On Tuesday, the Food and Drug Administration recommended a change in the discriminatory and unscientific policy that effectively prohibited men who have sex with men from donating blood for life. Those guidelines kept any man who had sex with another man — even just once — since 1977 from donating blood forever.
While gay discrimination has been reduced in so many other areas of life, up until now, there hasn't been enough medical or political will to intervene on the blood ban. That policy perpetuated stigma without improving safety.
However, the new policy would ban blood donation for men who have had sex with another man for the past year. So the most likely outcome is that the vast majority of gay or bisexual men still won't be able to donate blood.
And I'm OK with that.
I've researched, written and thought about the FDA's blood ban for years, with an intense, personal interest. I first donated blood when I was sixteen at the Oxnard High School blood drive, while reading Interview with the Vampire. (The novel was very gay, but I didn't yet know that I was, too.)
Blood donation and products loomed large in a family in which both my late father and sister had cancer and relied on them. So I donated blood, plasma and platelets as often as I was allowed. When I finally realized I was gay in my mid-twenties, and still hadn't had sex with a man, I experienced a hematological twist on Elaine's "spongeworthy" conundrum from Seinfeld, and asked myself if a particular man I was going to lose my virginity to was worth giving up donating blood.
My college thesis was on pioneering African American hematologist Charles Drew, and my first ever investigative feature in a national magazine was on the FDA's blood donation ban. Writing that article for the Advocate, I discovered that, while I do have a problem with the lifetime ban, I don't have a problem with banning men who have sex with men in the past year. Most years of the past decade (but not all, sadly) this would have included me.
There is no science — none — that suggests that, if a man had sex with another man in 1978, you couldn't take his blood and safely screen it for HIV. A one-year ban, however, would be based on the risk assessments of a practice — the practice of a man having sex with another man — and not unscientifically shaming gay men. This might sound like a fine difference. But it's an important one.
As I understand it, the act of a man having sex with another man imposes a risk on his potential blood donation on the same level as taking IV drugs, having been incarcerated, or having had sex with someone who is an IV drug user or has been incarcerated. The flaw in the lifetime ban, where it breaks with any sound scientific reasoning, is in pretending this risk lasts a lifetime; at most, such a risk lasts a year. For example, people who have been in jail for more than 72 hours are only banned for a year.
People who want to eliminate the ban altogether often ask me, "But don't they test all the blood which is collected?" Yes, they do. But there are highly complicated statistical models created to ensure the safety of our blood supply, and those models argue there is good reason to impose donation restrictions on populations who engage in certain risky practices. Figuring in the incubation period of HIV to show up in a test, and the statistical likelihood of lab mistakes (such as false negatives, or mixed up blood units), I think it is reasonable public health policy to exclude blood from the pool which would be collected from people whose practices (not their identity) increase their likelihood of being HIV positive.
Again, this would include me. According to the Centers for Disease Control, "African American gay and bisexual men accounted for almost as many new HIV infections as white gay and bisexual men, despite the differences in population size of African Americans compared to whites." Also, while the overall gay male population of the US is only 2%, according to the CDC, this group "accounted for three-fourths of all estimated new HIV infections annually from 2008 to 2010." It also doesn't matter if you think you are negative: less than half of "gay and bisexual men aged 18 to 24 years knew of their infection."
This is can be hard to say aloud because the virus has such stigma, but if you are a man who regularly has sex with other men, you are demographically more likely to have HIV. According to the advocacy group Gay Men's Health Crisis, men who have sex with men, on average, "are over 44 times more likely than other men to contract HIV, and over 40 times more likely than women to contract HIV." It is irrelevant if that sex is in what is supposed to be a monogamous relationship. (Indeed, the best research available suggests that about half of male gay couples are openly non-monogamous.)
Critics are right to argue there has been a double standard here; while some projections suggest that one in three black men could be incarcerated in his lifetime, all black men are not outright banned from donating blood. People who have been incarcerated have been only been banned for a year. Meanwhile, all gay men have been effectively banned en masse for life.
The problem with this sensible solution the FDA is finally advocating — a one year ban for a man after his last time having sex with a man – is that it's politically unpopular. Gay men don't want to be told they still can't donate if they've had sex with men in the past year. But after scares of sero-conversion through blood transfusion, like Ryan White at the 1980s, the FDA doesn't want to do anything at all that could create the perception that any donation was compromised, even one in 10 million.
Furthermore, in a population as large as the United States, the donor blood pool is so large, that gay men's blood isn't really needed (another politically unpopular thing to say). So the push to revise a policy — one that highlights a discriminatory past against gay men, which will only piss off gay men presently, and which will only benefit men who have sex less frequently than once a year — has little political support.
However, no matter how popular or unpopular, the FDA needed to make this change in a policy that scrutinizes the most intimate aspect of our bodies so that it reflects the real science of risk and not to pander to stigma. I am relieved they have finally done so.
Steven W. Thrasher is a weekly columnist for the Guardian and a doctoral student in American Studies at New York University. You can follow him on Twitter @thrasherxy.
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