Friday, July 12, 2013

Allowing Gay Blood Would Increase Safety

The FDA still maintains a lifetime ban on gay and bisexual male blood donors. It is tempting to see this ban as overt homophobia, although I'd like to think that the decision-making body at the FDA has some other rationale in mind, at least in part.
They claim is that the ban increases the safety of the blood supply.

And so we have the ideal set-up, pitting "Safety" against "Homophobia". A battle between Rights, with Science judging the fight.

Is a lifetime ban on gay blood donors safer than allowing gay blood donors to give without restriction? Sure, but that's not an alternative that anyone is advocating for.

Some advocates for changing the policy deferring gay/bi male donors claim that all the blood is tested anyway, so we don't need the ban.
All the blood is tested for HIV, but there are cases where the blood tests negative even though it is infected, and one of those circumstances can be when a person has just been infected, and often the blood is highly infectious during that "window period". So, it is judicious to reject gay/bisexual donors who might have been infected recently. I think the best solution there would be to apply the same criteria used to defer anyone else who might have been infected recently, to say you can't donate for a year after sex with another man, even with a condom.
I've heard two logical arguments for why to exclude gay and bisexual men from donating blood for longer than a one year window - one is that there are extremely rare cases where an established HIV infection would still test negative, and the other is that the blood is tested only for those viruses that are pretty common and that they have good tests for - it isn't possible to test for everything, certainly not things we don't even know exist yet. I think both of these arguments from the side of "Safety" are compelling, but they don't operate in a vacuum.

Nobody is arguing for gay and bisexual men to be able to donate without restriction, so the question is what restriction will maximize "Safety" while reducing the role of "Homophobia" in making blood donor deferral policy? Often this is portrayed as though it is a balancing act, where every reduction in homophobia compromises safety.

But there are good reasons to think that reducing the role of homophobia in blood donor deferral policy would actually increase safety. Notwithstanding all the discussion about "window periods" and emerging infections and so on, there are three important phenomenon going on related to how people respond to a deferral policy that reeks of homophobia. How do people react when confronted with a policy that sounds, smells, and tastes like prejudice?

Frankly, some people are comforted by it. I'm sure there are lots of people who feel like the blood supply is safer because they believe gay and bisexual donors are excluded from it. They may make my stomach churn, but they don't make much difference in my argument.

Most gay and bisexual men are revolted by the policy, and as a result wouldn't touch blood donation with a ten foot needle. Again, not relevant to my argument.

Some gay and bisexual men, however, have learned that the easiest way to negotiate homophobia is to lay low. Keep your voice down and your wrists locked in position. Where this presents a problem is that given the choice between potentially outing oneself or deflecting the question about whether you've had 'sex with another man, even once', some men who should be deferred just slip past the question using the same techniques they've learned in dealing with other homophobic situations. Changing the policy so that it doesn't reflect homophobia (say by changing the deferral criteria to be the same as other HIV risk factors) would actually make the blood supply safer in regards to this group.

The second group I'm thinking of is predominantly heterosexual, but really could potentially include any donor. By including a deferral policy that sounds, smells, and tastes like rank homophobia, it "cheapens" the validity of other deferral policies, leading to people being less careful answering them. What I mean is that when the basis of one deferral policy is so obviously shaky, some potential donors will think that the other criteria (such as which drugs you've taken recently, or travel history) are also not strongly based in the need to keep the blood supply safe, and may be "encouraged" to give a less than honest answer, especially if they feel any social pressure to donate.

The third group I'm concerned about are the people who don't start giving blood at all. And the blood banks are worried about them too. Lots of people become regular donors for life after getting started in high school and college. But young people these days are especially sensitive to the acrid stench of homophobia. So by maintaining this policy that sounds, smells, and tastes like homophobia, the FDA is turning potential donors away in droves. Potential donors who are at very low risk for HIV and other blood-borne pathogens. Potential donors who otherwise would be likely to save dozens of lives over the coming years. There have even been organized efforts to keep blood drives off campuses until the policy changes.

The most dangerous pint of blood is the one that's not there when you need it.

Dear FDA, it's time to bring your deferral policy into the 1990's. Dump the homophobia and increase the safety of the blood supply.

1 comment:

  1. If you are homosexual and need a blood transfusion, would you go without the transfusion or would you take blood from someone who is homosexual AND tests negative on the standard blood tests?