the above as efficiently and practically as possible

All three of these goals conflict to some extent. We could have an incredibly safe blood donor pool if we only collected blood from certified virgins who are never allowed to come in contact with potential disease vectors, but such an approach would cause large shortages of blood and be phenomenally inefficient (and rather creepy to boot). Alternatively, we could do a great job with criteria 2 and 3 by collecting blood from everyone and transfusing it without testing it, but criteria 1 would suffer greatly. It's a balancing act, and the FDA has to do its best to satisfy criteria 1 and 2 while keeping the process efficient enough to make some degree of economic sense.

Note that feelings of fairness, equality, and inclusion are not included in the above goals. If the science determined that the best way to run a blood system is to only accept blond donors, and that by doing so we could still produce enough blood for medical purposes, that's what we would do. The system excludes broad categories of people who, on average, present greater than average risks, because in the absence of perfect testing for all diseases known now or to be discovered in the future, there's no other way it can work. Ultimately, the FDA has decided that the current set of rules gives us a suitable quantity of blood with minimal risk and reasonable efficiency, and the system works pretty darn well.

Now should those rules be revised? Quite likely, but they should be revised because a man who had sex with another man 30 years ago isn't a significant risk to anyone's safety as determined by epidemiological studies. I realize you think it would be great for all gay men to be able to donate, but any change has to be based on an analysis of the risk/reward benefits rather than a mere desire for social inequality. It would be swell if people who have spent time in parts of Europe or in Malaria zones could donate too, but we exclude them because they present a threat to criteria 1 and we don't need them to satisfy criteria 2. The "policy decision" you speak of is overboard and lacks any sense of nuance, but it is not wholly absurd by any means.

Gay people should have the full array of civil rights granted to heterosexuals, including the right to marry, but no one has the right to donate blood. That's why it's called a donation. We should use the epidemiological data to revise the rules where it makes sense to do so, but some people are simply going to pose a greater threat to the safety of the blood system than others, and sadly a number of gay men fall into that category. We should do whatever we can to not exclude potential donors who, in reality, don't present greater risks, but the FDA has to draw the line somewhere on these more risky donations whether it makes people feel bad or not.
posted by zachlipton at 3:50 AM on February 28, 2010 [13 favorites]


Blood samples are pooled when tested for HIV from blood donors; individual units are only tested if a pooled specimen comes back positive. Perhaps this adds to the reason for the restriction: extra cost if "higher risk" donors start donating, there would be a few more HIV+ samples, and so more units would need individual testing.
posted by gramcracker at 4:48 AM on February 28, 2010 [1 favorite]


Here's the thing: on average, blood from gay donors is statistically more likely to carry HIV than blood from heterosexual donors.

The proportions of new HIV infections in the US in 2007 were almost equally split between MSM and heterosexuals/IV drug users. Of this split, heterosexuals are about 40% of the total, with MSM at 50% and IV drug users about 10%. IV drug users cannot donate blood, so we can focus on the gay/straight divide, for purposes of argument. Further, we can look at HIV infection incidence for women, and note that heterosexual women as a group are almost exclusively represented. When you count new infections for men and women, about 31% of those infections result from heterosexual behavior.

The distinction between HIV incidence rates by sexual orientation seems not nearly as stark as it once was.

Gay people should have the full array of civil rights granted to heterosexuals, including the right to marry, but no one has the right to donate blood.

Of course. But there is a clear stigma against gay people that is a holdover from the early 1980s, when AIDS was considered a "gay cancer". In the sense that the ARC is a party to that odious line of thinking, it still is. Prospective donors should know that.
posted by Blazecock Pileon at 4:59 AM on February 28, 2010 [1 favorite]


HIV tests are accurate to within 0.003%, according to the papers referenced by wikipedia. So for every 100,000 people tested, 3 would show up negative when they were actually positive. Which is a pretty good rate.

However, if you've had sexual activity with a new partner, or a regular partner who has other partners, within the three months prior to the test, that accuracy rating drops way lower since the antibodies might not be showing up in your bloodstream. So bilateral monogamy or celibacy for three months, then get tested, for HIV, Hep A, B and C and the usual.

Anyone who has a number of casual partners should take these precautions before giving blood, regardless of gender or sexuality. A lot of people I know don't. So do that, then decide whether it's okay to give blood.

For the record, I am entirely truthful on my form except about my queer boyfriend. YMMV.
posted by teraspawn at 5:04 AM on February 28, 2010 [1 favorite]


[few comments removed - if you're not answering the OPs question, please take this to email or MeTa.]
posted by jessamyn at 5:05 AM on February 28, 2010


I would lie on this question. As some poster says above, it's not your job to guess why they are asking the questions. If your bank asked, would you tell them? No? Then there's no need to tell the Red Cross either, it's none of their business.

