Recently, I have seen some controversial posts on social media about how the blood donating system in America is homophobic because men who have sex with men (MSM) are barred from donating blood if they have engaged in anal sex within the last 12 months. This regulation comes from the fact that a significant number of HIV cases are gay and bisexual men. The CDC released that 67% of cases of HIV were of this demographic in 2015. This is due to the high risk that anal sex adds to getting HIV. This is a significant number and I do understand the need to be careful not to contaminate donated blood.
I wouldn’t personally claim that this is homophobic. I do, however, wonder a few things. Since other people that aren’t MSM can still be unaware that they have HIV when they donate, shouldn’t the measures to prevent donated blood giving HIV to others with tests be advanced enough to allow MSM to also donate? Again, the staggering statistic of MSM with HIV does make this regulation validated in my eyes. If we are in such a blood shortage, maybe getting rid of that entire demographic is worse than just being extra careful.
Another thought of mine is if the measures that blood donation centers take to even guarantee they aren’t getting MSM blood are that effective. Donators could be dishonest about how long ago they have engaged in anal sex or when they got tested in relation to that.
There is testing that can detect HIV antigens, antibodies, and the virus itself after certain time intervals. However, no medical test is 100% accurate; over time, most of the HIV tests, the p24 antigen detection test excepted, would gradually become more accurate. (https://qph.fs.quoracdn.net/main-qimg-7d55bdfd2b6dbadade87779a9cf092b8.webp) It is one thing for a doctor to tell a patient that he/she does not have an indication of HIV in an initial sample; however, over time, if the virus had been acquired, there would be more antibodies present, which would be more readily detected later. Why take the risk of infecting those not already infected by accepting samples at 6 months instead of waiting until 12 months after last MSM encounter, when the confidence levels of the tests would be much higher? (http://i-base.info/guides/testing/test-accuracy-results-and-further-testing)
As of 2014, less than 10% of the U.S.’s population has ever had MSM encounters. (https://www.washingtonpost.com/news/speaking-of-science/wp/2016/06/01/study-same-sex-experiences-are-on-the-rise-and-americans-are-increasingly-chill-about-it/) This means that some of this percentage may be eligible to donate, if they have not had MSM encounters in the past year. Even if hypothetically all of the less than 10% are not eligible to donate, if a decent percentage of the remaining 90% of the population that did not ever have MSM encounters are more than able to donate blood. I think the solution to a blood shortage, even in the face of a catastrophe, is greater public education and support for blood donation from the overall population, rather than spending money to screen donations from high-risk populations. I am far from homophobic, but the current guidelines requiring 12 months post-MSM encounter to me seem to make sense based on numbers – both % risk and cost in dollars for additional screening…..?
I did find myself questioning, as I was thinking about this issue, what happens in blood post-donation… i.e. does any virus present continue to reproduce? Does freezing the blood suppress that activity? Additionally, do groups who are prohibited from donating blood based on age, weight, having had tattoos, recent history of cancer treatment etc etc view these guidelines as discriminatory as well?
I wouldn’t say that the 90% of the population who are not MSM are “more than able to donate,” since a third of HIV cases occur in this demographic. The probability of a false negative for HIV tests is also quite low after the first three months post-exposure (https://www.ncbi.nlm.nih.gov/pubmed/25033879). I think the 12 month requirement is excessively long, but I agree that the time limit would be less of a problem if people were more enthusiastic about donating blood.
I’m curious if it’s feasible to test the blood for HIV after donation. I also think testing for HIV at the time of donation could be a good thing just so that more people are getting tested and are aware of their status.
While my high school education included a pretty thorough review of the history around HIV/AIDS and other STDs, I had never heard of the differentiation between M, N, O and P strains of HIV. Also, do all patients who get AIDS first experience the symptoms of acute HIV that we discussed?
Up to four weeks after the initial HIV infection, people may experience those acute, flu-like symptoms that we discussed in class. Since these symptoms are relatively ephemeral (lasting several days to a few weeks), people may dismiss them more readily. But, some people infected with HIV do not show any symptoms at all for 10 years or more (HIV.gov). They may pass through the clinical latency stage, in which the active HIV virus reproduces slowly over time, without symptoms as well. Using my knowledge from this group’s presentation and the supplementary article, the progression to the diagnosis of AIDS often has the most prominent symptoms. Symptoms and illnesses during this stage can result from opportunistic infections that take advantage of the infected person’s weakened immune system. Ultimately, I think that the highly variable nature of HIV calls for an individualistic approach to evaluation, long-term treatment, and care. I hope that helps!
