Gay Marriage (and other Rights) in the U.S: Don't weary about it

[Xantavia]

I stopped giving blood years ago due to getting into tattoos and piercings. At the time, I wasn't allowed to donate because I had had some work done X amount of time ago. Never once did it cross it my mind that I was being discriminated against. I understood there were certain things that was considered risky behavior that made me ineligible. I'm not saying its right to not accept blood from a gay man, but it is done in the spirit of safety.

[kuronosan]

So you can't prove you're right because the regulations are confidential and we'll have to take your word for it?

Do you at least know the name and label of the regulation that says only antibody tests are required ?

Procedures are confidential. Regulations are posted here:

http://www.fda.gov/BiologicsBloodVac.../ucm151757.htm

If that doesn't clear it up, the tl;Dr of that says "EIA *or* PCR" for screening, not "OMGPCRONRY".

If the screen is negative, you are not required to test for RNA.

I can see the confusion because of how it's written, but it basically says "these tests are required, and here's the tests you can do".

The SOP for each lab varies, but it generally goes "do the 1/2 Ab and if it's positive, confirm with PCR".

What I'm confused about is what your issue is. I support gay donors. All I've been doing is having to justify statement after statement while you try to hole-punch. No, I don't have sympathy for your plight as a gay donor when people like me, regardless of sexuality, are deferred permanently just because of where you were raised.

Be happy there's even an option to test for HIV.

They don't even do prion testing for BSE.

[Psion]

I think the issue is that it singles out people for being gay, rather than targeting the high risk behavior (anal sex). If it was a year ban for ::anyone:: who had anal sex in the last year, it might be easier to swallow, but instead it singles out gay men as excluded.

[Restrat]

until molecular scientists share their PCR recipes and make it easy for all laboratories to get their hands on it for testing, that's the way it is.

I'm a little confused about this part... I can go to any number of government/educational databases and get the sequence for the HIV virus, design primers, and order them for under $15. Even less when I worked in a large lab that had a good deal with one of the companies. Is there some secret HIV test or primers that hospitals and lab companies are keeping from the broader healthcare community?

[kuronosan]

I'm a little confused about this part... I can go to any number of government/educational databases and get the sequence for the HIV virus, design primers, and order them for under $15. Even less when I worked in a large lab that had a good deal with one of the companies. Is there some secret HIV test or primers that hospitals and lab companies are keeping secret?

It doesn't have to be regulated by the FDA if it's a "home-cooked" (in-house) recipe. Tons of molecular labs do this.

The downside is the scientist running that test needs to have research data proving its effectiveness. It's one of the many changes the medical field wants to enact. Also, it allows the scientist in question to charge whatever they want and pass injunctions or file lawsuits if someone is caught using their sequence.

Yea, there are standard primers. Through research, you can develop more specific or sensitive primers that work better than those. It's a selling point more than anything else. If you're not a hospital, why should people send things to you?

Because your test is 95% accurate instead of 92% or has a PPO of 90% instead of 80%. For some people, that's a significant difference.

It's far cheaper to develop and use your own stuff than buy it, and from a business perspective is why things are as they are. When you're talking about buying $15 primers that's all good but if you're doing thousands of tests a month how many are you going to buy? How many are going to fail to sequence and will need to be repeated? How many will fail to recombine?

There are more factors at play that shouldn't be. That's what I said at the beginning. Buttsex, homosexuality, or any reason the FDA has for their decision is stupid. But, the risk factors are entirely different and shouldn't be ignored. Kuya admittedly lied about his donor status (and I have no reason to believe he's HIV+), a very dangerous thing to encourage, and then proceeded to strawman an argument I'm still trying to figure out.

All I'm doing is pointing out facts from experience and knowledge. I've nothing to gain from arguing the point for myself. I'm in it for the patients.

[Salodin]

I think the issue is that it singles out people for being gay, rather than targeting the high risk behavior (anal sex). If it was a year ban for ::anyone:: who had anal sex in the last year, it might be easier to swallow, but instead it singles out gay men as excluded.

Last I donated, the question was "if a male, have you have intercourse with some one of the same sex?"

Considering the question, no this does not target gays over just high risk behavior.

[kuronosan]

I think the issue is that it singles out people for being gay, rather than targeting the high risk behavior (anal sex). If it was a year ban for ::anyone:: who had anal sex in the last year, it might be easier to swallow, but instead it singles out gay men as excluded.

And that's the part (of the FDA's announcement) I don't agree with. Why this has turned from that point into how the FDA relates infectious testing is beyond me. His argument seemed to be that it's okay because they test every single unit using NAT, but that's not true.