If I needed blood to save my life, I would not be picky about the sexual orientation of the donor.
posted by jrockway at 6:32 AM on February 28, 2010


[seriously, metatalk if you can't answer this question without ALLCAPS grar at other posters]
posted by jessamyn at 7:10 AM on February 28, 2010


I personally wouldn't lie. They don't want my gay blood? Well fuck them, then. I wouldn't be offended if you lied about it and gave blood, though. Two more factual things to add to the discussions:

Last time I raised a stink about this (at a work blood drive) I learned that the Red Cross does have a humane alternative. If you want to give the appearance of giving blood, say as to not tip off your coworkers that you're gay, you can go through the whole process, having the blood drawn. And mark on some secret form that they should simply destroy the blood rather than use it, which will be done confidentially. It's stupid, but I appreciate they made the effort.

Haitians used to be forbidden from donating blood because of the high HIV incidence in the population. After a lot of protest that the policy was racist, the ban was lifted.
posted by Nelson at 7:53 AM on February 28, 2010 [2 favorites]


Interestingly, this is identical to a moral problem posed by the medieval Dominican theologian Silvester Mazzolini (1456-1523) to show that it is sometimes acceptable to tell a lie in a good cause:

A traveller, on arriving at the gates of a city, is asked by the guards whether he has come from some particular town which they believe to be infected by plague. The traveller knows that there is in fact no plague in the town, or alternatively he knows that though there is plague there, he has not contracted it. If he confesses that he has come from the town, the guards will not admit him. He has no duty to tell them where he has come from, but he does have a duty to satisfy them that his admission will not jeopardize the health and safety of their city. In these circumstances it was held to be permissible for the traveller to reply not to the guards' question itself but to their 'remote intention', as Sylvester termed it. In other words, what the guards really wanted to know and had the authority to ask was whether the traveller was carrying plague. If he was not, he could say 'no'. Given the circumstances, this reply was ambiguous, and. in his sense, truthful.

(Quoted by J.P. Sommerville, 'The 'new art of lying': equivocation, mental reservation, and casuistry', in Leites (ed.), Conscience and Casuistry in Early Modern Europe (1988), p. 169. Also discussed by Jennifer Jackson, Truth, Trust and Medicine (2001), p. 49, with regard to its contemporary application to medical ethics.)

So this is not a new problem; moral philosophers have been grappling with these issues for centuries. Nor is it by any means an easy problem to solve. The people in this thread who are saying 'lying is lying and LYING IS ALWAYS WRONG' may need to think a bit more carefully about the ethical issues involved here. Moral absolutism is reassuringly simple, but that doesn't necessarily make it right.
posted by verstegan at 7:58 AM on February 28, 2010 [12 favorites]


Just to add, this isn't a uniquely American issue. Canadian Blood Services (who cover all Canada but Quebec) also prohibits MSM from donating. ('What you must know to give blood' PDF)
posted by Adam_S at 8:11 AM on February 28, 2010


Just to correct a misconception, the incubation period of prion diseases such as mad cow or cjvd is still not well understood, but could be up to 50 (!) years before symptoms appear.(medicalnewstoday.com/articles/45811.php) Prion diseases aren't viral or bacterial or cancerous. It's a whole different bag of wax and therefore it isn't really a fair comparison to HIV and other yet unknown STD vectors.
posted by Skwirl at 8:35 AM on February 28, 2010 [2 favorites]


Blazecock, your back of the envelope statistics are highly misleading.

While 40 percent of new transmissions are high-risk heterosexual people, that's still pretty damning considering that men having sex with other men is not roughly half the population. Also, considering that heterosexual women make up two-thirds of the heterosexual population with HIV, it's likely they fall into the same category I do, a straight woman who has had penetrative sex with a man who has had sex with other men.

While straight, we're also barred from donating blood. So the Red Cross does do a decent job screening us out, so long as we're readily informed about our sexual partners background.

If I were to be a more risky person and catch HIV, the chances of me passing it on to a future partner is fairly low. This is purely because I do not possess a penis, not because HIV is homophobic. Now there are other risk factors that my future partners should worry about, such as HPV or fronting for my abortion. But since heterosexual sex can be vanilla enough to avoid minor abrasions and tearing, blood to blood transmission is fairly uncommon. Again, this isn't homophobia, this is simple epidemiology.

I'm not happy that the facts are the facts, and I fully support that we shorten the amount of town a person has had MSM contact since we now have better information about the incubation period of the disease. But since the OP is currently having sex with other men, however safely, he does fall into a higher risk than the rest of the population for HIV.

And it's not about the fact that the ARC would still equate the risk profile of any act of sex between two males with IV drug use with dirty needles, which is a comparison not supported by science or reason. It's a fact that a bright line needs to exist between accepting and not accepting donor blood. You can't decide to accept 40% of MSM blood because it's 40% less likely to be HIV positive compared to drug users. You are either in a high risk category or you aren't. It's not a competition.
posted by politikitty at 8:59 AM on February 28, 2010 [2 favorites]


The Ethicist says answer honestly.
posted by purpleclover at 9:31 AM on February 28, 2010


"I personally wouldn't lie. They don't want my gay blood? Well fuck them, then. I wouldn't be offended if you lied about it and gave blood, though."