What particularly interested me about HIV is how so many of the methods available to combat it are preventative. I know now that we do have antivirals that can be used as direct treatments for viral infections – such as Tamiflu for influenza – but I also learned about preventative antivirals for HIV in this presentation that come in forms such as vaginal gels. I also read an article about how 80% of new HIV infections come from 40% of the people who are currently infected, nearly half of whom are unaware of their infected status. The U.S. government has plans to increase access to HIV testing and treatment, to help people know if they are affected and to start antiretroviral therapy as fast as possible – another preventative treatment by minimizing the exposure and effect of the virus on people to begin with.
Many STIs such as HPV are relatively harmless. Medicine is cheap, available, and effective, and the symptoms are generally manageable. However, HIV is potentially crippling if not quickly diagnosed, and can remain a hassle for one’s entire life even if it is.
Current laws do not criminalize most sexual deception, even when accounting for STIs. In most cases, it is not feasible to sue on the basis of lying about STIs before sex, but in the case of HIV, the consequences are much harsher. Morally, I would think this type of deception to be deplorable, but the legal situation is obscenely complex. Here is an interesting read on the subject: https://www.hivlawandpolicy.org/fine-print-blog/when-hiv-a-crime-sexuality-gender-and-consent
I learned a lot about HIV/AIDS from this team’s presentation, especially in terms of the different strands. My prior knowledge of HIV consisted of basic information from high school and college biology courses. I also heard stories from media and people who lived in the United States during the 80s. Up until the 90s, getting diagnosed with HIV was unfortunately a death sentence. During the early 80s when HIV started to become a public health issue, people were terrified since not much was known about the disease. Even as scientists discovered more about how the disease, false information about HIV remained, including the notion that HIV is transmitted by touching an infected person. These misinformations lead to a lot of prejudice towards patients and especially the gay community. One article talked about how Princess Diana was one of the public figures that helped to break down these stereotypes by publicly shaking hands with AIDS patients and holding babies with HIV. This shows how important celebrities or political figures are in swaying public opinion, especially for health related issues. Since many infected public figures tried to stay silent during this period to not ruin their careers, Princess Diana took a big step in addressing the societal pressures of HIV/AIDS. I respect the impact she has made. I wonder, however, if sometimes the media actually does more harm than good when it comes to delivering information about health.
I think a very important development in the treatment and prevention of HIV is the prevention of mother-to-child transmission. As stated in the presentation, the chance of transmission can be lowered to 1% with treatment. Thus, being tested for HIV and other STI’s is one of the most important ways of preventing the spread, whether to a partner or to a child. The CDC recommends HIV testing as a part of prenatal care, yet I believe that this testing should be made mandatory. Currently, the HIV testing is offered with an option to opt-out. There are large limitations on access to HIV testing and treatment depending on socioeconomic status. Access to health care and sex education put those in poverty at a disadvantage, which is why I believe sources such as Planned Parenthood play an important role in aiding those unknowingly or knowingly living with HIV or other STI’s. (https://www.cdc.gov/hiv/group/gender/pregnantwomen/index.html)
In regards to the legality of informing a previous or current partner of your HIV status, I believe that testing centers should make it mandatory to inform those that are potentially infected. Passing laws and regulations regarding this issue would allow those that may be affected to immediately pursue treatment options.
It would have been nice if there was more discussion of the social impact of HIV. The presenters mentioned how it was more common in the gay community, but carefully avoided words such as “gay” or “LGBT” and didn’t really say much more on the matter. When President Stanley spoke afterwards, he did talk a bit about how AIDS wasn’t known to be caused by a virus at first and people thought it might be a lifestyle disease, but it still felt very much like tiptoeing around the point. The Reagan-led US government didn’t care so much about the AIDS crisis because they saw it was mostly affecting gays and they were very right-wing. The disease devastated the gay community and really became focused on in wider society only when middle/upper straight people started to get infected in larger numbers. This is relevant information, and I get that the presentation was more focused on the biology of it but I’m less than thrilled at how thoroughly it was left out.
I was surprised about how HIV is relatively new disease only appearing a few decades ago. Meanwhile, it has caused so much devastation across the globe. I believe it is the most dangerous disease we have talked about so far because it makes you susceptible to many other diseases that you would otherwise be protected of. Even though it wasn’t discussed as much, HIV/AIDS did start a very prominent social movement. People knew when a celebrity had HIV/AIDS such as Magic Johnson and Freddie Mercury. Unfortunately, it did cause fear against gay men when it came to donating blood. Even though the HIV rate is higher amongst them, it’s tragic to think that this stereotype arose causing people to think there is something physically wrong with gay men.
