Point Bleeding Discrimination
by Casey Pence
Counterpoint A Commitment to Safety
by Max Warhol
There are around 130,150 men in the United States who may want to give blood annually, but are currently unable to. This could amount to an extra 219,000 pints of blood per year, with the ability to save an additional 657,000 lives. Unfortunately for the people who need this blood, these men have had sex with other men, and consequently, are banned from donating their blood by the Food and Drug Administration (FDA).
This policy arose in the midst of the AIDS crisis of the 1980s and was designed to limit the spread of HIV. There was cause for concern; blood testing technology was less advanced than it is today requiring a stricter initial screening process., As time and technology have progressed, however, every ounce of blood is now being tested for HIV, guaranteeing new levels of safety. In addition, the Red Cross and the American Association of Blood Banks support lifting the ban on gay men from donating blood. The ban still exists since it is supported through two avenues: culture and science.
Any and all other sexual orientations are not prevented in any way from giving blood. Only men who have sex with men are affected. This perpetuates the stigma that gay men are largely responsible for spreading HIV/AIDS. While, in some cases, gay men do have the highest infection rate, many other populations are at an increased risk of HIV that is unrelated to sexual orientation. According to the Center for Disease Control and Prevention, in 2006, black men were six times as likely to contract HIV than white men, and more than twice as likely than black women. Black women were also more likely to contract HIV—about fifteen times more likely than white women.
As one would expect, there are no restrictions to donating blood based on race. To implement such a restriction would be a gross generalization of a community as a whole. But gay men are generalized, lumped together, and excluded from donating based on a common cultural misconception arising from sexual deviance. Certain groups will always be at a greater risk for disease, whether divisions are based on race, gender, sexual orientation, or any other aspect of a person. To pinpoint and exclude only some of these groups is both insulting and hypocritical.
Under the current policy, men who have had sex with another man prior to 1977 are still permitted to donate blood. Before the AIDS epidemic began and prior to 1977, if you had lots of gay sex, go ahead and donate! Get a tattoo in a dingy parlor 13 months ago? Have at it! Had a bad case of gonorrhea a year ago? Who cares! Hire a prostitute in the year 1976? The FDA says your blood is still great! These asinine restrictions undermine the cause of collecting needed blood, and when compared to one another, only highlight the ridiculousness of the ban on gay men who have had sex after 1977.
Even men who have the same male sexual partner for years or consistently practice safe sex are not allowed to give blood. The FDA states that while they realize this is not ideal, better questionnaires during the initial screening process may be useful in the future; but according to the FDA, “this cannot be assumed without evidence.” How can the FDA ever gain evidence that any of its donors are true to who they say they are? What’s to stop a heroin junkie from donating, or someone who has lived in the Congo for their entire life? They can simply lie during the questionnaire. These are groups who are restricted from giving blood, and yet the Red Cross takes their word when they go in to donate. Gay men can lie too. But for them, they are not lying about tattoos or drugs; they are lying about who they are, forced to sacrifice dignity in order to save lives.
The scientific support for the ban is, in reality, mostly a scare tactic. There is a disease test failure rate of 1 in a million. I’m not going to say that this is not significant: any transmission of disease through blood transfusion is a tragedy. But gay men are not the only ones spreading HIV, and it is not going away. There will always be disease slipping through the cracks and creeping into the blood supply. The FDA should not make assumptions about what will happen if gay men give blood without putting it to the test or entrusting gay men to know when they are safe to donate.
In the meantime, all privileged with the ability to give blood should regularly do so, in order to make up for the millions of pints of blood lost as a result of this ban.