This nicely sums up my personal feelings on the matter.
posted by CrayDrygu at 9:54 AM on February 28, 2010 [1 favorite]


You are paying for the sins of the past. At the beginning of the AIDS crisis, about 30,000 people were infected with the virus simply because they exposed to blood products.

Policies may need to change, but the caution you are experiencing is the result of those infections and so much death that were basically because medicine fucked up. The speed with which we came to understand AIDS was blood-borne was a mess.

FDA. The relevant questions:
What about men who have had a low number of partners, practice safe sex, or who are currently in monogamous relationships?
Having had a low number of partners is known to decrease the risk of HIV infection. However, to date, no donor eligibility questions have been shown to reliably identify a subset of MSM (e.g., based on monogamy or safe sexual practices) who do not still have a substantially increased rate of HIV infection compared to the general population or currently accepted blood donors. In the future, improved questionnaires may be helpful to better select safe donors, but this cannot be assumed without evidence.
And more:
Isn't the HIV test accurate enough to identify all HIV positive blood donors?
HIV tests currently in use are highly accurate, but still cannot detect HIV 100% of the time. It is estimated that the HIV risk from a unit of blood has been reduced to about 1 per 2 million in the USA, almost exclusively from so called "window period" donations. The "window period" exists very early after infection, where even current HIV testing methods cannot detect all infections. During this time, a person is infected with HIV, but may not have made enough virus or developed enough antibodies to be detected by available tests. For this reason, a person could test negative, even when they are actually HIV positive and infectious. Therefore, blood donors are not only tested but are also asked questions about behaviors that increase their risk of HIV infection.

Collection of blood from persons with an increased risk of HIV infection also presents an added risk to transfusion recipients due to the possibility that blood may be accidentally given to a patient in error either before testing is completed or following a positive test. Such medical errors occur very rarely, but given that there are over 20 million transfusions every year, in the USA, they can occur. For these reasons, FDA uses a multi-layered approach to blood safety including pre-donation deferral of potential donors based on risk behaviors and then screening of the donated blood with sensitive tests for infectious agents such as HIV-1, HIV-2, HCV, HBV and HTLV-I/II.
Please don't lie to public health officials. Please don't. I understand science can seem cruel, but the attempt here is to act out of evidence and proof. I don't think it's malice or discrimination in this case. It's a painful history of failure, and the inability to prove that what you in your GUT feel is true, is actually scientifically true.
posted by artlung at 10:32 AM on February 28, 2010 [3 favorites]


Also, there was a Frontline report in 1993: AIDS, Blood, and Politics. It's not online, but there's a NYTimes review that covers the very controversy you're asking about. Here's a large quote:
The "Frontline" investigation goes back to 1981, when a mysterious disease, then known as gay cancer, appeared among homosexuals. Not only would the virus spread rapidly through sexual contact but it would also contaminate the nation's blood supply. Many homosexual men had been giving blood in an effort to help find a vaccine against another disease, hepatitis B, that seemed to attack homosexuals. Some of the blood carried the new disease, soon to be known as AIDS, and entered the ordinary supplies of blood banks and found its way into the veins of people who needed transfusions.

When hemophiliacs, who rely on the injections of a blood product to keep them alive, died of the new disease, doctors at the Centers for Disease Control began to suspect that AIDS was being transmitted by blood. And when reports came in that other blood recipients had been infected, calls for tests of both the blood supply and donors met a powerful resistance that would allow thousands of continuing deaths.

Tonight's report is more about the play of influence in Washington than about strictly medical matters. At first, decision makers were understandably cautious about acting on inconclusive evidence of a connection between the volunteered blood and AIDS, but the resistance continued even as the evidence grew stronger and stronger.

Pressure groups played a part. When one blood bank began asking male volunteers whether they had had a sexual relationship with another man and rejecting those that said yes, homosexual groups protested that they were being discriminated against. The American Red Cross and the American Association of Blood Banks, seemingly seeking any reason not to confront the problem, declared: "Direct or indirect questions about a donor's sexual preference are inappropriate." Critics say that an unwillingness to bear the cost was at the bottom of the resistance of most blood banks to proposals to test donors.
posted by artlung at 10:40 AM on February 28, 2010


Don't lie.
posted by lorrer at 10:42 AM on February 28, 2010


[if your answer does not have some sort of "here is some advice for the OP" angle to it, it needs to be in metatalk or email.]
posted by jessamyn at 11:35 AM on February 28, 2010


Blazecock, your back of the envelope statistics are highly misleading.

The numbers I calculated were taken directly from the CDC's web site. In various parts of the world, women and heterosexuals represent most new HIV infections.

No act of sex is zero-risk. But there is no distinction made by policy makers between sexual behaviors of various risks, if you are male and happen to have sex with another male — if you're gay or MSM, you're automatically labeled a disease carrier.

If you are straight, an automatic discrimination is made that allows you to donate because you are heterosexual (with a few exceptions) despite there being in the United States almost as much of a risk of HIV infection if your heterosexual activities are high-risk.

