At the end of 2015, the Food and Drug Administration (FDA) changed its policy on accepting blood donations from men who have sex with men (MSM). Before the change, MSM had lifetime bans. Now, they are permitted to donate blood, but only after a full twelve months of celibacy.
This isn’t much, and I’m hesitant to celebrate it as even a small victory, for the homophobic root of the policy remains.
The FDA instituted its “indefinite deferral” policy for MSM in 1983, in response to the intensifying AIDS crisis. A lot has changed in the 32 years since that decision. In 1983, we understood almost nothing about HIV/AIDS, and gay men were dying by the thousands. The policy in that context makes sense. Now, however, we understand exactly the way in which the virus compromises the immune system. It used to be that living with HIV was a race against time: would the treatment drugs kill you, or would the disease? We now have antiretroviral therapy that stops HIV’s development without slowly killing the body. HIV is no longer a mystery.
But how long is three decades in terms of the public consciousness? For many, the AIDS crisis and gay men are inextricably associated with each other. Of course, this association is the fault of sensationalist media coverage and fear-mongering by prominent figures. The communications director for President Reagan, Pat Buchanan (yes, of continued Fox News fame) once attempted to portray the decimation of a community by disease as some modern Sodom and Gomorrah being destroyed by divine intervention: “The poor homosexuals—they have declared war upon nature, and now nature is exacting an awful retribution.” Reagan had no comment.
Consider the effects of a decade of fear-mongering about this disease and gay men. The tail end of the crisis was less than 30 years ago. People don’t forget. The misinformation and prejudice remains.
How does this translate into policy? The FDA’s guidelines for blood collection agencies previously stated: “Male donors who have had sexual contact with another male, even once, since 1977 are indefinitely deferred. Males who have had sex, even once, with males may be at risk of transmitting infectious diseases.” There’s no mention of whether sexual contact was with protection or if either participant was on PrEP, a medicine that helps prevent HIV. To the FDA, all gay sex, regardless of protection against transmission, is apparently risky enough to warrant denial, no further questions asked. In 2013, spokesman for the American Medical Association, Dr. William Kobler called the policy “discriminatory and not based on sound science.”
It’s about far more than giving blood, though. It’s about pernicious perceptions of MSM communities as contagious and dangerous. It’s about the stigmas that survive from the horrors of the 80's.
Moreover, the FDA’s current policy is more than just erring on the side of caution. It is extremely discriminatory and heteronormative in its own right. Risk levels for non-MSM identifying people are identified on a case-by-case basis. A heterosexual person responding “yes” to questions of whether they have engaged in sex work, intravenous drug usage, or sex with a person with HIV are deferred for a year. MSM, however, are lumped into an “untouchables” pile with no evaluation of risk level. To put it into a real world example, a monogamous gay couple who have always tested negatively for HIV are forbidden from donating unless they become chaste for a year, while a heterosexual person engaging in frequent unprotected sex with multiple partners is permitted to donate.
By generally targeting men who have sex with men, the FDA perpetuates the misconception that AIDS is just a “gay disease.”
All of this is somewhat moot anyway, because blood can now be rigorously screened with multiple testing processes before it ever gets used for transfusion. RNA testing for HIV detection is able to scan for the virus itself, unlike older testing methods that tested for the antibodies produced by the body in response to contraction. Antibody testing meant that there was a several month period immediately after contraction of the virus where it could go undetected in some testing, which perhaps lent some merit to a deferral policy (though still not a lifetime ban). But now with RNA testing, conclusive results on the HIV status of blood can be obtained in as few as nine days after contraction.
A survey done by the Williams Institute at the University of California, Los Angeles, calculated that approximately 300,000 extra pints of blood from 360,000 new donors would be donated if the FDA did away with the deferral period.
From the eagerness with which the FDA disqualifies potential donors, you might assume that there must not be a huge need for blood. Unfortunately, there is, especially for rarer blood types. Why is the FDA committed to a policy that compromises the health of the nation as a whole on the basis of an outdated fear, rather than science?
I shouldn’t have to lie about my identity to give blood that I know is HIV-free. I shouldn’t have to lie to give blood that will be confirmed to be HIV-free.
Spencer Campbell PO '19 is an intended history major from New Rochelle, New York. He enjoys hiking, queer politics, and Frank Ocean.