It’s time for one of the those end-of-the-year-reflection kind of posts. You know, did you make your New Year’s resolution, what did you learn most from this year, blah, blah, blah.
Well, this being a blog about a lot of sex-related things (oh, who am I kidding, it’s mostly a blog about sex) I thought this was a good time to reflect on the ghosts of partners past. The recent past.
This has come to my mind because I recently read a great article on the US stats on sex partners (the 2011 National Health Statistics Report on Sex Behavior) AND the CDC has just proposed new guidelines for organ transplant donors indicating that 2 or more partners a year should exclude you from the donation pool. While I applaud the desire to reduce the possibility of HIV (and Hep B and C) infected donors, I’m not sure this is the way to do it.
First of all, while STDs is a numbers game (more exposures, the greater the risk), there is no study that I’m aware of that says 2 or more partners a year puts you into a specific risk pool. We have that data for HPV (4 or more partners puts you in the “probably caught it” group), but not for HIV.
The other issue is honestly in disclosure. If you are doing a known donation, say for your mom, are you really going to be truthful and tell mom’s doctor that you can’t donate because you had 3 sex partners this year? What if you are 18 versus 45, would you be more likely to disclose your sexual history. What if you are married and not monogamous (it happens: 3.9% of married men and 2.2% of married women have had 2 or more sex partners in the past year). Would you be honest and exclude yourself from donation or would you lie? After all, if you’re married you’ll probably also incur more that just mom’s wrath. That is of course assuming you can get a history. What if the donor is an otherwise healthy young man with a fatal head injury from a motorcycle accident? Who will provide the number of partners he had in the past year?
But what if you are monogamous but, unbeknownst to you, your partner of 5 years is not? What if he/she had 25 partners this year while secretly doing meth (because meth house sex leads to an even higher quality of partner selection).
What if your one sexual encounter in the past 3 years was a prostitute? Of what if your one sexual encounter was with your first boyfriend who happened to have sex with a prostitute in Nigeria when he was spending a semester in Africa 3 months ago?
What if you have had 3 sex partners but used condoms every single time and insisted your partners be tested for HIV before you had sex with them versus a person who had one unprotected sexual encounter that was a hook up from a bar and last names were not disclosed or quickly forgotten? Who is at greater risk?
It’s not just about the numbers. I can tell you many sad stories that resulted from 1 exposure, and having spent a good part of my fellowship working in an STD clinic I have heard the case histories I described above more than once. So until evidence based medicine tells us that 2 or more partners puts you into a different risk category, I think the better answer is for the transplant team to take a detailed history (which INCLUDES a sexual history) and do rapid HIV testing.
And as an aside, donors aren’t screened for rabies, but there has been at least one recent well-reported case of a donor dying from an unrelated cause, donating, and then multiple recipients contracting rabies. The rabies case clearly indicate that we have an imperfect system that will always be imperfect. There is no rapid test for rabies and often people who are exposed and have no idea (because if they have an idea, they are usually getting their rabies post-exposure prophylaxis and immunization series).
How many people would the CDC policy exclude from the donation pool? Take at look at the graph, which shows the choices that Americans ages 15-44 made regarding opposite-sex sexual partners in the previous 12 months.
- 11% have never had sexual contact with the opposite sex
- 6.1% have been sexually active, just not in the past year
- 69% of women had one sexual partner
- 13% would be considered too high risk by the CDC (2 or more partners in the past 12 months).
- 11.2% have never been sexually active with the opposite sex.
- 6.6% have been sexually active with the opposite sex, just not in the previous 12 months.
- 62.5% have had one opposite sex partner in the past year.
- 18.5% have been sexually active with 2 or more opposite sex partners.
The CDC proposal raises an interesting point and should really give us all pause to think more carefully about our sexual history and the choices we make with our bodies. Although I’m not sure the policy is scientifically sound.
If you have even had sex with anyone you are at risk for an STD.
What do you think about the CDC’s proposal?