And this gets to the crux of Anon's question, in that a lot of people have sex, but some people have less risky sex than others, regardless of genders of partners. The existing policy doesn't attempt to address that reality. Fair-minded people can be allowed to consider whether the policy is moral or logical when it does not address certain important realities.
posted by Blazecock Pileon at 12:59 PM on February 28, 2010 [1 favorite]


This thread (not just the question, but also the many answers where people blithely report lying to public health officials) has made me reconsider an elective blood transfusion.

Please don't make my healthcare a forum for your politics.
posted by d. z. wang at 1:05 PM on February 28, 2010 [2 favorites]


My daughter (now 5) has to receive transfusions with regularity due to her leukemia. Please know that no matter how much we all dislike the rules they do serve a purpose. The blood donation center has limited their liability by asking the question. If my daughter is tested HIV positive, you better believe I'm suing the hell out of the company that does the screenings. If the donor is found to be you and that you knowingly lied on the questionairre...you better run and not just from me.

Bottom line: Don't put a stranger's life (i.e. my baby) at risk because you don't like the rules. As with learned with the mistake that was Bush: If you don't like the rules, change them. Don't break them.
posted by TauLepton at 1:05 PM on February 28, 2010 [5 favorites]


Excuse me, that should have read "as WE learned"
posted by TauLepton at 1:06 PM on February 28, 2010


To assume the policy is pure science with no political influence is naive. The American Red Cross, the American Association of Blood Banks, and America’s Blood Centers have called the lifetime ban "scientifically and medically unwarranted." Anyone who has followed US agency decision-making for any length of time can tell you that science is generally just the language in which a political debate takes place.

Hearing now that the policy really exists to ensure efficiency in testing blood donations, rather than say, false negatives, couldn't the OP achieve the spirit of the rule by abstaining from sex within the testing window and also testing himself to ensure that he hasn't contracted anything? In that way, he would have taken upon himself any burden that might otherwise fall on the public health system, thus morally in the clear.

That said, I still would be concerned that neither the OP nor this forum has the scientific expertise to really make that decision and would instead support going through the political process. Here's another article about some nascent efforts to have the policy revised.

On preview, I would also encourage the worried commenters to revisit the policies on testing blood, the extremely low statistics for false negatives, and the fact that men who have sex with female prostitutes can donate after just one year; why a longer window for MSM abstinence? Yes, you want to be safe, but there's no need to be 10000 times more safe with regards to one risk than with another comparable risk, which is exactly what the American Red Cross and the American Association of Blood Banks say in the link I provided above.
posted by salvia at 1:14 PM on February 28, 2010 [4 favorites]


Advocate for policy changes, absolutely.

But don't lie. If you want to do an ethical analysis of it, do it this way: who is harmed by the lie? Probably nobody. But you never know. What if there is some kind of STD out there that we don't know about yet? Will you really feel good about having made this donation if it turns out that way and some other person or people end up suffering just to make you feel good about having donated? Further, if it comes out that people are lying on their questionnaires, which it will eventually if people start lying, there will be a shitstorm of some kind and will surely impact the effectiveness of the blood donation system far more than missing your pint or two.

Alright, who gains from the lie? You do, since you get to feel good about donating. Blood shortages are generally localized things- some hospital forgot to place the order with the Red Cross that week, or a bus full of people with odd blood types crashed. Your donation does not help in that situation.

The Red Cross doesn't want *your* blood or *my* blood, they just need a good, steady supply of donors so that they can provide a good supply. If you and I don't donate, they will find someone else to do it.

Assuring them and the public that the blood donation supply meets guidelines is FAR more important to saving lives than your potential donations.
posted by gjc at 3:26 PM on February 28, 2010 [5 favorites]


It's not the CDC numbers I have a problem with, it's your interpretation.

Let's pretend America has 1000 people. The gay population is 100 people. We should only count half as men, but let's round it up to include bisexuals and self-identified heterosexual men who have sex with men.

We have 100 HIV infections. 50 caused by men having sex with other men. That's roughly 50% of the MSM population infected after a year. 40 of these new infections stem from high risk heterosexual activity. That's 40/900. Not even 5% of the heterosexual population.

That is why your interpretation of the CDC data is highly misleading. Because you're pretending that the gay male population is comparable in size to the heterosexual population.

I absolutely advocate shortening the window to only a year of abstinence. The policy was created when we did not have enough information about HIV, and breakthroughs in science absolutely justify a smaller window. But when you accidentally contaminate the blood supply, you overreact to stop it from happening again. Nobody thinks that removing our shoes in the airports is the key to stopping terrorism. Yes, it's reactionary, and time to reevaluate. But don't lie and say that the risks of HIV in the gay community is comparable to the straight community in the United States. The statistics come nowhere close to making that assumption.

There is nothing wrong with having high risk sex. Especially when the alternative is the closet. I've taken myself out of the donation pool, despite the fact that I could have easily made a decision not to sleep with bisexual men. But it's a decision that you are making for yourself. To force that decision on other people by donating blood they've clearly said they do not want is highly unethical.
posted by politikitty at 4:20 PM on February 28, 2010 [3 favorites]


The numbers I calculated were taken directly from the CDC's web site.

