Still Waiting After All These Years: FDA and Gay Blood Donation

Update (December 30, 2014): The FDA recently announced that it would relax the lifetime ban on blood donation for men who have sex with men. Instead of banning all men who have had sex with men after 1976 for life the new rule permits gay men who have been celibate for a year to donate. This rule does not make exceptions for monogamous partnerships. It’s not the comprehensive, behavioral risk assessment that countries like Italy, Spain and Russia conduct and it still stigmatizes all gay sex as inherently risky. This is far from a victory for civil rights; it’s more like a baby step.

The FDA recently balked at lifting the 31-year-old ban on blood donations from gay and bisexual men. The FDA erected the ban during the AIDS crisis, before HIV was a known and understood virus. Naturally, at this time blood tests did not exist for HIV. The ban bars any gay man who had had sex with another man at any point after 1977 from donating blood.

The FDA was not considering lifting the ban entirely. Instead, it would require that gay and bisexual men be celibate for a year prior to donating blood. This deferral policy is similar to the policies of Australia and the United Kingdom. Other nations have longer periods in which gay and bisexual men have to remain celibate; Canada and New Zealand require five years of celibacy while South Africa requires six months. None of the data from these nations indicates that there is an increased risk of HIV transmission from blood transfusions.

The FDA does not take the same hard line against straight people. Women who have had sex with gay or bisexual men are allowed to donate after twelve months. Straight people who have sex with prostitutes can donate after a year. Straight people can even have sex with HIV-infected partners and donate blood after a year. Nonsensically, if you’re straight and have multiple, anonymous sex partners you’re still eligible to donate. Under the current policy a man who has had oral sex with a single partner since 1977 would be out of the donor pool but a woman who has unprotected sex with either of those two men is not excluded. Dr. Charlene Garlaneau, Assistant Professor of Women’s Studies at Wellesley College, points out “this dichotomy reflects and reinforces common stereotypes: MSM as risky and potentially dangerous sexual beings while their female sexual partners are victims and “innocent bystanders.” In her article, Blood Donation, Deferral, and Discrimination: FDA Donor Deferral Policy for Men Who Have Sex With Men from the American Journal of Bioethics she points out that the FDA has routinely classified male homosexual activity as a “dangerous lifestyle choice” while framing any female contact with gay or bisexual men as victims of incidental exposure.

Behavior-based policies like these make the FDA’s categorical rejection of all men who have had sex with men since 1977 patently unreasonable. Many nations, including Spain, Italy, Poland and famously anti-homosexual Russia don’t have policies that categorically bar gay and bisexual men. These nations opt to prohibit donations based on the behavior of the donor. If the donor changes sex partners they are prohibited from donating for a short time. If donors engage in unprotected sex with multiple partners, use intravenous drugs or pay for sex they may be banned from donating blood for life.

This isn’t the first time that the FDA has banned a group of people from donating based on something unrelated to sexual behavior. In 1990 the FDA banned all Haitians from donating blood after the CDC erroneously identified Haitian nationality as a risk-factor for HIV in 1982. The CDC removed Haitians as a risk group just two years later in 1985 citing a lack of epidemiological evidence that Haitian origin was a risk factor for the disease. The FDA ban prompted protest from Haitians and Haitian-Americans. 50,000 people marched in New York City to protest the ban. The FDA voted soon after to cease using geographic and national origin as criteria for donor bans.

The current ban on gay blood donation imposes a homophobic, zero tolerance, policy without any regard for individual behavior. This is inexcusable in light of the tolerance for risk-factor behavior for straight people. It frames gay and bisexual men as tainted or diseased even in the absence of a diagnosis. This same framing of good and bad blood was present in the blood banks of the 1950s. Blood donated by black donors was separate from white donors and never given to white patients. “White blood” could be given to black patients in an emergency.

Gay and bisexual patients are in the same situation today only without the option of being given “gay blood”. If you’ve ever had sex with a man your blood is too dirty to donate to other men who have done the same. Categorically rejecting the donations of healthy gay and bisexual men is humiliating, stigmatizing and unnecessary in an era of accurate, widespread, early HIV testing. (the NAT assay shortens the undetectable window to 12 days). The Red Cross, The American Medical Association, the AABB and America’s Blood Centers all support lifting the lifetime ban. It’s well past time for the FDA to do the same.