I found the opposing treatments strategies for HIV and Tuberculosis interesting. These two infectious diseases are almost complementary, with Tuberculosis remaining the leading cause of death for individuals with AIDS, as the mycobacterium attacks the weekend immune system. However, the strategy for defeating TB involves containment, where comparatively smaller epidemics with lower numbers if infected individuals are treated first to contain spreading. Opposingly, the strategy for eradicating HIV involves treating the areas of higher infection instances first. I found this interesting, as the mode of transmission determines treatment strategy. For aids, it is rarely transmitted through accidental contact, so the solution involves awareness and precautionary measures. TB, on the other hand, is easily transmitted as an airborne pathogen forcing infectious disease specialists to focus on containment.
The presentation was interesting as it explained how HIV infects hosts, and how treatments such as antiretroviral therapy have been developed to mitigate the compromising of the immune system and to prolong and increase the quality of the life of patients who may suffer from HIV/AIDS. It was also interesting to learn that two people have been cured of AIDS through their cancer treatments, even through it is not a viable treatment option.
One thing that I tried to find out was about extracellular vesicles and their impact on HIV/AIDS. This was also mentioned in the third Honors College Faculty Roundtable last semester. It seems that host extracellular vesicles have a dual role in the spread of HIV, with the following factors facilitating and inhibiting infection by HIV:
Inhibiting:
1. Extracellular vesicles from CD4+ cells may inhibit infection by binding to the CD4 molecules on the virus
2. Extracellular vesicles from CD4+ and CD8+ as well as from fluids such as breast milk or semen carry molecules such as A3G and CAF to restrict replication of HIV
3. Extracellular vesicles may compete with HIV and prevent it from binding to T-Cells
Facilitating:
1. Camouflaging HIV due to physical association
2. Transfer of HIV components to host cells
Maybe interesting developments may come in the future with extracellular vesicles to learn more about HIV and possibly develop better treatments or a more comprehensive cure.
Recently, I have seen some controversial posts on social media about how the blood donating system in America is homophobic because men who have sex with men (MSM) are barred from donating blood if they have engaged in anal sex within the last 12 months. This regulation comes from the fact that a significant number of HIV cases are gay and bisexual men. The CDC released that 67% of cases of HIV were of this demographic in 2015. This is due to the high risk that anal sex adds to getting HIV. This is a significant number and I do understand the need to be careful not to contaminate donated blood.
I wouldn’t personally claim that this is homophobic. I do, however, wonder a few things. Since other people that aren’t MSM can still be unaware that they have HIV when they donate, shouldn’t the measures to prevent donated blood giving HIV to others with tests be advanced enough to allow MSM to also donate? Again, the staggering statistic of MSM with HIV does make this regulation validated in my eyes. If we are in such a blood shortage, maybe getting rid of that entire demographic is worse than just being extra careful.
Another thought of mine is if the measures that blood donation centers take to even guarantee they aren’t getting MSM blood are that effective. Donators could be dishonest about how long ago they have engaged in anal sex or when they got tested in relation to that.
There is testing that can detect HIV antigens, antibodies, and the virus itself after certain time intervals. However, no medical test is 100% accurate; over time, most of the HIV tests, the p24 antigen detection test excepted, would gradually become more accurate. (https://qph.fs.quoracdn.net/main-qimg-7d55bdfd2b6dbadade87779a9cf092b8.webp) It is one thing for a doctor to tell a patient that he/she does not have an indication of HIV in an initial sample; however, over time, if the virus had been acquired, there would be more antibodies present, which would be more readily detected later. Why take the risk of infecting those not already infected by accepting samples at 6 months instead of waiting until 12 months after last MSM encounter, when the confidence levels of the tests would be much higher? (http://i-base.info/guides/testing/test-accuracy-results-and-further-testing)
As of 2014, less than 10% of the U.S.’s population has ever had MSM encounters. (https://www.washingtonpost.com/news/speaking-of-science/wp/2016/06/01/study-same-sex-experiences-are-on-the-rise-and-americans-are-increasingly-chill-about-it/) This means that some of this percentage may be eligible to donate, if they have not had MSM encounters in the past year. Even if hypothetically all of the less than 10% are not eligible to donate, if a decent percentage of the remaining 90% of the population that did not ever have MSM encounters are more than able to donate blood. I think the solution to a blood shortage, even in the face of a catastrophe, is greater public education and support for blood donation from the overall population, rather than spending money to screen donations from high-risk populations. I am far from homophobic, but the current guidelines requiring 12 months post-MSM encounter to me seem to make sense based on numbers – both % risk and cost in dollars for additional screening…..?