That's not what the commenter meant, and that should be obvious from context.

From the numbers you listed or other CDC numbers, about 52% of new transmissions in 2004-2007 were men who have had sex with men, some of whom also are IV drug users. Where men who have sex with men is very emphatically not the same thing as being gay.

I can't easily find any numbers that seem reliable on how many people in the US are men who've had sex with men. Let's go nuts and assume that 15% of the US population is homosexual, which seems an absolute ceiling to me, and that half of those are men, and that another half-percent of the population are non-gay men who've had sex with at least one man. That is, eight percent of the population is in the relevant risk group. Who have 52% of new transmissions.

Then the relative risk of HIV infection among the population of men who've had sex with men is about 650% that of everyone else.

We can certainly talk about the sensibility of the current effectively lifetime ban, but you cannot pretend that men who have had sex with men are not at dramatically higher risk of HIV infection, all else equal.
posted by ROU_Xenophobe at 4:20 PM on February 28, 2010 [1 favorite]


Where men who have sex with men is very emphatically not the same thing as being gay.

The issue of terminology — "gay" vs "MSM" — is a distinction that is important in other social contexts but not so relevant to the issue of discrimination. Either way, if you're a man, and you sleep with someone of the same gender, you are automatically treated as a carrier of HIV, despite the relative risks of your sexual practices, whether you or society calls you "gay" or anything else.

Not as much thought is given to blood donors who are heterosexual, regardless of the relative risks of their sexual behaviors. No phlebotomist asks the prospective donor if he or she uses condoms with their opposite-sex partner or partners, for example — or at they hadn't, back when I used to give blood. Members of this group will be turned down for other non-sex-gender-based risk factors. Still, worldwide, heterosexuals are the greater source of new HIV infections by number; in the United States, less than half, but not by much.

The question is where the basis for a decision comes from: Is it coming from 1980s attitudes about the genders of the people involved in sexual behavior, or from the actual risk of their behaviors irrespective of genders in the year 2010?

Regardless of how you, personally, answer that question, I think at least asking it will get one closer to understanding why some (myself included) have come to the conclusion that this is now an issue of irrational discrimination, and act accordingly. I think it's worth asking. I do not give blood or donate to the Red Cross, though I would genuinely welcome to opportunity to do so again at some point in the future. Others have given other suggestions.
posted by Blazecock Pileon at 4:55 PM on February 28, 2010 [1 favorite]


The same thought is given to heterosexuals as homosexuals. Phlebotomists find that when it comes to additional details beyond orientation, people lie. If you ask them, about 75% of Americans vote.

So the FDA and ARC is pretty much left with either unreliable data on an individual's HIV risk, or the relatively reliable data on a demographics HIV risk.

Ultimately the OP is going to make their own decision. But they should make that decision based on an accurate understanding of the risks the ARC worries about. It is not the absolute number of infected, or even the percentage of infections by group that is relevant.

It's the scenario where you randomly pick out one gay male and one straight male. The likelihood that you picked out a straight male with HIV from the entire population is much smaller than the likelihood that you picked out a gay male with HIV. Until the HIV infections become 90% heterosexual transmission, that fact doesn't go away. That's not homophobia, that's statistics.

And that is the important fact to the ARC.
posted by politikitty at 5:21 PM on February 28, 2010


A lot of posts are still talking about the hypothetical risk...but the OP knows that he doesn't have HIV, so isn't that irrelevant?
posted by Not Supplied at 7:00 PM on February 28, 2010 [1 favorite]


The OP knows that at the time he took his last test he was negative. The OP assumes he still is today. He may be. He may not be. Has he had sex with a new partner? Does he know that partner's history 100%? Did they take all safety precautions possible and did those precautions work? We do not know that information.
posted by onhazier at 7:30 PM on February 28, 2010 [1 favorite]


A lot of posts are still talking about the hypothetical risk...but the OP knows that he doesn't have HIV, so isn't that irrelevant?

Actually, he doesn't know that, based on the information he's given us, to the certainty that's required here to substitute his own judgment for that of public health officials. To begin with, HIV tests are not 100% accurate, whether they are the tests labs use as part of a standard STI panel or those used by blood banks on pools of donated blood. Even if we ignore that problem for a moment, there's a "window period" in which a person can be infected but tests cannot detect that infection. With the old tests, that period used to be a lot longer, but the new tests have reduced it to more like a month or thereabouts, but that's only an average.

The OP appears to be currently having sex with multiple male partners (he says "I am a man who recently became sexually active with other men"). If one of those partners is infected and passes on the virus a month before the OP donates, the OP will still test negative and the blood supply will be contaminated and no one will be the wiser until a transfusion recipient develops HIV. Since transfusion recipients are often rather ill for other reasons, an HIV infection represents a very real possibility of death.

If the OP had a single MSM encounter 30 years ago and has received regular testing since then, he would be far more certain of his HIV status and there would be more room for debate here (though I think I would likely still come down on the "don't lie to public health officials" side of the equation, while fully recognizing that lying is not by any means an absolute wrong).

