Harrison Weinerman
Pechennino
Writing 150
9 November 2017
Gay Men Not Being Allowed to Donate Blood Hurts the Innocent
As a hallmark of modern medicine, blood transfusions save an estimated 4.5 million lives in the US alone each year. Organizations like the American Red Cross work to encourage healthy candidates to donate blood, but were up until recently, due to FDA restrictions, unable to accept blood from any man who has reported ever having sex with a man. This policy was instilled in the 1980s over concerns about HIV transmission and AIDS. Recently, the lifelong ban was retracted in lieu of a one year deferral on donations from men who have sex with men (MSM), but the policy has not kept pace with the science, and most gay men are still unable to donate blood, even in light of blood shortages and tragedies that return the topic to discussion. The FDA’s mandated one year deferral of blood donations from men who have had sex with men in the last year is an improvement over the previous lifelong ban on donations, but relies on outdated and incorrect assumptions about health risks from gay donors. This perpetuates incorrect stereotypes about gay men’s health, HIV risk, and safe sex practices. These stigmas not only inhibit the progress of gay rights, but also hurts victims who cannot receive blood transfusions from healthy people willing to donate.
HIV did not become a topic of national concern until the AIDs epidemic of the 1980s, when the HIV virus was first discovered, but not many studies had commenced by this point in time. Most research on the topic was reactionary to the discovery that small but significant amounts of people—mostly gay—were getting sick and dying (CDC, early years). This contributed to the public perception at first that HIV and AIDs were simply “gay” problems. This perception led to mostly necessary prohibitions of gay men from donating blood at the time, considering the lack of research on HIV as well as less accurate HIV blood tests. This ban has continued to color the discourse surrounding HIV and AIDs in the decades since, even as research has progressed.
Modern research shows that anyone can contract HIV, not just MSM (NIDA), and new testing methods are incredibly effective at detecting if a person has HIV. Despite this, there are still concerns because MSM have higher rates of HIV infection and an inability to test for HIV within the first weeks of infection resulting in a continued ban. Most new cases of HIV are from gay men, but this can mostly be attributed to a subgroup of the population that does not practice safe sex. Unprotected anal sex puts participants at a much higher risk of contracting HIV than those who participate in unprotected vaginal intercourse, but MSM who practice safe sex negate this higher risk factor. Simply put, gay men who are unsafe should not poison the reputation of the vast majority of those who are both HIV-negative and continuing to reduce their risk to or below that of the average heterosexual person. The FDA’s guidelines do not reflect this.
Furthermore, many risk factors of already allowed activities of blood donors are even greater than sexually active MSM. For instance, heterosexual women can donate even when having unprotected vaginal sex with one partner. This comes despite the fact that according to the CDC, unprotected vaginal sex puts the female at a higher risk for contracting HIV after being exposed than protected anal sex, even without taking PrEP. It is worth noting that unprotected anal sex transmits HIV more frequently per 10,000 exposures compared to unprotected vaginal intercourse (CDC), which then in combination with incorrect condom usage and/or lubricants degrading the condom to a breaking point faster, contributes to a higher HIV transmission rate through protected anal sex than protected vaginal sex (Planned Parenthood). However, this point is rendered moot by the fact that again, the FDA already allows participants in monogamous unprotected vaginal sex to donate, implying that they consider this risk factor to be negligible which is still greater than the risk of transmission through protected anal sex. Furthermore, studies show that participants in monogamous relationships are not less likely contract an STD than those in non-exclusive relationships, due to the fact that people who say they are monogamous often are not, in reality, even writing that “although persons in [consensually non-monogamous] relationships had more sexual partners, the precautions they took did not appear to elevate their rate of STIs above an imperfect implementation of monogamy,” (Lehmiller). MSM that practice safe sex are not riskier than what’s already allowed. Furthermore, the FDA’s suggestion that monogamous heterosexual people pose less risk than MSM is not only flatly incorrect, but contributes to the stereotype that all gay men not only have significantly more sexual partners than their heterosexual counterparts, but are more likely to have an STD than heterosexual people who participate in unprotected sex, even when MSM themselves are practicing safe sex. This demonstrates that the FDA’s guidelines on blood donation that are purported to be based on quantifiable and objective risk data, are simply not.
