MEDICINE JUNE 20, 2013
In an important step, the American Medical Association voted to condemn the FDA’s longstanding ban on gay men donating blood at its biannual conference Tuesday. The good news is, this criticism from the largest physician’s organization in the country has as good a chance as anything of kick-starting the review of the ban supposedly underway at the Department of Health and Human Services, which has been languishing in silence since 2011. The less good news is, the AMA’s suggestion is a little bit vague.
The group called the ban “discriminatory and not based on sound science,” and announced that they "support the use of rational, scientifically-based blood and tissue donation deferral periods that are fairly and consistently applied to donors according to their level of risk.” But what would deferring donors—deciding who to turn away, and for how long—“fairly and consistently” really look like? Risky behavior being evaluated across the board, without regard for gender or orientation, one would hope. (When I asked the AMA if that was their position, they declined to comment.)
Fairness, interpreted pretty much however you will, would be a big improvement over the ban, which applies to any man who has had sex with a man—even once—since 1977. It went into effect in 1985, when HIV/AIDS was spreading rapidly and no one understood why or how. In recent years, it’s become a lightning rod for controversy: gay rights advocates say it’s discriminatory; blood banks say it's bad policy—especially when the national blood supply is at its lowest level in 15 years, and a repeal of the ban would deliver in an estimated 219,200 pints of blood each year. In 1985, the FDA didn’t have the technology to rigorously test each donated drop, but today that’s its policy, regardless of the donor. The FDA says those tests aren’t 100 percent effective (though they aren’t far off—the Red Cross estimates that half a dozen people have been infected from a blood transfusion in the last decade), and maintains that at least 61 percent of new HIV cases come from men having sex with men, so therefore the ban is warranted. But clearly that argument stands at the top of a very slippery slope. As a columnist at The Philadelphia Inquirer wrote in April: “Studies show that male circumcision decreases the transmission of HIV from women to men by 60 percent. Are uncircumcised men prohibited from donating? No. And African American women have a higher rate of HIV infection than white women. Are African American women prohibited from donating? No.”
Until this week, the AMA supported a conservative alternative to the lifetime ban: no sex with a man for five years before the day the needle enters your arm. The FDA has indicated that if it does away with the ban, this type of five-year abstinence policy is the most likely outcome. The Red Cross and others favor a one-year policy instead. A number of other countries that adopted bans on gay men donating blood during the AIDS crisis have also shifted to one- or five-year “deferrals”: Argentina, Australia, Hungary, Japan, New Zealand, and Sweden, to name a few.
But these blanket deferrals aren’t scientific, and they aren’t just. In the U.S., heterosexual men and women who sleep with an HIV-positive partner are told to wait a year between that tryst and their next blood donation, at which time, if they haven’t contracted the virus, they’re good to go. (The same policy applies to women who sleep with men who have slept with men, and to people who sleep with commercial sex workers. In all of these cases, the donor doesn’t have to be abstinent for that intervening year—he or she can donate as long as the “risky behavior” is in the past.) In sum, straight people are trusted to faithfully report their exposure to the virus and their test results, but gay men become untouchable if they sleep with anyone at all.
There’s another way to keep the blood supply safe. In 2010, the AIDS advocacy group the Gay Men’s Health Crisis released a report that recommended, among other things, surveying all potential donors for risky behavior. That way, a heterosexual donor who has unprotected sex with multiple partners gets flagged, while a homosexual man who has been in a monogamous relationship for 20 years gets to give. The report notes a few countries that screen donors this way. In Sweden (which also has a one-year deferral policy), donors are deferred for three months after sleeping with a new partner; in France, a person is automatically deferred four months for having unprotected sex. And, both of these windows align with the timeframe of an HIV test, which is considered fail proof at about three months—no need to wait a year.
If the AMA wants to support policies that are “rational,” “scientifically-based,” and, above all, free of prejudice, it should clearly advocate for screening individuals’ actions, not their orientation. Its resolution seems to point in that direction, but it doesn’t spell things out enough to carry much force.
Nora Caplan-Bricker is an assistant editor at The New Republic. Follow her on Twitter @ncaplanbricker.