health lab by dr. joel
There are two things I don’t like about Valentine’s Day. First, I’m usually single. Second, thanks
to the cutesy connection with hearts and gifts, there are blood drives everywhere you turn.
I used to love blood drives. My father is a multi-gallon blood donor, and always taught me
it was an important thing to do for other people that doesn’t cost anything
but time. Going with him to the blood bank was one of my earliest encounters
DonATInG BLooD
with medicine. The first time I went with him, I got sick just watching the blood
drip. But I kept going, and I got over it. When I was finally old enough to donate,
they put the needle in, and I almost passed out. I kept giving blood, with the
for Men
room closing in on me each time, because I felt like it was the right thing to
do. After the first time I slept with a man, I went to give blood anyway. I hadn’t
WHo SLEEp
even thought about it until I was reading the list of “deferred donors” and came
upon “Have you had sex with another man since 1977?” Rather than complete
the donation process and “defer” at the end, I left. And I’ve never gone back.
With Men
Had I decided at that moment to never have sex with a man again, the current
guidelines say I can never give blood. The FDA makes the rules for the blood
supply, and as far as they are concerned, that one sexual encounter (and each
of the subsequent ones) has tainted my blood with a mark that no number of
negative HIV tests will ever remove. I’ve had my share of subtle slights as a gay
man, but not many things actually make me feel like a second-class citizen. As
a physician, this one does it like a punch in the gut, or perhaps a bit below.
I’ve read some of the research and I understand the reasoning. Men who
sleep with men (MSM) are more likely to have HIV. Accepting our blood risks
putting more infected units into the blood supply. Since the tests aren’t
perfect, that means more infected blood might sneak through. That puts
more people’s lives in danger, and it could make people lose faith in the blood
supply. Unfortunately, it’s not quite that simple. There are other groups, such
as people with multiple partners, who have an increased risk of HIV and are not
excluded. The FDA, at least on their website, doesn’t set a number for accept-
able risk – they just say which groups are excluded. Some groups at increased
risk for HIV or other transmissible diseases can donate after a limited deferral
period. Transplant recipients, for example, can donate after one year. In addi-
tion to MSM, recipients of the lifetime ban are IV drug users, sex workers and
people exposed to mad cow disease.
It also turns out that not all MSM have the same HIV risk. Safe sex and mo-
nogamy can decrease the risk of contracting HIV and other diseases, but these
practices are not part of the analysis. According to the FDA, this is because
“no donor eligibility questions have been shown to reliably identify a subset
of MSM who do not still have a substantially increased rate of HIV infection
compared to the general population”.
The FDA started an MSM deferral policy in 1983, when the risk of contracting
AIDS from blood transfusion was first recognized. Despite new information
and better tests for HIV (and other diseases), the policy has stuck. It was last
reviewed and continued in 2007, despite testimony from the American Red
Cross and other groups stating that it “does not appear rational to broadly dif-
ferentiate sexual transmission via male-to-male sexual activity from that via
heterosexual activity on scientific grounds”.
Groups like the Gay and Lesbian Medical Association (GLMA) continue
to lobby the FDA to change this policy. Even if they win, I probably won’t be
rushing off to the blood bank. The two most frequently discussed alternatives
are to limit the deferral period for MSM to either one or five years after a homo-
sexual act. Those changes might make things fairer, but it would take a pretty
slow year or a lot of resolve for me to donate. I’d have to consider it, though. Blood donation
comes up at Valentine’s Day because it is an important act of love for people we don’t know.
We just need to come up with a way to protect transfusion recipients without discriminating
based on whom else we love.
78 RAGE monthly | FEBRUARY 2009
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