Editor’s Note: Ben Tinker is a supervising producer for the CNN Medical Unit. Follow him on Twitter @tinkertime. The opinions expressed in this commentary are solely those of the author.
Current FDA policy imposes lifetime ban on men who have sex with men
New draft guidelines propose shortening ban to 12 months from last sexual encounter
Tinker: Rules still don't provide fair treatment for all
During my senior year of high school in suburban New York in 2003, there was a blood drive held in the school’s cafeteria.
A blood drive is especially significant to young people. It represents one of the first times they feel like they’re making a difference in the world. It’s far more substantial and meaningful than holding a bake sale or working a car wash.
My friends and I were excited to donate. Most of us met the Red Cross donor guidelines:
– Be in good general health and feeling well
– Be at least 17 years old (16 years old with parental consent in some states)
– Weigh at least 110 pounds
I signed up, along with just about everyone else in my class, save for the handful of girls who made sure everyone knew they didn’t tip the scales at 110 pounds.
My civic pride swelled. I could be saving someone’s life, I thought. I’d seen my mom come home with “I saved a life!” stickers many times. While she never made a big deal out of it, she led by example. Now it was my turn.
YES, I’m “feeling healthy and well today.” NO, I’m not “currently taking an antibiotic.” YES, I have “read the educational materials.” I moved along quickly, ticking off all the YES/NO boxes on the standard health history questionnaire, until I stopped cold at Question No. 34.
“From 1977 to the present, have you had sexual contact with another male, even once?”
I didn’t know how to answer this question, so I paused, pondering. The technician noticed my pen hovering mid-air and asked if I had any questions. Sheepishly, I asked her if safe sex counted. You know, with a condom, like I learned in sex ed class from Ms. Dundee.
“Yes,” she told me, “even one time, since 1977.” I wasn’t even born in 1977.
In case you’re wondering, when this happens, they do let you continue the donation process, in an effort to protect your privacy – though your blood is discarded in the end. Instead of walking away knowing your blood could potentially save lives, all you get to walk away with is a Dunkin’ Donut and a box of apple juice, to keep your sugar up.
I kept my chin up, too, but it wasn’t until the summer of 2009 before I fully grasped the ridiculous nature of this policy. I was reporting for CNN on a New Jersey high school student who decided to protest the policy, following his own deferral.
At the time, I asked Dustin Weinstein, now 26, about the rise in heterosexual HIV rates, especially among African-American women.
“I don’t think (barring black women from giving blood) would be allowed,” he told me. “There’d be a huge public outcry.”
He’s right – and that’s exactly the point. There exists right now a major double standard.
If you’re straight, you’re screened based on your behavior. If you’re gay, you’re screened for who you are.
To better illustrate this, allow me to share just two more questions from the questionnaire. “In the past 12 months, have you …
– 17. Had sexual contact with anyone who has HIV/AIDS or has had a positive test for the HIV/AIDS virus?
– 18. Had sexual contact with a prostitute or anyone else who takes money or drugs or other payment for sex?
Under the current policy, if I were straight, but had sex with a prostitute or someone who tested positive for HIV/AIDS, I could wait just 12 months before becoming an eligible donor again. Instead, I am turned away indefinitely, along with every other American man who has had even one sexual encounter with another man since 1977, and even if we followed safer sex practices than our heterosexual peers.
This is a textbook example of discrimination – and the policy has been in place since 1992.
Over the last 23 years, there have been protests, both political and medical, to this policy.
In 2006, the AABB (formerly known as the American Association of Blood Banks), America’s Blood Centers and the American Red Cross said in a joint statement that the lifetime MSM blood-ban was “medically and scientifically unwarranted” and urged the FDA to modify blood donation policies so that they are “comparable with criteria for other groups at increased risk of sexual transmission of transfusion transmitted infections.”
Finally this week, the FDA did just that, issuing new draft guidance for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products.
The new recommendations propose a 12-month deferral on donations for men who have sex with men, no longer a lifetime ban.
Extensive data is already available from countries that have changed their MSM deferral policy to one year, most notably Australia.
“During the five years before and five years after a change from a lifetime deferral to a one-year deferral in Australia, there was no change in risk to the blood supply, defined by the number of HIV+ donations per year and the proportion of HIV+ donors with male-to-male sex as a risk factor,” according to the report.
Other countries that have implemented a one-year deferral policy include Argentina, Australia, Brazil, Hungary, Japan, Sweden and the United Kingdom.
America’s Blood Centers insists our blood supply here in the United States is safer than ever. Thirteen tests, including 10 for infectious diseases (HIV, hepatitis, syphilis) are performed on every unit of donated blood.
The use of donor education material, specific deferral questions and advances in donor testing have reduced the risk of HIV transmission from a blood transfusion from about 1 in 2,500 units prior to HIV testing, to a current estimated risk of about 1 in 1.47 million units, according to the National Institutes of Health.
While it is possible to detect HIV in a unit of blood 9 to 11 days following infection, the NIH says that once a person is infected with HIV, it generally takes about three months for the body to produce enough antibodies to be detected by an HIV antibody test. For some people, it can take up to six months.
Double that and you get a year. It’s similar to waiting twice the incubation period for a disease like Ebola before declaring the virus eliminated.
The question, now, is whether the new recommendations go far enough.
“While the new policy is a step in the right direction toward an ideal policy that reflects the scientific research, it still falls short of a fully acceptable solution because it continues to stigmatize gay and bisexual men,” says David Stacy of the Human Rights Campaign. “This policy prevents men from donating life-saving blood based solely on their sexual orientation rather than actual risk to the blood supply. It simply cannot be justified in light of current scientific research and updated blood screening technology.”
“The FDA may have had good intentions behind this policy, but asking gay and bisexual men to be celibate for a year before donating blood is in practice still a lifetime ban,” says GMHC CEO Kelsey Louie. “Instead of evaluating all potential donors to determine their actual risk to the blood supply, the FDA is telling the next generation of young gay and bisexual men that they are inherently diseased.”
According to a recent Web-based government survey on blood donation rules: “When asked about shortening the deferral period to last male-to-male sexual contact, the most common response was that one year was ‘acceptable as a compromise,’ especially if shorter periods might be considered after confirming the safety of the new policy.”
Sexual discrimination aside, screening affects the general population that relies on a safe and plentiful blood supply for medical treatment.
Under current rules and regulations, just 38% of Americans are eligible to donate blood, according to the AABB. And only 3% of those eligible actually donate, according to the Red Cross. We simply can’t afford to turn away perfectly healthy blood donors for the wrong reasons. Your life may depend on it.
Today marks the beginning of a 60-day comment period, during which experts and members of the public are encouraged to submit comments to inform the official guidelines, which are expected to be issued by the end of this year.
I encourage you to join me in sharing your research and your thoughts. Together, we can make our voices heard and initiate logical, long-overdue change.
Most of my friends tell me they feel great after giving blood, not just physically, but mentally – knowing their donation of just 1 pint could be used to save up to three lives.
I hope to one day know that feeling.