Obviously I hope the OP never gets HIV (I hope no one does in fact), but simply being careful and receiving regular testing is not enough to know for sure, especially when engaging in a high-risk behavior, and when it comes to blood transfusions, we try to be pretty darn sure. Note that high-risk here doesn't mean it's somehow Bad or Wrong or Immoral or Evil (it's none of those things), it simply means that it is statistically a higher risk for infection. It's no different than the fact that living in New Orleans puts you at a higher risk for murder or living in San Francisco puts you at a higher risk for an earthquake.

Also, it's not just HIV that's a concern here. Hepatitis and other infections are also big issues for blood transfusions, and the screening questions seek to reduce the risk of transmission for these conditions as well.
posted by zachlipton at 7:30 PM on February 28, 2010 [1 favorite]


Exactly regularly tested and has 'borderline paranoid sexual practises'. That's as certain as anything is in this life.
posted by Not Supplied at 8:10 PM on February 28, 2010


Ok a comment got deleted so mine now sounds weird...but the point is I don't see why you still see it as a high risk individual.
posted by Not Supplied at 8:12 PM on February 28, 2010


I will have advice for the OP. I will. Promise. Pinky-Swear, even.

However: "Here's the thing: on average, blood from gay donors is statistically more likely to carry HIV than blood from heterosexual donors."

Yes, depending on how you cut it. "Blood from people who have promiscuous sex without protection is statistically more likely to carry HIV" sounds more correct. I have one partner, we always use protection, and my yearly HIV tests continue to show negative. I don't see how I'm any riskier then my best friend who's had at least 4 partners in the last year, one while so totally smashed he has NO IDEA what they were doing. In Aus, having had sex of *any kind*, protected or otherwise, with another man excludes you from donating blood for life.

The way the ban is structured in AUS feels more like "We don't want icky gay blood, we might catch The Gay!" then a medically based opinion. I've argued with myself about the ethics of donating blood by lying, doing more good that way. I've wavered back and forth on the issue and at the moment I'm on the 'yes' side, because I'm not any riskier then any other donor, and the idea that I am is frankly insulting.

BUT, I haven't donated. I've refrained for some time, and my current attitude is "Fuck 'em". If someone is dying because they need blood, and I can't donate because they might live but with a tiny chance of contracting something OMG EEW, then fuck 'em. (Yes, I know some perfectly healthy people regularly need to consume blood products in some manner.) I won't even donate to the Red Cross because I think the policy is discriminatory. And whenever asked about it, by donation drive staff or friends or work-mates trying to arrange group donations, I tell them why I don't support the organisation.

To the OP: I don't think you should donate. Not because you're MSM, but because you sound like your sexual activity at the moment is risky. It had nothing to do with lying. I don't think that lying in this situation is unethical IF you know you're not a risk. I'm afraid, however, that with the detection window and your new found mantoys... you sound like a risk to me. Sorry.
posted by Quadlex at 8:50 PM on February 28, 2010


but the point is I don't see why you still see it as a high risk individual.

Because he is! I'm sorry if that fact doesn't jive with the world we all wish we lived in, but a man who is currently having sex with multiple male partners is a high risk individual when it comes to blood donation. In order to function, the system works on averages and broad categories of people. We should do a better job of not excluding those who really don't represent substantial risks, but some donors are simply going to be higher risks than others. If we accept donors from those individuals because we don't want to discriminate, we're putting politics before science, which is precisely what you want to avoid here. The OP is a high risk individual.

I don't see how I'm any riskier then my best friend who's had at least 4 partners in the last year, one while so totally smashed he has NO IDEA what they were doing. In Aus, having had sex of *any kind*, protected or otherwise, with another man excludes you from donating blood for life.

I don't think you are a higher risk than your best friend, and if I had a choice between the two, I'd take your blood over his any day of the week. But again, the system works on averages and broad categories of people based on measured epidemiological data. No one has the time or ability to determine a complete history of your sexual health practices, nor do we have a scientifically proven model for what to do with your answers once we have them. Banning you for life doesn't make sense, which is why the Red Cross and others have strongly recommended a revision of this policy. But until we come up with a proven system that can better categorize people, you belong to a group that is higher risk on average than the one your friend belongs to. Coming up with such a new system isn't so easy because people lie and these things aren't so easy to test given the consequences of a mistake. Whatever system we have is always going to exclude some people who probably ought not to be excluded, because it's a mass system and that's how averages work.
posted by zachlipton at 10:11 PM on February 28, 2010


There are three separate questions here:

1. Is the policy good/ok/based on sound science, for the overall general population of potential blood donors?

2. Are you (specifically you) a higher HIV risk than you realize?

3. Should you lie on the form if you think the policy is bad?


I don't know the answer to question 1, and it's mostly immaterial to your question. Because even supposing the answer is "no, the policy is bad", you still have to address questions 2 and 3.