I did find myself questioning, as I was thinking about this issue, what happens in blood post-donation… i.e. does any virus present continue to reproduce? Does freezing the blood suppress that activity? Additionally, do groups who are prohibited from donating blood based on age, weight, having had tattoos, recent history of cancer treatment etc etc view these guidelines as discriminatory as well?
I wouldn’t say that the 90% of the population who are not MSM are “more than able to donate,” since a third of HIV cases occur in this demographic. The probability of a false negative for HIV tests is also quite low after the first three months post-exposure (https://www.ncbi.nlm.nih.gov/pubmed/25033879). I think the 12 month requirement is excessively long, but I agree that the time limit would be less of a problem if people were more enthusiastic about donating blood.
I’m curious if it’s feasible to test the blood for HIV after donation. I also think testing for HIV at the time of donation could be a good thing just so that more people are getting tested and are aware of their status.
While my high school education included a pretty thorough review of the history around HIV/AIDS and other STDs, I had never heard of the differentiation between M, N, O and P strains of HIV. Also, do all patients who get AIDS first experience the symptoms of acute HIV that we discussed?
Hey Charlie,
Up to four weeks after the initial HIV infection, people may experience those acute, flu-like symptoms that we discussed in class. Since these symptoms are relatively ephemeral (lasting several days to a few weeks), people may dismiss them more readily. But, some people infected with HIV do not show any symptoms at all for 10 years or more (HIV.gov). They may pass through the clinical latency stage, in which the active HIV virus reproduces slowly over time, without symptoms as well. Using my knowledge from this group’s presentation and the supplementary article, the progression to the diagnosis of AIDS often has the most prominent symptoms. Symptoms and illnesses during this stage can result from opportunistic infections that take advantage of the infected person’s weakened immune system. Ultimately, I think that the highly variable nature of HIV calls for an individualistic approach to evaluation, long-term treatment, and care. I hope that helps!
Source: https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/symptoms-of-hiv
What particularly interested me about HIV is how so many of the methods available to combat it are preventative. I know now that we do have antivirals that can be used as direct treatments for viral infections – such as Tamiflu for influenza – but I also learned about preventative antivirals for HIV in this presentation that come in forms such as vaginal gels. I also read an article about how 80% of new HIV infections come from 40% of the people who are currently infected, nearly half of whom are unaware of their infected status. The U.S. government has plans to increase access to HIV testing and treatment, to help people know if they are affected and to start antiretroviral therapy as fast as possible – another preventative treatment by minimizing the exposure and effect of the virus on people to begin with.
The article mentioned above, for those interested: https://www.cnn.com/2019/03/18/health/hiv-reduce-infections-hhs-cdc-bn/index.html
Many STIs such as HPV are relatively harmless. Medicine is cheap, available, and effective, and the symptoms are generally manageable. However, HIV is potentially crippling if not quickly diagnosed, and can remain a hassle for one’s entire life even if it is.
Current laws do not criminalize most sexual deception, even when accounting for STIs. In most cases, it is not feasible to sue on the basis of lying about STIs before sex, but in the case of HIV, the consequences are much harsher. Morally, I would think this type of deception to be deplorable, but the legal situation is obscenely complex. Here is an interesting read on the subject: https://www.hivlawandpolicy.org/fine-print-blog/when-hiv-a-crime-sexuality-gender-and-consent
I learned a lot about HIV/AIDS from this team’s presentation, especially in terms of the different strands. My prior knowledge of HIV consisted of basic information from high school and college biology courses. I also heard stories from media and people who lived in the United States during the 80s. Up until the 90s, getting diagnosed with HIV was unfortunately a death sentence. During the early 80s when HIV started to become a public health issue, people were terrified since not much was known about the disease. Even as scientists discovered more about how the disease, false information about HIV remained, including the notion that HIV is transmitted by touching an infected person. These misinformations lead to a lot of prejudice towards patients and especially the gay community. One article talked about how Princess Diana was one of the public figures that helped to break down these stereotypes by publicly shaking hands with AIDS patients and holding babies with HIV. This shows how important celebrities or political figures are in swaying public opinion, especially for health related issues. Since many infected public figures tried to stay silent during this period to not ruin their careers, Princess Diana took a big step in addressing the societal pressures of HIV/AIDS. I respect the impact she has made. I wonder, however, if sometimes the media actually does more harm than good when it comes to delivering information about health.