That does not mean I think they shouldn't, or that I think gay people aren't being targeted, or that I think anal sex is the highest risk factor (far from it). But unless you're practicing clean or proper anal sex whether you're gay or straight you are at risk for infection of any kind because of the nature of mucous membranes. Higher risk than needles? Well, no.

I don't understand what the connection is between how the FDA regulates testing and his point. Right now I don't feel like he has one and is just arguing whatever he feels is anti-gay.

[Kuya]

Procedures are confidential. Regulations are posted here:

http://www.fda.gov/BiologicsBloodVac.../ucm151757.htm

If that doesn't clear it up, the tl;Dr of that says "EIA *or* PCR" for screening, not "OMGPCRONRY".

If the screen is negative, you are not required to test for RNA.

I can see the confusion because of how it's written, but it basically says "these tests are required, and here's the tests you can do".

The SOP for each lab varies, but it generally goes "do the 1/2 Ab and if it's positive, confirm with PCR".

What I'm confused about is what your issue is. I support gay donors. All I've been doing is having to justify statement after statement while you try to hole-punch. No, I don't have sympathy for your plight as a gay donor when people like me, regardless of sexuality, are deferred permanently just because of where you were raised.

Be happy there's even an option to test for HIV.

They don't even do prion testing for BSE.

I'm perfectly willing to admit if i'm wrong about RNA tests, but here's the problem:

Using the same link you provided:

HIV, type 1 (FDA-licensed screening test either for anti-HIV-1 or combination test for anti-HIV-1 and anti-HIV-2; and FDA-licensed screening NAT test for HIV-1, or combination NAT that includes HIV-1) (establishments not utilizing an FDA-licensed screening test that tests for group O antibodies must evaluate donors for risk associated with HIV group O infection);

Look at the "and" I bolded. It says anti-HIV and NAT. This paragraph only ever uses "or" when referring to anti-HIV-1 or combination test for anti-HIV-1 and anti-HIV-2.

Was this the paragraph you were referring to? You yourself admitted it wasn't clear. Isn't there anything where the FDA unequivocally says antibody test OR NAT test?

edit: underlined where it says either/or

[kuronosan]

This argument is just going to keep going because you're too determined to be right to listen.

I explained it. If it's not good enough then just say so. Stop asking for clarification and then casting it aside when it doesn't fit your agenda.

Edit: I apologize. I understand where you're coming from Kuya. Unfortunately it just isn't that clear. I'm trying my best to explain it as it works in the field.

I stand by my point, however. If that's not good enough I don't know what else to say. I know my job. That's the best I can give you without breaking the law or getting fired.

[Kuya]

For the benefit of people who are reading this thread, and responding to Kuro's confusion on how we got to discuss RNA testing, i'll provide a summary:

The position of some gay and bisexual men including myself: The FDA's ban on gay and bisexual men donating simply on the basis of their sexual orientation as opposed to specific behavior is discriminatory and unnecessary and perpetuates HIV stigma. The one year ban is still unreasonable since it makes no distinction between monogamous gay and bisexual men and those who engage in sex with multiple partners. It also doesn't ask about the use of condoms. I contend that the one year ban is still unnecessary.

Priran made a flippant comment about this position:

On the other hand it hurt some people's feelings so you can really see how it forced their hand.

Seemingly trying to say that bisexual and gay men have no foundation on which to denounce the FDA's ban as unnecessary.

I accused him of not having looked into the position that gay and bisexual men are advocating. He never acknowledged whether this was true. I proceeded to post a study to show that gay and bisexual men who are challenging the one year ban have scientific evidence behind their claims:

Now, for the benefit of people who genuinely want to know if the grievance gay and bisexual men have has some basis:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3729137/


The IRA policy in more detail:

The first time Priran responded to the study, he claimed that just because it works in Italy, it doesn't mean it works in America:

Your anecdotal point reached from one point of data is shit because it establishes that there are valid reasons for banning people out of blood donation including factors under the umbrella of "high HIV risk", but does not provide enough demographic data to say that just because in Italy you can ban out everyone at unacceptable risk of HIV infection without resorting to whether or not somebody's had gay anal sex, that you can do the same thing in America. There is a need for screening and which metrics are useful is going to vary with the population considered.

And I dunno, you might. Get as indignant as you want about my not caring enough about your feelings to tiptoe around the fact that your behavior pattern might result in you donating contaminated blood, being offended isn't some nuclear option to win an argument.

