Why Is Blood Donation Still Incredibly Homophobic?

When University of Missouri defensive end Michael Sam is selected in this week's NFL draft, it will be a soft milestone—the first time that an openly gay athlete is drafted into one of the major American sports—making discrimination based on sexuality seem that much more archaic. But you might not realize that there are certain facets of modern life where such discrimination is not only accepted, it's federally mandated.

Under FDA rules, for example, a man who has had sex with another man is ineligible to donate blood in the United States, even if he has a clean bill of health. Michael Sam may soon become a progressive icon of courage and acceptance, but if he wants to donate blood and acknowledges sexual activity with another man, he will be turned away at the door. It's an outdated, homophobic artifact of the HIV/AIDS epidemic, rooted in the ignorance of the time.

The FDA established the ban in mid-1980s after public health officials realized that thousands of hemophiliacs—including, most famously, Ryan White—were receiving transfusions of HIV-infected blood. Patients undergoing surgery were also transfused with tainted blood, including tennis legend Arthur Ashe, who is believed to have contracted HIV from a transfusion during an operation on his heart. Without a good way to test blood for HIV, the FDA decided to classify any man who had engaged in a sex act with another man in the highest-risk blood-donor category—the same category as IV drug users and people with possible exposure to mad cow disease—and forbade them from donating blood indefinitely. Many other industrialized countries followed suit. As the FDA explains on its website:

"FDA's primary responsibility with regard to blood and blood products is to assure the safety of patients who receive these life-saving products. FDA uses multiple layers of safeguards in its approach to ensuring blood safety, which include donor screening and deferral based on risk factors, blood testing for markers of infection, inventory controls, and deferral registries. The use of these multiple layers helps to assure the safety of the products in the event that one layer fails. A history of male-to-male sex is associated with an increased risk for exposure to and transmission of certain infectious diseases, including HIV, the virus that causes AIDS. Men who have had sex with other men (MSM) represent approximately 2% of the US population, yet are the population most severely affected by HIV. In 2010, MSM accounted for at least 61% of all new HIV infections in the U.S. and an estimated 77% of diagnosed HIV infections among males were attributed to male-to-male sexual contact."

This was done before there was a reliable test for HIV. But today we can easily test blood for HIV (with the over-the-counter mouth swab OraQuick Test) and for other viruses like hepatitis B and C. In just a few hours, I can tell someone if they have HIV or not. A lot has changed in 30 years, but despite these advances, FDA policy remains stuck in the '80s.

The United States still mandates that if you answer yes to any of the following, you are banned from donating blood:

  1. For men: Have you had sex with another man, even once since 1977?
  2. Have you ever injected intravenous drugs?
  3. Have you engaged in sex in exchange for money or drugs since 1977?
  4. Have you ever had clinical or laboratory evidence of AIDS or HIV infection?
  5. Have you received clotting factor concentrates for hemophilia or other clotting disorders?

And if you answer yes to having sex with one of the following in the past 12 months, you're banned for a year:

  1. A person who has HIV infection or AIDS
  2. A prostitute
  3. A person who currently or previously used intravenous drugs
  4. For women: a man who has had sex with another man
  5. A person receiving clotting factor concentrates

So as it stands, a married homosexual man in a monogamous relationship who practices safe sex and is HIV-negative is considered more of a threat to the blood supply than a straight man who just had sex with a prostitute. To put it mildly, this policy is preposterous; it's a relic from the 1980s that has outlived whatever usefulness it had and now simply formalizes discrimination. More importantly, it has no public health benefit, which is why so many countries are now reconsidering the ban. England lifted its lifetime ban in September 2011, and changed the policy to simply restrict men who have had sex with another man within the past 12 months. Canada's ban is five years, and South Africa's is six months; Spain and Italy don't prevent gay men from donating blood at all. This variation obviously has to do with politics, not science, and the United States is lagging behind.

In 2006, the American Red Cross, in conjunction with the American Association of Blood Banks and American's Blood Centers, presented a joint position to the FDA's Blood Products Advisory Committee (BPAC) stating that "the current lifetime deferral for men who have had sex with other men is medically and scientifically unwarranted." Bowing to public pressure, the United States Department of Health and Human Services Advisory Committee on Blood and Tissue Safety finally revisited the outdated policy in 2010 and agreed that the ban on blood donations from gay men was "suboptimal" but kept it in place pending additional research to "create a road map forward," as one panelist said.

If you believe that was a good decision, one that errs on the side of caution and will ultimately protect our nation's blood bank from high-risk donors, it's useful to know that many of those who are banned simply ignore the policy and give blood anyway. In one study, 42 percent of homosexual men said they had donated blood, which means that the FDA's discriminatory policy isn't even being followed. So what's the point?

Advances in our ability to rapidly detect HIV and other infectious diseases like hepatitis B and C, coupled with a foreseeable shortage in the blood supply, have evaporated any benefit to the ban on donations from sexually active gay men, and this should compel the US Food and Drug Administration to stop excluding healthy gay donors. It's outrageous to think Michael Sam and others can shed blood, sweat, and tears on the athletic field but can't give to a blood bank.

Matt McCarthy is board-certified in internal medicine. You can follow him on Twitter here.

Image by Jim Cooke.