Proposed FDA Blood Donation Policy Perpetuates Stereotypes and Stigma

The FDA's proposed policy change for blood donations by gay and bisexual men--from lifetime deferral to eligibility after a year of sexual abstinence--still makes no sense and will continue to stigmatize gay men.

The agency claims the new policy would be based on medical science. But how "scientific" is it to accept someone's word that he hasn't had sex in a year? Will a doctor's note be required to certify his celibacy?

In three decades of writing about LGBT issues, I've never seen a reliable census of the nation's gay population. The FDA cites a study claiming that "men who have sex with men" account for seven percent of the population--and that, even more specifically, only about half of us have had sex with another man in the last five years. This suggests that about half of all gay and bisexual men--the unsexed half--could become blood donors if the FDA approves the proposed new guidelines.

Everyone concedes the current lifetime ban makes no sense. The American Red Cross and blood banking organizations in November called the policy "medically and scientifically unwarranted." In its place they supported "rational, scientifically based deferral periods that are applied fairly and consistently among blood donors who engage in similar risk activities."

The proposed policy is neither rational nor scientifically based. Current HIV screening procedures have been highly successful in preventing the virus from entering the nation's blood supply. The FDA estimates the risk of HIV infection from a blood transfusion in the U.S. today at about 1 in 1.47 million. What's more, the agency says no transmissions of HIV, hepatitis B or hepatitis C have been documented in U.S.-licensed plasma derived products in the past two decades.

Before the FDA instituted the lifetime deferral policy in 1985, gay and lesbian activists pushed for self-deferral from those whose behavior put them at potential risk. In my book Victory Deferred: How AIDS Changed Gay Life in America, I describe a 1983 brochure, "What You Should Know About Donating Blood," developed by activists and the regional American Red Cross blood bank program in Boston. This was a year before the discovery of HIV, when no one knew exactly what was causing AIDS. The brochure requested self-deferral by anyone who had ever had hepatitis, injected drugs, or traveled to a malarial area. It added the line, "If you're a man with anonymous or multiple sexual partners, please don't donate."

The FDA's proposed guidelines recommend that donor educational materials also ask about specific behaviors: whether you've tested positive for HIV; exchanged sex for money or drugs; used non-prescription injection drugs; or in the past 12 months had sex with an HIV-positive person, received a transfusion, had a needle stick, tattoo, ear or body-piercing, syphilis or gonorrhea.

Adding "sex with another man" to the list as an inherently risky behavior is not only broad but also highly stigmatizing. Why? Not all gay and bisexual men are at equal risk because not all of us engage in high-risk unprotected anal intercourse.

It would make much more sense--and would be more medically precise--to ask all prospective donors, regardless of sexual orientation, whether they have had unprotected anal intercourse within the past 12 months. It's the riskiest sexual behavior of all, whether between two men or a man and woman, and the leading cause of HIV infections among men who have sex with men.

The FDA cites the "robust data" from Australia's policy change as a basis for its own proposed new guidelines. The Land Down Under moved from a lifetime deferral to a 12-month celibacy requirement for men who have sex with men. FDA references Australia because the country also has a voluntary blood donor system "and has a similar percentage of men reporting male-to-male sexual contact at some point in their lives." Of course we know not all men report this personal behavior to anyone, let alone researchers, and often don't admit it even to themselves.

If the FDA wants to look abroad for a successful model, I suggest looking to South Africa. The country has an estimated 6.3 million people living with HIV, five times the estimated 1.2 million in the U.S. As many as 33 percent of gay and bisexual South African men are believed to be HIV-positive.

Yet South Africa in 2014 changed its own lifetime deferral policy for gay and bisexual men because it was criticized as discriminatory--and in fact was discriminatory in that heterosexuals, who have a higher rate of HIV/AIDS in South Africa, could engage in risky sex yet still donate blood.

The new South African National Blood Service policy actually favors people in monogamous relationships--regardless of their sexual orientation. Rather than focusing on the sex of one's partners, the policy bans anyone who has a new sexual partner or multiple partners in the previous six months.

So why won't the FDA likewise adopt a general policy for all prospective donors, regardless of sexual orientation? Or at least distinguish between gay and bisexual men in monogamous relationships vs. those with new and/or multiple partners? Still more dubious numbers.

This time the agency claims that data "do not support the concept" of low risk for monogamously coupled men because it says infidelity among male couples is about the same, 25 percent, as for heterosexual couples. And HIV is more prevalent among MSM with multiple partners.

This means of course that heterosexuals--even those from populations known to have high rates of HIV infection, such as African-Americans--can have as many partners as they want, engage in whatever sexual behavior they choose, yet remain completely acceptable as blood donors.

The bottom line is this: The proposed new blood donation guidelines are a step forward in that they acknowledge the advances in screening mean infected blood is less likely than ever to get anywhere near a transfusion recipient. That is real progress.

But instead of frankly addressing specific behavior that renders a would-be donor ineligible, the FDA is perpetuating stereotypes of gay men who can't be trusted and assumptions about what "all" gay men do in bed.

If it's a rational, scientifically based policy the FDA wants, it needs to get past the assumption that all gay and bisexual men are vectors of "bad blood" merely for having sex.