I told him it would be more productive if he could be more specific on why he thinks it wouldn't work in America:

I didn't understand the first part of your post. It's not quite clear to me whether you are addressing the study I posted regarding blood donation policy in Italy.

I think what you meant to say was: While studies in Italy might show that a blood donation policy based on individual risk assessment rather than blanket bans on gay and bisexual men has not shown a higher incidence of HIV infection via blood donations, you still object to the applicability of the policy in America because of population differences. I think this is what you were trying to say. If that is the case, this sort of argument is used all the time when discussing policy from other countries being brought to a different country. The key here is if you're just going to use this argument as a shield to prevent changing blood donation policy into a more rational policy, or if you're genuinely interested in finding ways to adapt the Italy policy into a successful American one.

Of course, the difference is the former doesn't care what gay and bisexual men have to say and the latter is genuinely interested in attending the grievance this group is trying to make. The latter is constructive criticism as opposed to pure obstructionism.

I suspect you are the former, but you have a chance to prove me wrong in this thread. Do you have any ideas on how we can adopt Italy's policy into the USA successfully? Do you have specific concerns on the applicability of this policy and how we could overcome them?

Finally, being offended isn't a nuclear option for winning arguments. But being empathetic enough to hear why people are offended and looking to see if these offenses have an empirical and logical basis because you care to find out is what an empathetic person does. A non empathetic person, merely relies on his pre conceived notions to arrive at early conclusions without regard for the concerns of others.

In the next post Priran made, he ignored my request. This is when Kuro first responded to me with something. His argument was if it's only discrimination when you aim the ban at gay people or is it discrimination when done to other groups:

So if giving blood was statistically higher on probability to cause death or sickness in a population is it discrimination or only when homosexuals are the ones who fit the description?

Serious question. I can't even give blood because I lived in Europe. Banned for life, just for not being born in America.

And you think it's discrimination?

Yea, buttsex is a bullshit reason but there are far bigger bullshit reasons.

I told Kuro that just because other people might be discriminated when donating blood doesn't mean gay and bisexual men aren't justified in contesting the blood ban, nor does it mean they don't have a basis for doing so. I also asked him if he disagreed with the research I posted:

Do you want to contest the ban on people who've traveled to Europe? Go right ahead. I'm not going to stop you. Now, please try not to use that as a reason why gay and bisexual men shouldn't think the ban on them donating blood is unfair and unjustified.

Did you disagree with the research I posted?

Kuro did not directly address my reply, but instead made this post:

I swear to god anyone with the slightest victim complex has to paint any contesting statement as fervently evil.

Was he saying I have a victim complex? Was he saying i was painting him at fervently evil? I dunno.

Priran came back to make another snap without addressing the study again:

I wasn't saying anything that general, I was talking specifically about you. I'm pointing how hypocritical your risk assessment is between risks posed by others to you (people cheat [or whatever your rationale is], so you wear condoms when having sex with your only partner so you don't get HIV) and by you to others (the idea that gay men are at risk of having HIV is 30-year old hysteria, so you lie to screeners so you can donate blood).

I then proceeded to call him out again for not responding to my request for comment on the study itself.

He then responded and said:

I didn't refuse to address your point, I addressed it and then refused to enable your deflection into an argument about my motives. If you have any evidence that just IV drug use+prostitution covers the bases for high HIV risk in the US as well as it does in Italy I'd be interested in seeing it, but until then I'm still opposed to basing these kinds of decisions on political pressure. GMOs upset a lot of Americans, and European policies about those are fucking stupid too.

I corrected him and told him Italy's policy also classifies certain MSM behavior as high risk. He replied:

I didn't miss those parts, it's just giving a 4 month deferment for an infection with a potentially 6 month incubation period. It shouldn't require explanation about why that's stupid and those lines can be generally understood to, in practice, be in place to screen out Hep B and C, which both have incubation periods of about 2 months.

I corrected him and told him 4 months deferment is for "at risk" groups and permanent deferment is for "high risk" groups. I also added this:

Oh, I almost forgot.

While it might take at most 6 months to detect HIV in rare cases via antibody tests, the FDA also requires RNA testing to confirm donated blood is HIV negative. RNA testing can detect HIV in blood after 10 days from initial infection:



http://www.cdc.gov/hiv/basics/testing.html



https://www.aids.gov/hiv-aids-basics...rgan-donation/



http://www.fda.gov/BiologicsBloodVac.../ucm074934.htm

Priran then proceeded to argue that people lie, questioned what permanent deferal means, and questioned that the FDA does not require RNA testing but rather recommends it according to what I posted. This is when the RNA argument started and when Kuro replied to me with this:

That's great. I specialize in immunochemistry testing, hematology, and immunohematology. No lab will do RNA PCR testing unless the screen is positive or there is sufficient reason to believe it will be positive. There is a whole world of paperwork and liability to take into account with state and federal-reported diseases. If it's positive, it better stay positive.

