Screening Blood Donors

The death in San Francisco of a 66-year-old nun who got AIDS from a blood transfusion underscores the threat that the deadly disease presents to public health. The nun’s death will increase pressure to approve and put into use a new test that screens blood for a possible link to AIDS. The state Legislature is on the verge of passing legislation that would require blood screening for AIDS throughout California. But there are important issues of ethics and privacy that should not be swept aside in the haste to eliminate AIDS from the blood supply. Society should think carefully about how to implement a test that could identify gay men, who account for 75% of the 8,215 AIDS cases to date, and expose them to social, economic or medical discrimination.

The first thing to consider is that the test, which is expected to be approved shortly by the federal Food and Drug Administration, is not a predictor of AIDS. It indicates only whether an individual’s blood has AIDS antibodies--that is, whether the person has ever been exposed to the virus that causes the disease. It is estimated that 30% to 40% of the gay male population of San Francisco has already been exposed and would test positive, though only a small fraction of those people will come down with AIDS. “The test is absolutely unreliable as an indicator of whether you will get the disease,” said Dr. Neil Schram, director of the L.A. Task Force on AIDS. “The majority will not come down with AIDS,” agreed Dr. James Chin, chief of the infectious-diseases section of the state Department of Health Services, who guessed that 5% to 20% of those whose blood tests positive for AIDS antibodies would actually get the disease.

Nonetheless, health officials maintain that safety and prudence require that blood that tests positive for AIDS antibodies should be discarded. That seems sensible enough. The question then turns to what to do about the donors of such blood.

State law requires that the Health Department maintain a list of all persons who may not donate blood--a list that now contains the names of 80,000 people who have had hepatitis. Physicians must report the names of patients with hepatitis to county health officials, who add them to the blood-donor deferral list. The plan now is to add to the list the names of persons whose blood tests positive for AIDS antibodies, raising the specter of a state-maintained list of homosexuals that could become available to employers or to insurance companies.

It is essential that steps be taken to ensure the confidentiality of all such information. Two bills before the Legislature--one by Mike Roos of Los Angeles, the Assembly Democratic leader, and the other by Assemblyman Art Agnos (D-San Francisco)--would implement such steps. On Friday the Assembly passed both bills, which now go to the Senate. Roos’ bill would revise the blood-deferral list so that it does not mention the reason that an individual may not give blood. That is an excellent idea, and it should be adopted. Roos also proposes that the state set up alternative sites where gay men may have their blood tested for AIDS antibodies without becoming part of the blood-donation apparatus or list. Such testing could be done anonymously, protecting the rights of gay men. It would also help protect the blood supply from contaminated blood that gives a false negative result on the AIDS test.

For two years gay men have been urged not to donate blood because of possible contamination of the blood supply. Schram continues to tell gay men not to give blood--first because of the possibility of contamination, and second because of the possibility of a violation of civil rights. Nonetheless, some gay men may now resume donating blood in order to have it tested. Alternative testing sites would satisfy their desire to find out about possible threats to their health without compromising either the public safety or their own. The Legislature should create these alternative testing sites to protect individuals and to protect society.