Today, an FDA panel is live-streaming its discussion of whether to change the agency’s long-standing ban on blood donation from gay men to a ban only on gay men who’ve had sex with a man in the past year. I’m tempted to joke: I hope none of us will qualify.
The ban — which, to say the least, is seriously flawed — was instituted in the early years of the AIDS crisis, to prevent HIV from getting into the blood supply at a time when there were no reliable tests to detect HIV in blood. But this particular proposed change, which the Red Cross has long supported, is flawed as well. Speaking on the FDA panel today, both a representative from the Human Rights Campaign and the president of the Gay and Lesbian Medical Association expressed the views that: first, the ban should not target gay men specifically, but be based on a survey regarding specific HIV-risk behaviors; and, second, a year is an excessive waiting period.
They happen to be exactly right on both points. The current test used to screen all donated blood for HIV can detect the actual virus as soon as 9 to 12 days after infection. (That’s compared to the first-generation test, which could only detect antibodies to the virus, and not until several weeks after infection.) Given that narrow window of “blind spot” risk on the newest test, the question all donors should be asked on the form they fill out should be something like: “In the past” — let’s make it six weeks — “have you engaged in HIV risk behaviors — including condomless anal or vaginal sex, or shared drug-injecting paraphernalia — with an HIV-positive person or someone whose HIV status you did not know?” (The same question should be asked about hepatitis B or C, which donated blood is also screened for, as well as all other known blood-borne pathogens.)
The question should not be: “If you’re a man, have you had sex with a man in the past year?” What if you’ve been having monogamous sex with your HIV-negative or your HIV-positive-but-medicated-and-uninfectious longtime partner the past year, while meanwhile a straight man or woman has been having condomless sex with multiple partners? (Currently, the policy also bans hetero men who’ve had sex with an HIV-positive woman or a sex worker in the past year. But it asks no such questions of heteros who’ve had sex with multiple partners of unknown HIV status.)
Don’t get me wrong, I don’t believe that not hurting the feelings of gay men comes before protecting the blood supply. But given that, as recently as this summer, the Red Cross was once again — as it has for years now — bemoaning a shortage of blood donations, it’s ridiculous to turn away all gay men who’ve had sex in the past year. If rigorous behavior-based screening is combined with HIV-testing of donated blood, there’s just no reason for special conditions targeting one group.
Not all experts seem to want to move immediately on this, though. “This is a first step” away from a targeted ban on gay men, Debra Kessler, director of special donor services at the New York Blood Center, told me by phone today. But what about questions based on behavior rather than identity? “Those questions haven’t been tested,” she said. (For the record, lest you think the U.S. is particularly homophobic around this, the U.K. also bans men who’ve had gay sex in the past year and Canada bans them for five years; more rationally, Spain and Italy have policies that ban all donors based on recent unsafe sex, regardless of identity group.)
True, HIV incidence among gay men is dramatically higher than in the general population; the FDA says that HIV incidence in gay blood donors is 200 times higher than in donors at large. Kessler, without giving numbers, said that when the NY Blood Center has to call a donor to tell them they’d tested HIV-positive, the donor is usually a gay man. And though the chance of an HIV-infected donation getting into the blood supply is infinitesimal owing to the accuracy of the current test, Kessler said it could still happen. (Last time it did, she said, was in 2008.)
And of course, you could argue that, from a supply point of view, it’s probably easier for the Red Cross and other blood collectors to ramp up efforts to get more blood from the general population than to take the “risk” of collecting from gay men. But do that, and you’re still missing out on a lot of good blood. I remember how, in the first hours of 9/11, many gay men lined up to give blood and either weren’t asked if they were gay or simply lied because they knew that they were HIV-negative and they were desperate to help in an emergency.
A gay HIV activist friend of mine, who asked that I not use his name, said that he supported the one-year ban. “HIV infection in men who have sex with men is high enough that even if the testing is done, the sensitivity of the test” — which has about a 99.6 percent accuracy rate — “makes it likely that there will be blood-product-borne HIV transmission.”
Besides, he noted, “I don’t think giving blood is an inalienable right.”
I see my friend’s point. But I don’t agree with him. As long as any gay man — even one in a monogamous relationship who’s recently tested HIV-negative — is turned away when heteros with multiple sex partners are not, I can’t support the proposed change. It’s discriminatory and it’s supporting a longtime, ugly belief that gay men are in some sense contaminated.
Of course, sadly, a lot of us do have HIV-infected blood. The CDC estimates that more than half of the more than 1 million Americans living with the virus are gay and bi men. Said my activist friend, “What the gay community should be outraged at is that HIV incidence among gay men is high enough that such a policy is even arguably necessary.” There, I am wholly in agreement. But how to fix that? Well, that’s another story.