I also don't know the answer to question 2, but it seems like you would have to be Very Fucking Sure before you donated blood -- even if they never asked you a question about sex at all. Do you feel equipped to take on that risk assessment, weighing the science etc, on behalf of someone else who will get your blood?

But even this ends up being immaterial to the practical question, because they WILL ask you about sex.

So, question 3. Should you lie on the form? Suppose the policy is bad and you feel Very Fucking Sure you are a Zero HIV risk. Should you lie then?

No. Because the world doesn't need your blood that badly. It makes sense morally to lie when something very important is accomplished that way, which can't be accomplished another way. But the case of blood donation is not one of those cases. Blood donation is very good, and it's important that a large enough group of people do it regularly, but even so -- enough blood will get donated even if you refrain. So there is not enough moral obligation there to make it okay for you to lie.

Help in other ways.
posted by LobsterMitten at 11:14 PM on February 28, 2010


There is a MetaTalk post about this thread.
posted by Kattullus at 12:00 AM on March 1, 2010


In Aus, having had sex of *any kind*, protected or otherwise, with another man excludes you from donating blood for life.

Just in case the OP is actually posting in Australia, let me just point out that this is wrong. The Australian Red Cross Blood Service website says:

Within the past twelve months have you:

* Had male to male sex? more info
* Had sexual activity with a male who you think might be bisexual?
* Been a male or female sex worker (e.g. received payment for sex in money, gifts or drugs?)
* Engaged in sex with a male or female sex worker?

If the answer is 'yes' to any of the above questions, then a 12 month deferral is applied.


Obviously this does discriminate against gay men, but it does not preclude donating blood after a period of twelve months from the last time a man has had sex with a man. (Hey, it happens! They are called dry spells! But I'd still get tested before donating anyway...)

By the way, they also restrict blood donation from people who have been in prison or gotten a tattoo in the previous twelve months.

The way the ban is structured in AUS feels more like "We don't want icky gay blood, we might catch The Gay!" then a medically based opinion.

Yeah, it's really NOT that at all.
posted by crossoverman at 3:23 AM on March 1, 2010


Because he is! I'm sorry if that fact doesn't jive with the world we all wish we lived in, but a man who is currently having sex with multiple male partners is a high risk individual

I think you're still stuck on the fact that over the whole population this group is higher risk. If someone is tested and always uses condoms, the risk is vanishingly, vanishingly small. It doesn't matter if you're gay or straight.

The reason why men having sex with men is higher risk over the population is to do with social factors, not cause there's a special man aids that's somehow more virulent.

If you're not convinced consider they would happily take blood from a married man who fucks his wife without a condom even though the milkman could be fucking her up the arse...so the idea that their standards are ridiculously high is just not right.
posted by Not Supplied at 4:19 AM on March 1, 2010 [3 favorites]


Let's introduce some science here, because I'm tired of talking out of my ass. The FDA did their own study, the results of which are reported in last June's issue of Transfusion: Quantitative estimate of the risks and benefits of possible alternative blood donor deferral strategies for men who have had sex with men (institutional access required. I've summarized some key conclusions below, and would be happy to send a PDF upon request visa MeMail if you don't have access).

The study used probabilistic models to look at the increased risk based on two scenarios, termed MSM5 and MSM1, where donors are deferred for 5 years or 1 year, respectively, after MSM contact. These models assume that people would accurately self-report this information and complete the questionnaires honestly, a rather conservative estimate.

When they crunched the numbers, they determined that MSM5 would yield approximately 14,730 new non-infected donors (0.17% increase), while there would be 322 new HIV-infected donors and 35 HBV-infected donors attempting to donate in the first year. For MSM1, the numbers were 75,190 (0.88% increase), 1645, and 178. Given the best available data on testing accuracy and error rates, the FDA estimates that MSM5 would result in a mean of 0.03 additional HIV-infectious donations in the first year of the policy, while MSM1 would result in a mean of 0.18 additional HIV-infectious donations (.004 and .02 for HBV).

Finally, the FDA writes: "Similar analyses of scenarios that permit MSM who have not had sexual contact with other men in the past 12 months (MSM1) to donate blood have been conducted in Canada by Germain and colleagues and Leiss and colleagues and in the United Kingdom by Soldan and Sinka. All three concluded that added risks were not justified by the increased supply, although the MSM5 scenario remains incompletely evaluated."

I encourage those who are interested to read some of the other studies on this issue, some of which take contrary viewpoints to the above. Personally, it doesn't seem like MSM5 or even MSM1 would represent that much of an additional risk, but I was very surprised at the incredibly small numbers of donors such policies would add to the pool. Finally, I'll note that I wasn't able to find a single study that examined the idea of allowing those who engage in MSM to donate with no deferral period at all. Such a policy would be considerably more risky, as window period effects are essentially eliminated by MSM1 and MSM5, but would be present with our hypothetical MSM0 plan.

