Donation Disparities

If you drop into Adams House today or tomorrow to donate blood, you’ll be asked one of these two questions before you can roll up your sleeves. If you’re a man, you’ll be asked, “Have you had sex with a man since 1977?” and if you’re a woman, you’ll be asked, “Have you had sex with a man who’s had sex with a man since 1977?” And if you say yes to either, they’ll point you towards the door.

Let me not mince words. Blood donation is a fantastic mitzvah—at nearly no cost to the donor, the recipient receives an incredibly valuable gift—and the American Red Cross is to be commended for making it so easy for Harvard students to donate blood. So if you’re eligible, go to Adams today or tomorrow to donate. But much of campus isn’t eligible, because men who have sex with men (MSM) are not allowed to donate, and this prohibition is patently unfair and increasingly unwise.

The Red Cross is limited in its ability to collect blood by regulations spelled out by the Food and Drug Administration (FDA), which prevents individuals from donating if it deems them to be at risk for carrying number of diseases, including hepatitis C, HIV and the human form of mad cow disease. Screening for these diseases is a two-step process: first, the battery of questions that all donors face, such as those about sex with other men, and second, extensive testing of the donated blood. In 2000, a committee of FDA advisers narrowly voted to continue the restriction that men who have had sex with men since 1977 are barred from donating blood to protect the blood supply from HIV. But this requirement is both redundant and discriminatory. All donated blood is tested for HIV using two tests, one that tests for antibodies produced in response to an HIV infection, and another that tests for the genetic material of the HIV virus itself. Together, these tests are highly sensitive, meaning that they rarely produce false negatives, and are accurate when performed as soon as 10 days after the individual has been infected with HIV.

The problem with prohibiting MSM from donating blood is twofold. The restrictions propagate stereotypes about promiscuity among gays, and the restrictions imply that the spread of HIV is due to sexual orientation, not sexual behavior. Michael A. Feldstein ’07, the public relations director of the Bisexual, Gay, Lesbian, Transgender, and Supporter Alliance (BGLTSA), said, “The problem with these rules is that they perpetuate the notion that AIDS is a gay disease and that all of the blood of MSM is tainted.” Granted, it is not the role of the FDA to legitimize or de-legitimize any number of lifestyles (from injecting intravenous drugs to having sex with men to traveling to Africa or Great Britain) by allowing or disallowing such individuals to donate blood. The FDA’s job is, simply, to maintain an adequate, safe supply of blood for patients who need it. But the FDA is only succeeding on one count: the blood is safe. Donated blood is in short supply nationwide, and the problem is particularly acute in New England, where recent winter storms have lowered the level of donations across the region. “We probably have a day to a day-and-a-half on the shelf right now,” said Richard Benjamin, the chief medical officer of the American Red Cross New England region. “We would much prefer to have three or four days on the shelf.” Benjamin estimated that the number of individuals with safe blood but are rendered ineligible by the questioning process “makes the difference between having a copious supply of blood and not having blood on the shelf.”

Benjamin pointed out that questioning donors about their past behaviors does contribute to the safety of the blood supply. For example, he claimed that 97 percent of the risk of tainting the blood supply with HIV is removed by questioning. The solution, then, is to change the questioning process so it reflects the realities of the modes of HIV transmission: ask individuals about their specific sexual behaviors, not just blanket statements about their sexual activities. “There are no questions of protected sex. There are no questions about monogamous relationships,” said Feldstein, who is also a Crimson editor. “If you are heterosexual and you’ve had sex with a different partner every day for the past ten years, they would still let you give blood.”

Modifying the questioning procedures would have another benefit, too. As the prevalence of HIV among heterosexuals continues to rise, the current questions will soon be inadequate in the pre-filtering process of heterosexual donors, who currently comprise the overwhelming majority of donors. But the FDA seems set on preventing MSM from donating: The proposal that was rejected in 2000 would have allowed MSM to donate only if they had not had sex with men in five years. Lost in the details of the amount of time since a donor’s last sexual activity, the FDA has neglected both the realities of methods of HIV transmissions and the growing rate of HIV among the entire population, not just men who have sex with men.

Matthew S. Meisel ’07, a Crimson associate editorial chair, is a chemistry concentrator in Currier House.