Blood donation is a noble act of charity, a practice that saves millions of lives every year. The US blood donation system is one of the best in the world, and the speed, efficiency, and safety that exemplify it result from careful regulation by the Food and Drug Administration (FDA). The FDA’s primary role in this process is to keep our blood supply free of infectious diseases, ranging from hepatitis B and C to HIV and variant Creutzfeldt-Jakob disease, a fatal condition caused by the same protein at the root of “mad-cow disease.” One plank of the FDA’s blood donation policy involves preventing men who have had sex with men (MSM) from donating blood, and critics claim this policy is outdated and discriminatory. However, this policy is founded on solid scientific evidence that has not been refuted, and it remains a crucial practice in improving public health.
To better understand the reasons for the deferral policy towards MSM, we must examine its history. This policy arose in 1983 in the midst of the HIV/AIDS crisis. FDA research concluded that in order to prevent the spread of HIV and other infectious diseases through the supply of donated blood, men who had had sex with other men at least once since 1977 would be indefinitely deferred from donating blood. This information is obtained via a survey question. This policy has been reviewed a number of times in the following decades, most recently in June 2010 by the US Department of Health and Human Services (HHS) Advisory Committee on Blood Safety and Availability (ACBSA), and repeatedly HHS and the FDA have upheld this policy. ACBSA did find that current donor deferral policies are suboptimal and established a working group to determine ways to improve the policy, but this only means that deferrals must be reformed, not scrapped. This policy undoubtedly reduces this risk of disease transmission through blood transfusions, and it is essential that it remain in place.
Now that the HIV/AIDS panic has subsided, many believe that the FDA’s deferral policy is outdated and should be removed altogether. But this view ignores the particular risks posed by blood donations from MSM. HIV prevalence among MSM is 60 times higher than in the general population, 800 times higher than among first-time blood donors, and 8000 times higher than among repeat blood donors. Men who have had sex with men are also the largest donor group found HIV-positive by blood tests, and MSM still account for the largest number of new HIV infections.
Indefinitely deferring MSM blood donation therefore clearly reduces the risk of HIV transmission, and it is particularly useful for reducing the number of people who donate during the “window period,” the time during which no symptoms of HIV appear in HIV-infected individuals. Critics object that donations are tested for HIV anyway, but testing on each donation still fails 1 in 1 million times. There are 20 million total annual transfusions, and as the FDA website notes, “even a failure rate of 1 in a million can be significant if there is an increased risk of undetected HIV in the blood donor population.” Finally, gay men are also at a greater risk of contracting other diseases, such as hepatitis B and C, and FDA policy is designed to stem the transmission of these diseases as well.
It is important to note that the indefinite deferral policy for MSM is not, in fact, unfairly discriminatory. This policy is not based on prejudicial attitudes toward homosexuality but on scientific fact, and it passes no judgment on any individual’s sexual identity or gender expression. Scientific research demonstrates that deferring donations from MSM simply increases the safety of the blood supply, and the FDA’s commitment to maximizing health and safety requires that the policy remain in place.
Other critics of the policy may express concern that MSM deferral also excludes health donors and limits the quantity of blood available for transfusion. Certainly, not all or even most men who have had sex with men carry HIV, and the policy does to some extent reduce the supply of available blood. However, this impact is small, and regardless of its size, quality of the blood supply is more important than quantity. The FDA’s primary goal is to make the blood supply as safe as possible, and minimizing the risk of infecting someone with HIV through a blood infusion justifies eliminating even a large number of healthy donors.
As social practices and HIV detection technologies change and improve, a time may come when the MSM indefinite deferral policy can be significantly loosened or abandoned. The FDA continues to review the scientific basis for this policy and is constantly looking for ways to improve it. In the meantime, however, the FDA must fulfill its commitment to maintaining a safe blood supply. Retaining this policy is in the best interest of America’s public health.
About the Issue
Point author: Casey Pence is a volunteer at the University of Michigan Spectrum Center. He is O+.
Counterpoint author: Max Warhol is a student at the University of Michigan studying Political Science and Philosophy
Edited by: Aaron Bekemeyer, Mike Guisinger, and Leslie Horwitz
Cover by: Matt Rosner