I also wasn't able to find any studies on Not Supplied's plan to accept without deferral MSM donors who are regularly "tested and always use condoms." I suspect such a proposal would be difficult to model, as it is hard to know the extent to which people would accurately and honestly answer such questions, nor exactly what their answers mean in terms of infection rates. However, given that the FDA study shows MSM1 would only produce a 0.88% increase in blood donors, the number of new donors that would result from MSM0-WithTestingAndCondoms is likely to be fairly small indeed.
posted by zachlipton at 5:54 AM on March 1, 2010 [5 favorites]


We're kind of talking at cross purposes, at least with what I'm saying. The overall strategy used by the donation service might make sense and they might have crunched the numbers so it works out best over thousands of cases to get the best risk/reward.

I have my personal doubts about it which I can't quite formulate, but whatever.

I accept that people bend the rules...so I'm saying this individual knows to a high degree of certainty that he does not have any STD's - so I think it is ethical for him personally to donate, and anyone who bothers to look into it like him and engage in safe behaviour has put themself in a low risk category which may be hard to test for with questions, but which I would accept as safe.

Young male drivers are the highest insurance risk category, but if you knew someone who practised safe driving, took advanced driving lessons and got their car tested at a good garage would you feel bad about getting in the car with them?
posted by Not Supplied at 6:36 AM on March 1, 2010 [1 favorite]


Also I feel LobsterMitten made a good argument..if there's no shortage why bother, but in the UK at least there has been a blood donor shortage so you could be making a real difference.
posted by Not Supplied at 6:42 AM on March 1, 2010


I donated blood for the first time recently, after misinterpreting the travel restrictions (and dates thereof) that the Red Cross uses to weed out potentially risky people - namely with regards to Mad Cow Disease. The first time I tried to donate blood was about 8 years ago, and sat with a very nice and sympathetic lady who told me that I am borderline ineligible because of their travel restrictions, and that should I donate and be found out, I would be blacklisted from their donor list. I had a lot of "but but buts" for her, and was not content with this.

Now either they changed the restrictions or she was incorrect, because after carefully reading them over again, it turns out I am completely eligible (no lying I swear). But for 8 years, I felt kind of mad at the Red Cross. Not overtly, but I felt hurt that because of some travel as a child, beyond my control, when I appeared to be in excellent health, I was banned from donating blood. It's hard to not take it personally - like I'm banned because I have crazy bovine disease because I MOST CERTAINLY DO NOT HAVE CRAZY BOVINE DISEASE! I'm perfectly fine! Healthy! I have wonderful O+ blood to give! Who the hell is the Red Cross to critique my health status because of some places I went when I was a kid? What kind of dirty sick person did they think I was? I am not a dirty sick person! So not fair!

Now, I am not gay, and I do not pretend to know the frustration you may feel because of being banned from donating because of your sexual history. But I think I do understand that you feel personally hurt. It feels like someone has made a judgment about your personal life, and labeled you as something beyond "normal" and it doesn't feel good. It does feel like a personal attack.

But here's the thing. Donating blood? It's not about you. It's not about your feelings, however valid they are. It is a voluntary act for someone else, to give to someone else, and to help them. Plainly put - it's not about the donor, and it's not about you.

Please do not lie. I agree that it seems like some of the restrictions seem outdated, and it would be GREAT of you to put a stink about it, and rally support for change. But lying is not the way to go. Please remember that your feelings are at best secondary in this - blood donation is not there to make us feel good and charitable and valid, it is primarily to help those in need.
posted by raztaj at 10:02 AM on March 1, 2010 [3 favorites]


I think that continuing to donate blood and lying about your sexual activity is reckless and that you shouldn't do it. And actually I'm kind of shocked at how many people are lying on the intake forms about all sorts of disqualifying activities. I can't donate blood either due to the 5 months I spent in England during the 80s (during which time I never ate beef so I don't know how Mad Cow would even be in issue) but I feel like I need to respect their rules. Maybe I should be working to change their rules but in the mean time, I donate money rather than blood to the Red Cross.
posted by otherwordlyglow at 11:08 AM on March 1, 2010


Public health is not a zero sum game, so you can't do good by donating blood, do a good where they accept gay men; I volunteer for AIDS vaccine research programs. I can never donate blood, even if they lift the current limitations, because it takes multiple expensive tests to validate my blood is actually virus free, but antibody containing.
posted by No1UKnow at 3:30 PM on March 1, 2010


In case anyone is still looking at this thread: Senator Kerry and others are asking that the FDA repeal the regulation banning gay men from donating blood.
posted by onhazier at 12:22 PM on March 4, 2010


In case anyone is still looking at this thread: Senator Kerry and others are asking that the FDA repeal the regulation banning gay men from donating blood.

Uhh.. I made (my first! (attempt)) at an FPP on this, and it was quite promptly and properly swatted down ('cause it really belongs in MetaTalk). Which is to say: If, indeed, anyone is still following this thread, followups, comments, opinions, etc.etc. about the FDA, regulations, the influence of MetaFilter, etc.etc. probably belong here, or at least somewhere on MetaTalk.

Responses directly addressing the OP's question would still belong here, I reckon.
posted by Tuesday After Lunch at 3:38 PM on March 4, 2010


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