This year, the U.S. Food and Drug Administration eased the decades-long blood ban on donations from gay and bisexual men that had stood since the height of the HIV epidemic in the ‘80s. The new law bars only active homosexual men, which is to say men who have had sex with another man in the last year. In changing the policy for the slightly better, the FDA alluded to a major issue without actually confronting it: When it comes to minimizing the risk of HIV transmission, it’s not straight or gay that matters, but safe and unsafe.
What it should come down to is a question of safe or unsafe. Some countries have switched their policy to screen for risky behavior, regardless of sexual preference. Italy’s done it, and the research shows that it hasn’t had a significant impact on the country’s HIV epidemic. What’s stopping us from doing the same?
According to Sarah Schlesinger, a leading researcher on HIV vaccines at Rockefeller University, it’s important to put this query in historical context. “In the LGBTQ community there is a long history of stigmatization — inappropriately — for all kinds of things, and this can’t help but resonate in that way,” she told INVERSE. “In the blood banking community, there is a memory of not being rapid enough to respond or worried enough about the risks of transmitting viruses — unknown viruses — via blood transfusion therapy. And so those histories inform both positions strongly.”
The history of HIV transmission through blood donation is, to put it bluntly, devastating. When HIV was first reported in the U.S. in 1981, health officials simply didn’t know enough about the virus to deal with it. Blood banks didn’t begin screening the blood supply until 1985. Thousands of people were infected after receiving transfusions, and many of them died. There is a justifiable legacy of fear, and this legacy is not just because of HIV: Blood-borne, sexually transmitted viruses — such as hepatitis B and C, human herpes virus 8, human papilloma virus — can be spread rapidly through banks.
The current blood donation policy of banning men who have had sex with another man within a year doesn’t — or shouldn’t — put any fears to rest. It not only perpetuates the false notion that gay men are the only carriers of HIV, but it also fails to minimize the risk of transmission. Any person, regardless of sexual preference, can be a potential carrier of HIV if they’re not practicing safe sex. “If you have someone with a thousand lifetime sexual contacts, no matter what gender they are, it matters a lot,” Schlesinger says.
The policy also excludes a huge proportion of gay men that are perfectly healthy donors. While it’s true that men who have sex with men are the largest HIV-carrying demographic, those infected with the virus make up a very small proportion of the overall gay male population. According to a study by the Williams Institute at the UCLA School of Law, fully lifting the ban on men who have sex with men could increase the US blood supply by 2 to 4 percent, which, the researchers estimate, could save the lives of over a million Americans.
Science isn’t homophobic. It can’t be. What the science says is that potential donors need to be screened on the basis of their sexual behavior, not their sexual preference. How many partners have you had? Do you practice safe sex? Whether a donor is gay, straight, or gender-fluid, these are the questions blood banks need to be asking. The government’s current policy doesn’t force us to ask the right questions about our sexual behaviors, even though science tells us they’re the most obvious questions to ask.
In addition to Italy, an increasing number of countries are lifting the ban on gay blood donation, including Chile, Spain, Mexico, Poland, Portugal, South Africa, and, interestingly, the notoriously gay-hating Russia. To be fair, the FDA has addressed the reasons it hasn’t switched to an individualized risk assessment policy, citing resource constraints and referencing the fact that HIV infection is higher in men who have multiple gay partners compared to men with multiple opposite-sex partners. But, again, that’s comparing apples to gay apples, not to the apples most likely to be carrying disease.
And there’s still the stigma. Is it less important than the health of blood receivers? Yes, but that doesn’t make it acceptable.
“It’s not clear to me that there’s been any demonstration that deprivation of social equity is yielding a safer blood supply,” says Schlesinger. “I think we should strive to have both.”