Gay men, sex and AIDS.

This is a dialogue-form essay I wrote for a Coursera.org course on AIDS a couple of months ago, sort of in reply to a friend. As part of the assignment, I asked around for common (or not so common) myths about AIDS, and got a reply from a friend who was indignant about why gay men were banned from donating blood. So this was the essay I ended up writing. The requirement was that the essay should debunk the myth, in script form. Of course, I took liberties with imagining my friend’s replies XD I’ve removed the references that referred to the course lectures, but rest assured that the statements are legitimate. So if you see a number reference but no reference link below the essay, it means I was referring to a course lecture.

L: I don’t understand why gay men aren’t allowed to donate blood just because they are more likely to contract AIDS? Is it even true that they are more likely to contract AIDS? (When pressed) I’m not quite sure about how people contract AIDS, though.

L: I mean, seriously – isn’t that some kind of discrimination or something?

Me: Well, firstly, you say that you don’t know how HIV/AIDS is transmitted, right?

L: Yeeeeeah. And what’s the difference between HIV and AIDS?

Me: Hmm. HIV stands for Human Immunodeficiency Virus, which is what causes AIDS, or Acquired Immunodeficiency Syndrome – kind of like how the influenza virus causes the flu. One is the germ, and the other is the illness.

L: It’s a little confusing, but I think I get it. Why don’t they call it the same thing though?

Me: It’s a history thing[1]. Well, basically HIV is transmitted via body fluids – mostly blood, semen and vaginal fluids. 37% of men who have sex with men (MSM) have had anal sex [2], and the figure jumps to 42-44% when younger MSM are surveyed [2, 3]. One of the things about anal sex is that first, the inner lining of the anus is more delicate than the vagina, and therefore tears more easily; hence it’s easier for HIV to enter the bottom’s bloodstream from the top’s semen [5]. Second, the anus lacks the mucus produced by the vagina, which provides a small amount of protection from HIV transmission [4]. The virus can also move from the blood, if any, in the bottom’s anus to the exposed parts of the top’s penis [5], particularly if the top is uncircumsized [5, 6]. In developed countries like ours, unprotected anal sex is 17.5 times as likely to allow for HIV to be transmitted compared to vaginal sex, on a per-act basis [4]. And the crux is, only one in six MSM use condoms consistently when participating in anal sex [7, 8]. So in gay men, there is a higher chance that they will have contracted AIDS. And since one of the ways that HIV is transmitted is via blood, that’s why they’re not allowed to donate blood. However, it is true that 36% of younger women have also had anal sex [3], so the risk is equally relevant to them. The wording on blood donation forms should probably be changed to reflect that. Actually, there’s lots of things we can do about this issue, but people who have anal sex do tend to be more likely to contract AIDS.

L: Huh.

[2] http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2011.02438.x/abstract

[3] http://www.cdc.gov/nchs/data/nhsr/nhsr036.pdf

[4] http://ije.oxfordjournals.org/content/39/4/1048.long

[6] http://www.ncbi.nlm.nih.gov/pubmed/20139750

[7] http://www.aidsmap.com/Consistent-condom-use-in-anal-sex-stops-70-of-HIV-infections-study-finds-but-intermittent-use-has-no-effect/page/2586976/#item2586982

[8] http://www.retroconference.org/2013b/Abstracts/45832.htm



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