Blood products require a prescription, a and thus require FDA approval and certification. Since blood has a maximum shelf life of anywhere from 2-5 weeks, it would simply cost too much time and money to collect blood that could potentially be discarded before they can even test or get test results on high risk factors.

So yea, keep complaining to someone who's perfectly healthy and deferred for life for being born in the wrong country at the wrong time. I know my job. Buttsex is a bullshit reason, as I said, but don't mistake that for an illogical one. Working in health care I can tell you that eliminating ANY risk, even those less than 10%, is a top priority.

Now that isn't to say homosexuals have a higher incidence of STDs because of their lifestyle, but please don't call this discrimination. It's precautionary. Unless you've seen what tainted or reactive blood can do to someone, you have no room to talk.

I ignored his post because i didn't know what he was going on about. I then replied to Priran showing him that the CDC and Aids.gov say that RNA testing is required, even if the FDA only says recommend.

Priran claimed I should address kuro's post, and kuro replied to me again saying:

Of course donor blood is required to be tested.

But you don't do this for a living. I do.

I then asked Kuro to clarify what his argument was and he said:

Because the CDC isn't the governing body for Blood Products. The FDA is.

Considering my laboratory and all laboratories that deal with blood products are certified and inspected annually by the FDA and you're just some guy googling stuff on the internet I think that's reason enough.

But please, by all means, continue your crusade.

There are circumstances where HIV testing, specifically PCR, is called for. A negative ELISA or IFA, which is the screening test, is not one of those times.

But hey, what the heck do I know?

Source: Certified by the FD-fucking-A.

His argument is RNA testing donated blood is not required unless it tests positive on antibody tests. I then posted an FDA document that gain, says they recommend RNA testing negative blood and that they do not recommend testing positive blood, the opposite of what Kuro is saying.

Kuro god mad, came back and said:

The FDA provides two documents: recommendations and regulations.

The regulations only require EIA testing because it can be tested on plasma and detects antibody to HIV. White cells are absent (or nearly so) in donor blood, so HIV cannot grow. If the screen is negative, you aren't REQUIRED to RNA test (which isn't to say labs don't, most don't) because there likely won't be detectable levels of RNA or DNA, and HIV cannot replicate without host cells so it won't be growing anytime soon.

The other set is FDA recommended guidelines, which is what Kuya keeps posting. They're guidelines that, when a hospital or laboratory can afford to abide by them, they usually do. Since most molecular testing is in-house only and blood banks are typically local, it's usually not financially feasible (or logical) to send a segment of blood for PCR on the 0.05% chance you picked a segment that may or may not have a few hundred bases present if the screen is negative and donor has no risk factors.

Now, I'm not saying it should be this way. Unfortunately, until molecular scientists share their PCR recipes and make it easy for all laboratories to get their hands on it for testing, that's the way it is.

You don't have to listen to me, and that's fine. Post whatever documents you want and question what you will. But please don't ask for an explanation and when you get one that demonstrates why you're wrong, continue to post the same stupid documents over and over.

Laboratories are heavily regulated by at least 3-4 agencies and multiple laws. If I don't know them intimately my laboratory (and dozens of others) could face closure for non-compliance.

Considering my laboratory also has a blood bank, it would be VERY stupid of me to not know the procedures for collection and donation. I've been through this dozens of times. We've passed FDA inspection and accreditation every year.

So either my bosses bribe federal officials to ignore potentially fatal flaws in our processes, which could kill patients, or you'll have to take my word for it.

He posted a link to an FDA regulation and I am questioning that the link says Anti-HIV AND NAT.

Kuro is currently questioning what my issue is despite the fact that he is the one who initially began replying to me, despite the fact that i ignored him at least once:

What I'm confused about is what your issue is. I support gay donors. All I've been doing is having to justify statement after statement while you try to hole-punch. No, I don't have sympathy for your plight as a gay donor when people like me, regardless of sexuality, are deferred permanently just because of where you were raised.

Why this has turned from that point into how the FDA relates infectious testing is beyond me. His argument seemed to be that it's okay because they test every single unit using NAT, but that's not true.

