An unwanted donation
Is the ban on gay blood donation health-conscious or homophobic?
Michael Daniels hasn’t donated blood since 1983.
That was the year doctors realized the AIDS virus could be transmitted via blood transfusions. It was also the year the U.S. Food and Drug Administration (FDA) prohibited gay men and other so-called “high-risk groups” from donating blood in response to fear over the safety of the blood supply.
“[The ban] was put in place at a time when we didn’t have much understanding of the risk and we didn’t know how to make the blood safe,” said Dr. Richard Benjamin, chief medical officer of the American Red Cross.
In 1992, the FDA tightened the policy and prohibited any man who has had sexual relations with another man (called MSM) since 1977 from donating. That policy is still enforced today as one of several restrictions designed to ensure a safe blood supply.
While enacting the ban was medically necessary in 1983, continuing it is insensitive to gay men, several activists said. Viewing AIDS as a gay disease “irrationally criminalizes homosexual acts,” said AIDS activist Jay Blotcher, who lived in New York City at the time of the initial U.S. ban. He claimed the ban on MSM donation is a modern-day “blood libel.”
While a number of other countries imposed similar bans on MSM blood donations during the 1980s, several nations relaxed their policies this past summer, in part due to better testing methods. The United Kingdom, for example, lifted the lifetime ban in favor of a shorter one-year ban following homosexual relations, which several gay rights activists have called a positive step forward. Many said they hoped the ban on donation by homosexuals might mirror the path of a previous U.S. ban on tattooed donors, which was also reduced to a one-year ban before being overturned completely.
“The ban on gay donors is grounded more in bigotry and misinformation than it is in medical certainty,” said Blotcher.
The FDA, however, has not reversed its policy, despite growing pressure from activists and the urging of the American Red Cross. The FDA insists that MSM continue to pose a high risk: Prevalence of HIV in MSM is “60 times higher than the general population, 800 times higher than first-time blood donors and 8,000 times higher than repeat blood donors,” according to the agency’s website.
But these statistics could be misleading, several gay rights advocates said, because they do not take into account that blood donors — who are compensated only with free cookies — are a self-selecting group. It is likely the gay men who are HIV positive would choose not to donate, rendering the FDA’s statistic less telling, they said.
Since the 1980s, medical methods of detecting infection with HIV have improved significantly, further limiting potential risk, said Benjamin. Previously, it was possible to be infected for up to six months before testing positive. Today, that window is only ten days, he added.
But the FDA is not likely to change its policy anytime soon. A July 2011 report by the U.S. Health and Human Services (HHS) concluded that the FDA would need to conduct a “full evidence-based evaluation” to establish that lifting the ban would not endanger the blood supply. With the current restrictions, HIV contaminates less than one in every 1 million collected blood samples, according to the FDA. HHS does not yet have the funding to conduct an in-depth analysis of how lifting the ban might affect contamination, putting any hope of a change to the FDA’s policy on hold, according to the report.
The Red Cross, which collects and monitors all donated blood in the U.S., already takes stringent measures to ensure blood safety and meet FDA guidelines. The organization employs three screening methods: a donor questionnaire, testing blood samples and strict labeling. The questionnaire is designed to restrict those who engage in at-risk behaviors — such as intravenous drug use, unprotected sex or traveling to high-risk countries — from donating, according to Benjamin.
“[Without] the questionnaire, we would be taking an awful lot of blood that might be infected,” he said. This would “substantially increase the risk that somebody might make an error and release a product that shouldn’t be released.”
Every donated blood sample is tested for 12 blood-transferable diseases, including HIV and Hepatitis B. While this stringent level of testing is effective, it should not preclude other methods of screening, according to FDA public affairs specialist Paul Richards.
Still, there are currently “examples of inequity” in existing screening, Benjamin said. For example, women who partake in similarly high-risk sexual practices do not face the same lifetime ban as men who do so.
The FDA realizes some people view the ban as prejudiced and outdated, said Dr. Jay Epstein, the FDA’s director of the Office of Blood Research and Review, at an open workshop addressing the policy in 2006. But, he added, the “FDA’s primary responsibility is to the safety of the blood supply and those who will receive blood and blood products.”
Activists said they understood the original point of the ban, but argued that it is now outdated.
“You can sometimes understand why some knee-jerk policies were made in the wake of the AIDS epidemic,” said Alan Bailey, an LGBT (lesbian, gay, bisexual and transgender)* union officer for the National Union of Students (NUS) in the United Kingdom. Today, however, Bailey helps organize protests against the policy.
Daniels, who hasn’t donated for more than 27 years, co-organized a “Brothers in Blood” blood drive this October with the Red Cross and his LGBT-focused media company, Outlook Media. The drive encouraged gay men to bring friends to donate on their behalf. It collected four times the normal amount of blood of an average drive, Daniels said. For Daniels, this turnout symbolized the number of LGBT allies who might be inspired to donate more often if the FDA lifted the ban.
Bailey has organized several grassroots movements that attempt to raise awareness. NUS volunteers have made graphic demonstrations outside of blood donation centers, such as filling water bottles with red liquid to represent the blood that could have been collected.
“[The policy] should be based on safe sexual practices — not the gender of the person you’re sleeping with,” he said.
*This sentence has been corrected due to a factual error. 8:30 pm, December 8 2011.