This is the article: https://medium.com/queer-history-for-the-people/lady-di-destroys-aids-stigma-a631e2c67f2c
I think a very important development in the treatment and prevention of HIV is the prevention of mother-to-child transmission. As stated in the presentation, the chance of transmission can be lowered to 1% with treatment. Thus, being tested for HIV and other STI’s is one of the most important ways of preventing the spread, whether to a partner or to a child. The CDC recommends HIV testing as a part of prenatal care, yet I believe that this testing should be made mandatory. Currently, the HIV testing is offered with an option to opt-out. There are large limitations on access to HIV testing and treatment depending on socioeconomic status. Access to health care and sex education put those in poverty at a disadvantage, which is why I believe sources such as Planned Parenthood play an important role in aiding those unknowingly or knowingly living with HIV or other STI’s. (https://www.cdc.gov/hiv/group/gender/pregnantwomen/index.html)
In regards to the legality of informing a previous or current partner of your HIV status, I believe that testing centers should make it mandatory to inform those that are potentially infected. Passing laws and regulations regarding this issue would allow those that may be affected to immediately pursue treatment options.
It would have been nice if there was more discussion of the social impact of HIV. The presenters mentioned how it was more common in the gay community, but carefully avoided words such as “gay” or “LGBT” and didn’t really say much more on the matter. When President Stanley spoke afterwards, he did talk a bit about how AIDS wasn’t known to be caused by a virus at first and people thought it might be a lifestyle disease, but it still felt very much like tiptoeing around the point. The Reagan-led US government didn’t care so much about the AIDS crisis because they saw it was mostly affecting gays and they were very right-wing. The disease devastated the gay community and really became focused on in wider society only when middle/upper straight people started to get infected in larger numbers. This is relevant information, and I get that the presentation was more focused on the biology of it but I’m less than thrilled at how thoroughly it was left out.
I was surprised about how HIV is relatively new disease only appearing a few decades ago. Meanwhile, it has caused so much devastation across the globe. I believe it is the most dangerous disease we have talked about so far because it makes you susceptible to many other diseases that you would otherwise be protected of. Even though it wasn’t discussed as much, HIV/AIDS did start a very prominent social movement. People knew when a celebrity had HIV/AIDS such as Magic Johnson and Freddie Mercury. Unfortunately, it did cause fear against gay men when it came to donating blood. Even though the HIV rate is higher amongst them, it’s tragic to think that this stereotype arose causing people to think there is something physically wrong with gay men.
I found the opposing treatments strategies for HIV and Tuberculosis interesting. These two infectious diseases are almost complementary, with Tuberculosis remaining the leading cause of death for individuals with AIDS, as the mycobacterium attacks the weekend immune system. However, the strategy for defeating TB involves containment, where comparatively smaller epidemics with lower numbers if infected individuals are treated first to contain spreading. Opposingly, the strategy for eradicating HIV involves treating the areas of higher infection instances first. I found this interesting, as the mode of transmission determines treatment strategy. For aids, it is rarely transmitted through accidental contact, so the solution involves awareness and precautionary measures. TB, on the other hand, is easily transmitted as an airborne pathogen forcing infectious disease specialists to focus on containment.
The presentation was interesting as it explained how HIV infects hosts, and how treatments such as antiretroviral therapy have been developed to mitigate the compromising of the immune system and to prolong and increase the quality of the life of patients who may suffer from HIV/AIDS. It was also interesting to learn that two people have been cured of AIDS through their cancer treatments, even through it is not a viable treatment option.
One thing that I tried to find out was about extracellular vesicles and their impact on HIV/AIDS. This was also mentioned in the third Honors College Faculty Roundtable last semester. It seems that host extracellular vesicles have a dual role in the spread of HIV, with the following factors facilitating and inhibiting infection by HIV:
Inhibiting:
1. Extracellular vesicles from CD4+ cells may inhibit infection by binding to the CD4 molecules on the virus
2. Extracellular vesicles from CD4+ and CD8+ as well as from fluids such as breast milk or semen carry molecules such as A3G and CAF to restrict replication of HIV
3. Extracellular vesicles may compete with HIV and prevent it from binding to T-Cells
Facilitating:
1. Camouflaging HIV due to physical association
2. Transfer of HIV components to host cells
This is the article from which I obtained the above information:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191503/.
Maybe interesting developments may come in the future with extracellular vesicles to learn more about HIV and possibly develop better treatments or a more comprehensive cure.