...

I don't understand what the connection is between how the FDA regulates testing and his point. Right now I don't feel like he has one and is just arguing whatever he feels is anti-gay.

I posted this summary to remind him that we are arguing NAT because I said all donated blood has to be RNA tested and he claims otherwise. I also posted it to remind him that he is the one who first contested my claim (well, after Priran) and replied to me and thus began the argument we are currently engaged in. I also made this summary to remind him what NAT testing has to do with my whole argument.

Hopefully you all find this summary useful, and Kuro will stop being confused.

[Kuya]

This argument is just going to keep going because you're too determined to be right to listen.

I explained it. If it's not good enough then just say so. Stop asking for clarification and then casting it aside when it doesn't fit your agenda.

Edit: I apologize. I understand where you're coming from Kuya. Unfortunately it just isn't that clear. I'm trying my best to explain it as it works in the field.

I stand by my point, however. If that's not good enough I don't know what else to say. I know my job. That's the best I can give you without breaking the law or getting fired.

It's fine. I suspect you are probably right, but I'll see if i can find another way to confirm it.

[kuronosan]

I also wasn't trying to say you were directly victimizing. Only that I don't like it when people are offended by something therefore "discrimination".

Like I said. Try being told you can't donate because you were born in Africa and might transmit Ebola. Clearly if you could you would die or have symptoms, right?

It's a shitty reason, having gay males deferred for something they obviously have done. Sure. It's still a risk factor, and one that is easily ruled out.

Mine is not, and neither is that of millions just like me. Whether you're gay or not, if you were born or raised in Europe during the 80s you can never donate. Ever.

[Kuya]

People can be offended by something, it can also be discrimination, and they can also have a point. All 3 can happen independently, and all 3 can also coincide in one issue. My argument has been that despite the fact that the ban is offensive and discriminatory (not all discrimination is necessarily bad), gay and bisexual men do have a sound basis for questioning the life time or one year ban, as I have been trying to do this whole time.

My argument, which I hope everyone has understood, has not been to say that the one year or lifetime ban is discriminatory or offensive. My argument has been to go farther than that and show that there is an alternative to the one year ban that gay and bisexual men can be satisfied with that can also be just as effective in avoiding HIV contaminated blood.

[Priran]

I think the most interesting part of this thread is how you can both qualify and quantify kuya's ego. The former from his insistent google-sourced arguments that a professional in a field is wrong about his own job, and the latter by how many posts can go by before the argument starts getting away from him and he needs to make a giant post trying to reframe recap it for his own benefit anybody reading.

[BaneTheBrawler]

I think the most interesting part is how Kuya and Kuro have been having a civil discussion and you keep trying to poke and prod Kuya into something I'll infract.

Stop it.

[Salodin]

My favorite part of this thread is when we assume gay and bisexual men don't have intercourse in a way that the FDA considers high risk.

Kuya, are you willing to concede that when we say a gay or bisexual man is having relations with the same sex, we're talking about sexual behavior that is already considered high risk, e.g.: anal sex.

[Priran]

I think the most interesting part is how Kuya and Kuro have been having a civil discussion and you keep trying to poke and prod Kuya into something I'll infract.

Stop it.

Stick to modding things that actually happen, thought policing doesn't really work until you can read minds accurately.

[Kuya]

My favorite part of this thread is when we assume gay and bisexual men don't have intercourse in a way that the FDA considers high risk.

Kuya, are you willing to concede that when we say a gay or bisexual man is having relations with the same sex, we're talking about sexual behavior that is already considered high risk, e.g.: anal sex.

That takes for granted that two men only engage in anal sex as a form of sexual activity and that both the receiving and the penetrating partner have equal risks in contracting HIV.

[hey]

My favorite part of this thread is when we assume gay and bisexual men don't have intercourse in a way that the FDA considers high risk.

Kuya, are you willing to concede that when we say a gay or bisexual man is having relations with the same sex, we're talking about sexual behavior that is already considered high risk, e.g.: anal sex.

They don't women if they've had anal sex though, so clearly there's more to it.

[Salodin]

So you'd be ok with a question that asks whether a man pitches or catches rather then the ambiguous "have you had any male partners" question.

All this talk about rna testing is irrelevant. Gay and bisexual men are statistically more likely to be HIV positive; enough so that companies would rather not risk or take the time to go through all the tests needed to make sure their blood is free of the virus. This is not discrimination, this is economics. You really think these companies don't want your blood? Do you have any idea how much money they make on blood practically given to them for free?