Correction appended
The gay rights movement has scored a number of major successes as of late. Same-sex marriage is gaining momentum, as state legislatures from Vermont to Iowa vote to legalize, and even Miss California USA recently found out that opposing gay rights is no longer a socially "safe" stance to take (a discovery that likely cost her the Miss USA pageant crown). So perhaps it was a testament to the great strides the gay rights movement has made (or maybe just to my naivete, as a straight individual), that I was so surprised to find, at last Wednesday's blood drive, that the American Red Cross mandates that any man who has "had sex with another man even once since 1977," is not allowed to donate blood. My immediate reaction was disbelief could there really be a rule that effectively prevented gay men from giving blood? Shouldn't someone have contested it by now? It turns out that the restrictions aren't entirely without scientific basis. Male-to-male sex was responsible for half of all new HIV diagnoses in America in 2004, and according to the U.S. Food and Drug Administration, HIV prevalence among men who have had sex with men since 1977 is 60 times higher than that of the general population. A closer look at other eligibility requirements, however, shows that the FDA's policy of permanently deferring men who have had sex with men is not consistent with its policies for other high-risk populations. All of the other sexual risk behaviors, including having sex with a prostitute (with the exception of being a prostitute), require only a 12-month waiting period before donors are allowed to give blood. All donated blood is tested for HIV and other infections before being distributed. These tests produce a false negative less than once in every one million samples, as long as the infection occurred more than 21 days before the test. This three-week period after infection, when the body has not yet developed a strong enough immune response to be detected in testing, is known as the "window period." Requiring potential donors who have engaged in risky sexual acts to wait 12 months before donating blood therefore eliminates the possibility that a detectable immune response has not yet been generated. According to the American Association of Blood Banks, an umbrella organization whose members are responsible for collecting 80 percent of blood donations in America, "t does not appear rational to broadly differentiate sexual transmission via male-to-male sexual activity from that via heterosexual activity on scientific grounds." In other words, there is no discernible scientific reason why risky heterosexual sex should result in only a 12-month deferral period, while homosexual male sex results in a permanent deferral. The tests are no less effective for gay men, and the window period in gay men is no longer than in straight individuals. My biggest problem with the policy, though, is that it assumes that all male-to-male sex is risky. It does not make exceptions for men who have always used safe-sex practices, or who are in long-term monogamous relationships and have been tested for STDs. It is illuminating to note that one-half of all new HIV diagnoses in America in 2004 (the same percentage attributed to male-to-male sex) were found in African Americans. Yet no one would ever dream of declaring that all sexually active African Americans were ineligible to give blood. We would instantly recognize the irrationality (and the underlying prejudice) of assuming that all African Americans are engaging in unsafe sex practices. At the very least, the deferral period for those who have had male-to-male sex should be reduced to 12 months indeed, this recommendation was made to the FDA in 2006 by the American Red Cross, the American Association of Blood Banks and American Blood Centers. At best, though, the FDA should develop a new set of screening guidelines that would better separate the risky potential donors from the non-risky. The reality that many Americans don't see is that we don't have the luxury of turning away potentially healthy donors. Blood shortages are a very serious concern in the U.S. with only 5 percent of adults donating blood and the FDA's commitment to protecting patients who receive blood transfusions, while admirable, has resulted in overly stringent and illogical eligibility requirements. There are ways of protecting transfusion recipients that utilize the population of healthy potential donors more fully, and that move beyond baseless homophobic prejudice. The FDA owes it Americans to implement these more nuanced policies.
