Is your sex “dirty?” I don’t mean kinky. I mean inherently dirty. Does your sex always transmit HIV or other biohazards threatening the U.S. blood supply?
“Biohazard” may sound extreme, but after all we’ve learned about HIV since 1983 — when gay and bisexual men were barred for life from donating blood — the stereotype that HIV is only a “gay disease” is far from history. In fact, it’s still promoted by the U.S. government under President Obama.
Since the early “gay cancer” days, Gay Men’s Health Crisis has witnessed firsthand how fear, stigma, and discrimination have fueled the HIV and AIDS epidemic among minority groups most at risk for infection. This is why we’ve been a leader in the fight to replace the Food and Drug Administration’s outdated and unscientific blood ban with a system that screens all donors — gay, bisexual, straight, or transgender — based on whether they engage in high-risk practices that could lead to infection.
The American Medical Association, the Red Cross, America’s Blood Centers, and the Association of Blood Banks agree that the lifetime ban is not only discriminatory but is also medically and scientifically unwarranted. After all, HIV is transmitted by what you do, not who you are. Right? Not according to the U.S. government.
In November, an advisory committee to the Department of Health and Human Services recommended by a vote of 16 to 2 that gay and bisexual men finally be allowed to donate blood — but only if they’re celibate for a year.
If you’re an HIV-negative man who has sex with another man — even just once per year — regardless of whether it’s with your monogamous, HIV-negative boyfriend, partner, or husband, whether you use condoms, pre-exposure prophylaxis (PrEP), or other safer sex practices, you’re still banned from donating blood. Is the FDA now going to also require heterosexuals to be abstinent for one year, regardless of assessing their risk for HIV? Hardly. A similarly situated heterosexual man or woman is to the FDA an ideal donor.
The one-year ban, or “deferral” as it is more benignly described, was the result of years of research commissioned by the government to better assess the effects of moving away from the current lifetime ban. But the idea is not new. It’s been implemented with success in Argentina, Australia, Brazil, Hungary, Japan, and the U.K. Available research from these countries shows a one-year ban does not increase the risk of HIV transmission through donated blood.
For the overwhelming majority of gay and bisexual men, of course, celibacy for a year is a de facto lifetime ban. Many in our community rightly question the need for a ban at all. After all, isn’t all donated blood in the U.S. tested for HIV?
Yes, but it’s complicated. In the mid-’80s, the best testing technology could detect HIV within several weeks of infection. Today that “window period” — the time between infection and detection — has been reduced to approximately nine days. This means that infected blood could theoretically enter the system if transmission and donation occurs within that window period. Still, if it only takes nine days to detect HIV, why require celibacy for 12 months?
While the U.S. blood donation system employs checks and balances that make it among the safest in the world, unlike the system in Australia and other nations, it is decentralized and doesn’t always utilize the most technologically advanced testing and monitoring procedures. For example, since 2010 Australia has been testing each individual donation for HIV. In contrast, the U.S. primarily relies on pool testing, which, in order to reduce costs, combines samples from a group of donations and then tests for HIV. It’s possible that a sample from a donor recently exposed to HIV that would test positive individually becomes so diluted that the entire pool returns a false negative.
Of course, that HIV-positive donor could be gay or straight. In fact, since Australia implemented its 12-month deferral in 2000, the only case of transfusion-related HIV transmission resulted from a female donor exposed through heterosexual contact.
This is why GMHC and other HIV/AIDS and LGBT advocacy groups, as well as organizations representing those living with hemophilia and other blood disorders, are working together to demand that the FDA change the ban and join the growing list of nations that have a centralized and scientifically advanced transfusion transmissible infection monitoring system.
We’re not asking for something that has never been tried before. Chile, Italy, Mexico, Poland, Spain, South Africa, and Uruguay have implemented risk-based deferrals. In Italy, potential donors fill out a questionnaire, followed by an interview, which categorizes them by risk. For example, “at-risk” donors are deferred because they had a new sexual partner whose sexual history is unknown or had sex with a partner who was HIV-positive. “High-risk” donors are deferred for life because, for example, they reported selling sex for money or drugs or had recurring sex with an HIV-positive person. These restrictions apply regardless of gender or sexual orientation, and since this policy was implemented in 2001, transfusion-related infections in Italy have actually decreased.
Today the chances of switching to even a one-year ban for gay and bisexual men may be slipping. In early December, another government advisory group, the FDA’s Blood Products Advisory Committee, refused to vote on the HHS advisory committee’s overwhelming recommendation. It is unclear if or when the FDA will ultimately make a recommendation to change the ban, meaning that another egregious example of discrimination and gay exceptionalism may be here to stay — unless we do something about it.
The next step for advocates is clear. As in so many battles our community has waged and won, we need to build a national movement. Advancements in our understanding of and ability to detect HIV provide the scientific foundation for a blood donation system that defers donors based on their actual risk for HIV, regardless of sexual orientation or gender identity.
But until we force a change, the ban — a relic of the earliest, darkest days of the epidemic — will continue to judge those who wish to give blood by who they love, not the risk they pose.
KELSEY LOUIE is the CEO of Gay Men's Health Crisis.