Bleeding for a Change

Don’t let unprotected sex with an HIV-positive partner keep you from giving blood to the Red Cross next week. As long as the last sexual contact occurred over a year ago—and you are heterosexual—blood drive volunteers welcome your donation. But if you have had sex with another man since 1977, even once, even with protection, you are disqualified for life. No exceptions.

The Food and Drug Administration (FDA) banished gay donors from the blood supply almost two decades ago admist national hysteria and confusion surrounding HIV. Gay men were dying by the thousands at the hands of the mysterious disease, and media reports of heterosexuals transfused with infected blood only fueled anxiety. With public confidence in the blood supply shattered, the FDA was willing to take drastic action to avert crisis. The resulting gay ban remains in effect today.

The FDA prefers not to describe its policy so crudely, of course, and instead emphasizes the particular “high-risk” behavior in which gay men engage. The word “gay” appears nowhere on donation questionnaires, and the FDA’s published studies refer only to MSMs—”men who have had sex with men.” If accused of bigotry, the FDA can boast that it gladly accepts donations from lesbians and from male virgins of all persuasions.

But glaring inconsistencies within its safety guidelines reveal a homophobia that the FDA vigorously denies. If a man and a woman have sex with the same gay man, for example, the woman may donate blood again after 12 months while both men are barred permanently. More puzzling still, heterosexual sex with an HIV-positive partner only precludes donation for a year; even the most bizarre risk calculus would deem this more dangerous than sex between HIV-negative men.

The FDA denies that stereotypes have influenced its policies, of course, and it seeks refuge from critics behind a veil of statistics. After all, studies show that HIV incidence remains much higher among gay men, even though prevalence among heterosexual males has risen dramatically in the past decade. The CDC reports that in the year 2000, gay men accounted for the majority of reported HIV infections among male adolescents and young adults in America, even though gay men make up less than 10 percent of the population by most estimates.

These figures suggest that sexual orientation may deserve limited consideration in risk analyses, but they do not explain why the FDA has allowed a residue of homophobia to remain on its policies for 17 years. In Sept. 2000, the FDA narrowly rejected proposals that would have reduced the abstinence period required of gay men to either one or five years. About half of the nation’s blood banks publicly supported a one-year rule, which would have lead to 112,000 new donors, according to FDA estimates.

FDA Medical Officer Andrew I. Dayton insists that the decision was based solely on a scientific analysis of safety, which concluded that evidence supporting reform “was not forthcoming.” In a study Dayton presented before the deciding committee, he estimated that a one-year abstinence rule would introduce about 30 percent more infected blood into the supply ever year, putting up to three more blood recipients at risk of contracting HIV. “We [the FDA] are very sensitive to people’s feelings that they are being discriminated against,” he said. But without alternative estimates, a majority in the cautious committee was dissuaded from reform.

Dayton said he would not be comfortable changing abstinence periods without further research. In the interest of more donors and fairer rules, that research should begin as quickly as possible. At the same time, the FDA and the CDC should evaluate more fundamental changes to its donor screening. Condom use, the number of sexual partners and the type of sex—whether vaginal, anal or oral—determine the risk of HIV transmission more directly than broad identity categories. As BGLTSA Public Relations Chair Marcel A. Q. LaFlamme ’04 points out, “ultimately those statistically riskier categories come from risky behavior,” not sexual orientation.

Incorporating individual behavior into a new risk calculus could make the blood supply safer without relying on stereotypes of gay men. There are practical limits on the level of nuance possible through donor interviews and questionnaires, of course, and Dayton wisely warns against making them too much longer. “If you start asking to many questions, you start getting incorrect answers,” he said. But more accurate assessments of individual risk may only require a few new questions.

The FDA should immediately begin to coordinate studies on the impact of condom use and promiscuity on individual risk, and it should develop a timeline for revising its discriminatory policy on gay men. Thousands of healthy donors will be turned away this year while the Red Cross website pleads for help in addressing an “unprecedented need.” Those who can donate in next week’s blood drive should speak their mind to Red Cross volunteers, and those who are ineligible should let the Red Cross know what it is losing. A stereotype is no reason to put needy patients on a waiting list.

Blake Jennelle ’04 is a social studies concentrator in Adams House. His column appears on alternate Wednesdays.