Bigotry and blood

Thirty years ago, the U.S. Food and Drug Administration banned any man who has had sex with another man from donating blood. The policy was an understandable, and perhaps even reasonable, response to the devastating HIV/AIDS epidemic. At the time, blood-screening technology for detecting HIV was rudimentary and imprecise. Beyond knowing that a disproportionate number of gay men were infected, doctors’ knowledge of HIV/AIDS was limited. The very fact that doctors referred to AIDS as gay-related immune deficiency, or GRID, in the 1980s epitomizes the minimal understanding. Consequently, scientists and the nation’s blood banks considered a ban essential to ensure the integrity of the blood supply.

However, the science of the past should not determine the public policy of the present. Since 1983, there have been substantial, revolutionary advances in blood-screening technology and our understanding of HIV/AIDS. Today, all donated blood is tested for HIV. Given the sensitivity of today’s blood testing, only one HIV-positive donor will be missed out of one to two million people giving blood. Even the FDA acknowledges that modern HIV tests are “highly accurate.” Accordingly, the American Red Cross now calls the policy of excluding homosexuals “medically and scientifically unwarranted,” a conclusion shared by the American Medical Association, American Blood Centers and the American Association of Blood Banks.

And yet, the policy still stands. Thus, I fear that the FDA’s ban is now driven by discrimination, not data. Implicit in the policy is an egregiously unjust double standard. Two HIV-negative men in a committed, monogamous relationship (maybe even a marriage, dare I say it) are banned from donating blood for life. A heterosexual male who has sex with an HIV-positive female would be banned for 12 months, at most. For this reason alone, the prohibition contravenes the Equal Protection Clause of the 14th Amendment. To quote Justice White, the Equal Protection Clause is “a direction that all persons similarly situated should be treated alike,” a principle the FDA’s ban flagrantly violates by insisting that an HIV-negative homosexual is less suitable to donate than a “similarly situated” heterosexual. The policy also perpetuates pernicious and pervasive myths about gay men. Stereotypes hold that gay men are sexually promiscuous and the only people who contract AIDS, both of which — though it should go without saying — are incredibly false.

The FDA reaffirmed the ban this past summer and routinely defends its regressive policy in two different ways. First, the government agency contends that the ban does not single out gays because it bans heterosexual males who have engaged in homosexual sex from donating blood, as well. The ban, the FDA asserts, does not offer “any judgment concerning the donor’s sexual orientation.” Frankly, this argument is ludicrous. To paraphrase Ruth Harlow of Lambda Legal, this type of reasoning is tantamount to arguing that a law banning Roman Catholic mass applies equally to Catholics and non-Catholics. Second, the FDA declares that its prohibition is necessary to “protect all people who receive blood transfusions” on the grounds that “men who have sex with men and would be likely to donate have an HIV prevalence that is at present over 15-fold higher than the general population.” It claims that these men are “at increased risk for HIV, hepatitis B and certain other infections that can be transmitted by transfusion.” This strain of logic is extraordinarily dangerous. As astutely noted by William Saletan of Slate, black women are 18 times more likely to have HIV than white women. Is that a reason to bar black women from donating blood for life? Banning black women from donating blood strikes me as grossly unjust, but it seems to be the logical extension of the FDA’s statistical argument.

Ultimately, sexual orientation does not determine HIV prevalence; risky sexual behavior does. Instead of categorically excluding gay and bisexual men from giving blood, the FDA should focus on screening for risky behaviors, not on screening by social, ethnic or other groups. In this regard, America can learn from Mexico, Italy and Spain, all of which recently ended their bans on gay male blood donations and moved toward a focus on individuals and their actions. Rather than asking men whether they “had sexual contact with another male, even once,” the FDA should inquire about an individual’s condom use, drug use, number of partners and relationship status. It should ask for the last time an individual was tested for HIV, the last time an individual had sex and other germane factors.

Our country faces a blood shortage, which is one of the primary reasons I wanted to give blood. In June of last year, USA Today reported that the American Red Cross’s “national blood supply [was] at its lowest level in 15 years,” even though the organization was faced with unprecedented demand. A flyer for a blood drive in Frist Campus Center reminded me that donating can all too often be a question of “life or death” for recipients. As a young, healthy and HIV-negative male, I felt (and feel) a responsibility to do my part. It’s far past time for the FDA to update its discriminatory, antiquated policy and let people like me donate.

Duncan Hosie is a freshman from Belvedere, Calif. He can be reached at dhosie@princeton.edu.