The Blood Stigma Continues

More than 30 years ago, when the nation was in the grips of hysteria about the dangers AIDS posed to Americans, the federal government imposed a ban on donating blood on any man who had engaged in sex with another man since 1977. The “deferral” was lifetime.

Just before Christmas — ironically a time of year when the nation’s blood supply can become critically low — the US Food and Drug Administration announced a proposed rulemaking change that was pitched as a loosening of the restrictive policy, long criticized for its lack of a sound scientific basis, not to mention its stigmatizing impact.

Unfortunately, the proposal offers no significant advance on either front. And frankly, after years of advocacy for discarding a discredited public health policy, the idea — served up as reform — is insulting.

The FDA’s proposal is to limit the deferral from donating to only those men who have had sex with other men during the previous year.

That’s right — as a gay man, you can now join in the community of civic-minded blood donors as long as you’ve been celibate for a year.

This is an absurd outcome for a reform effort long urged on the government by expert groups including the American Medical Association, the Red Cross, America's Blood Centers, and the Association of Blood Banks.

HIV is not a gay virus or a bisexual virus or a transgender virus. It is a virus transmitted through known risk factors, and other countries — from Mexico to Spain to Italy — have satisfied themselves they can protect their blood supply by screenings based on risk assessment, not categorical exclusions.

One important safeguard on risk is testing. Even for those who have engaged in risky behavior, transmission can be confirmed or ruled out within 45 days. How the FDA could possibly have arrived at a one-year deferral — even had they assumed that every instance of gay sex involves HIV risk — is unclear.

Some might argue that potential donors may not be honest about their sexual risk. But the entire donation scheme is based on an honor system. Gay men are only excluded from donating because we are unwilling to lie about being gay and sexually active.

WHYY, the NPR television outlet in Philadelphia, quoted the FDA as saying that it rejected self-assessments of risk as unreliable and that “assessment of high-risk sexual behaviors would be highly burdensome on blood donation establishments and potentially offensive to donors.”

That statement should concern even those who don’t care that sexually active gay and bisexual men are categorically barred from donating blood, because it suggests the FDA is inattentive to the HIV risks brought to the blood supply by others. Absent some level of risk assessment of donors or DNA testing of donated blood, the FDA would seem handicapped in assuring the nation there are not HIV risks to the blood supply.

And, conversely, if those other sensible and medically prudent steps are taken, there is no justification for blanket bans.

Irrationally banning people from donating blood hurts those who need blood for life-saving procedures. And forcing gay and bisexual men, on every occasion when they are asked to give blood — for example, on the job — to respond, “No, I am barred by federal policy from helping out here” is an unnecessary humiliation visited on them.

The FDA and Health and Human Services Secretary Sylvia Mathews Burwell need to go back to the drawing board. The answer they’ve offered just ain’t good enough.