When the American Red Cross comes to campus at the beginning of every year to host a blood drive, nearly all students can give blood. All students that are, except for gay men. Currently, there is a blood donation deferral in all U.S. blood drives that forbids any man who has had sex with another man in the past year from donating blood.
“I don’t want to subject myself to walking in, saying yes on that form and being told, no you have to go, you can’t do this, while all my friends are giving blood,” CN Pittman, a senior studying science, technology and society, and a gay man, told me about his experience with blood donations. “Should having sex with a man in a year disqualify me from that when unprotected sex for straight couples doesn’t disqualify them? No, that’s not fair. The friends that I have who are gay, who don’t give blood for the same reason that I don’t, would be willing if this wasn’t in place. I would donate blood tomorrow.”
There is a common misconception regarding this rule that it comes from the Red Cross itself, but in fact, it was set in place by the US Food and Drug Administration. Jennifer Port, district manager of donor recruitment for the Red Cross in Durham, explained to me that the Red Cross is bound by the FDA when it comes to blood donations: “Blood is treated like a drug by the federal government … we have to follow the rules set forth by the FDA and we do because we look at the greater good, we are trying to save lives, but some of the rules are difficult for us to understand.”
Port went on to say that, “All the blood donated is tested three different ways for a variety of different things from the West Nile virus and HIV to hepatitis to make sure that it is safe to distribute to the public. And then the hospital will also check it.”
Despite these screenings, the FDA still enforces the deferral. This FDA deferral is actually the recently lightened remainder of what was once a lifetime ban for all men who have ever had sex with another man, but it is clear to see why the gay community may still see this deferral as unfair. When I contacted the FDA to ask them questions about the deferral, they agreed to answer my questions in writing, stating: “The deferral policy is a behavior-based policy, not one based upon sexual orientation.”
I think it is fair to say that a policy regarding men who have sex with men may disproportionately affect gay men. It is important to note, however, that this does not just affect gay men. Port pointed this out to me through a story of her own personal experience from when there was still a lifetime ban. “I talked to a gentleman in his 80s who had been a victim of abuse when he was a child, and he was deferred indefinitely for the rest of his life. He never understood. The gentleman had to pull me aside and say: ‘I can’t donate because I was raped by my uncle when I was a child.’ But you know, you don’t think about things like that.”
After speaking with Pittman and Port about their personal experiences dealing with this deferral, I thought it was clear that this was a completely unfair and unnecessary rule. In an effort to further understand the science behind blood donations, I reached out to Dr. Mehri McKellar, who works at the Duke Division of Infectious Diseases and specializes in HIV medicine. One of the first things that I asked upon meeting her was if there was truth to the claim that gay men are more likely to contract HIV than other groups.
“HIV is spread more easily through anal sex than through other forms of sex, so gay men are the group with the highest risk as a result,” McKellar said.
McKellar also spoke to the validity of the Red Cross’s efforts to screen the blood that is donated.
“The Red Cross does go through a whole barrage of tests with blood donations including testing for antibodies to HIV as well as a NAAT test, a nucleic acid test, and that’s actually looking for the virus itself,” McKellar said. “It can take anywhere from 2-4 weeks for your body to develop antibodies to HIV, so, if people are in this window period where they have been recently exposed, their bodies might not have antibodies already, but this NAAT test should catch it. There are situations though where the NAAT test could be negative but the person still has HIV, but it would be very unlikely to have both a negative antibodies test and a negative NAAT test.”
It is within this unlikely, but possible situation, that the rationale for the deferral exists. Even though gay men make up a small percentage of the population, the majority of people who have HIV are gay men. McKellar explains that even though these tests screening for HIV in the blood are very good, false negative tests are more likely within a few months of transmission. Within a year’s time, one of those tests is going to be positive.
“By giving this year mark [the FDA] are being entirely sure that they are not getting a false negative test,” McKellar said. This may seem like a reasonable explanation for the deferral, but it is possible for gay men to protect themselves from HIV. If a gay man, or any other person, is having monogamous protected sex, it is very difficult to contract HIV.
“Actually, nowadays even if one of the partners had HIV and they are put on treatment for their HIV, meaning that it’s not active in their system, it’s almost impossible to transmit HIV to their partner,” McKellar said. “Presumably they don’t even need condoms in that situation.”
Wondering what it’s like to have HIV with today’s medicine, I asked McKellar how easy it is for patients to do well if they are being treated for their HIV.
“It’s one pill a day for most of our patients,” she said. “That being said, I don’t want to belittle HIV. It is still a major medical problem and you have to go to your doctor on a frequent basis. I wouldn’t wish it on anyone, but it’s definitely much easier than it was even five years ago.”
It is clear that the problem isn’t that treating HIV is difficult, it’s that many individuals who have HIV are not getting the treatment either because they don’t know they have it or because of some socioeconomic reason. Only around 40 percent of people with HIV are receiving the treatment they need.
To be honest, I was expecting to learn from McKellar that there was no reasonable scientific explanation for this deferral at all. Instead, I learned that this is a very complicated issue. If only 40 percent of people with HIV are getting the treatment they need and the majority of people with HIV are gay men, then it is fair to say that gay men are at a greater risk than others to have HIV and not know it while not receiving the treatment they need. Looking at the deferral from a statistical standpoint it seems justified — it’s simply a numbers problem. But denying gay men the option to donate blood is not just a numbers problem, it’s also a civil rights problem.
There are ways to address this issue without disproportionately affecting gay men. Instead of the FDA using a blanket rule to increase safety from the unlikely event of a false negative test, they can emphasize the importance of detecting individuals with HIV, connecting them with care and keeping them in care. McKellar pointed out that people need to have a greater understanding of their status when it comes to HIV.
“I think a lot of patients assume that their doctors are testing them, but that’s not always the case,” McKellar said. “The patients have to realize that sometimes the doctors aren’t automatically ordering an HIV test. The doctor needs to be doing it and the patient needs to make sure that they’re tested.”
There are also ways to help those who are in less fortunate socioeconomic conditions.
“If they don’t have healthcare, there are free HIV testing sites available, and there is even a test available over the counter so you can actually test yourself at home,” McKellar said.
If the FDA put more resources into increasing the awareness and treatment of HIV, then maybe more than 40 percent of those who have the disease will receive the treatment they need. This is the real solution to the problem.
There is no denying that the FDA’s deferral almost certainly succeeds in ensuring safety, but only at the disproportionate expense of gay men. Benjamin Franklin once said, “Those who would give up essential Liberty for a little Safety deserve neither Liberty nor Safety.” Donating blood should be treated as an essential liberty. What is more essential for a citizen to be a full member of a society than to be allowed to sacrifice on its behalf? It is impossible to think about this issue without thinking about the recent tragic mass shooting in Orlando where gay individuals were targeted. How can it be fair to deny gay men the ability to help those victims on the same basis by which they were made targets? A blanket rule that is discriminatory in nature cannot stand.
As Pittman said, “I want to help people and I can’t right now. The world still has a long way to go.”