While some claim that the fact that certain members in the LGBT community engaging in riskier sex practices indicates quantifiable reasons to defer all sexually active gay men from donating blood, pre-donation questionnaires render this point irrelevant. Given certain activities that have already been banned for medical reasons (including the current and previous iterations of bans on gay men from donating blood) are screened through self reporting factors, there is no reason that new, more specific restrictions cannot be applied to the same questionnaire. For instance, rephrasing question number 19 on the standard questionnaire from “Male donors: Had sexual contact with another male?” to “Male donors: Had unprotected sexual contact with another male?” or something similar (AABB). While true that donors can lie on this questionnaire, it has always been the case that donors from any potentially disqualified group can lie. Much of the discussion surrounding the semantics of MSM blood donation directs attention at the issues with permitting all gay men’s blood donations, without considering the ability to screen for smaller, eligible subgroups instead.
Concerns over MSM’s risk for HIV is largely overblown which in turn negates their risk as blood donors. It is important to distinguish rates of HIV among all gay men and rates of HIV infection among those who practice some or all forms of safe sex. Condom use and PrEP (Pre-Exposure Prophylaxis, an HIV antiretroviral drug taken once daily to reduce possibility of contracting HIV) make it nearly impossible to contract HIV (PrEP Facts). In fact, people who take Truvada for PrEP 7 times per week have 99% protection. Taking 4 or 2 pills per week still protects people 96% and 76%, respectively. Condoms are estimated to be 98% effective if used properly (PrEP Facts), and only 85% effective on average because many people use them incorrectly. Using PrEP correctly requires taking a pill once a day. Furthermore, it is subjectively easier to use a condom incorrectly just once. By most measures, either or both of these measures makes a gay man’s risk for HIV lower than a heterosexual man or woman, especially considering heterosexual people’s only barrier against HIV is a condom. Despite this, the current law requires a one year cool down period, regardless of one’s actual risk, from time of last sexual contact for a gay man to donate blood.
The issue of FDA guidelines being slow to catch up to the scientific and political status of gay men’s health and HIV in 2017 perpetuates harmful and incorrect stereotypes about gay men. By ignoring the facts about HIV transmission rates and the risk level of most MSM, the FDA is sending a message to the public that gay people frequently engage in riskier sex practices, are far more likely to have HIV, and present a health risk to the general public, which by most measures is just untrue. According to the CDC, stigmas like this against MSM can affect income and job prospects, “access to high quality health care,” and even contribute to “poor mental health and poor coping skills, such as substance abuse, risky sexual behaviors, and suicide attempts” (CDC, Stigmas). This means that the message the FDA is sending about gay blood donor candidates can actually work to do the opposite of what they’re intending. Beyond that, from a purely human perspective, one would expect medical discourse to not be slanted and not contribute to the falsification of facts about a community.
If blood were in more plentiful supply, this discrepancy between the science and the FDA’s guidelines would be a matter purely of discriminatory behavior, but they’re not. Many blood banks are operating on a critical supply of 1 day or less of blood, while nearly 20% has 2 days or less of blood available (America’s Blood Centers). Arbitrarily rejecting donations from a healthy group of people ends up hurting those in need the most. At best, these shortages result in non-emergency surgeries being delayed until blood is in better supply. At worst, victims after a tragedy are not able to receive the transfusions they need. While admittedly gay men cannot solve all shortages of blood, when it comes to medical health, every unit of blood counts.
While true that more gay men have and transmit HIV than heterosexual men, it is important to separate this statistic from the risk factors of individual subgroups of the gay community that are at higher risk, like those not taking PrEP or using condoms. Furthermore, when evaluating activities and their risks for contaminating blood samples, it’s worth evaluating in the context of what is already deemed acceptably low or negligible. With blood donors in constant need, and shortages happening at alarmingly more frequent rates, any change that can improve the availability of blood should be welcome in society. The FDA’s current ruling on deferring donations from MSM takes it a step beyond that by implicating the social status of gay men in a discussion that aught to be derived solely from objective facts. By re-evaluating from scratch the dangers associated with accepting blood from certain groups of people, the FDA can put itself in a position to be among the first world superpowers to adopt a progressive and less discriminatory blood donation policy in the name of advancing public health and LGBT acceptance (GOV.UK, CNN). (1731 words).