Why the Lifting of the Gay Blood Ban Really Isn't

Donations Accepted If You Don't Have Sex for a Year... or Get a Tattoo?

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On December 22, 2015, the U.S. Food and Drug Administration (FDA) officially revised a decades-old policy banning gay men from making blood donations due to what they consider to be the high risk for HIV transmission.

In their revised guidelines, the FDA panel now allows gay men who have not had sex in previous 12 months to donate, the celibacy of which is confirmed by filling out a signed questionnaire. All other gay men, including those who have consistently used condoms, will continue to be banned.  

While some have seen this as the first step to lifting the 32-year-old policy, many activists and medical authorities have declared the decision both outdated and discriminatory, especially in light of the fact that HIV risk is assessed on a case-by-case basis for heterosexuals.

When questioned about this discrepancy in January, the FDA responded by stating that it would be "highly burdensome to blood donation centers and potentially offensive to donors" if individual assessments were made, while insisting there was still "not enough evidence" to justify the reduction of the year-long waiting period.

Among the policy's long-time critics, the American Medical Association, the Red Cross, the American Association of Blood Banks, the American Association of Osteopaths, the New York City Council and the Assembly Judiciary Committee in California have each called for an end to the ban at a time when an increasing number of countries—including Spain, Portugal, Italy and South Africa—have lifted their bans altogether.

History of the U.S. Gay Blood Ban

In 1983, the FDA recommended that any man who has had sex with another man since 1977 be banned from donating blood for a lifetime. The policy was established at a time when there was neither treatment nor the means for HIV testing. (It was only in 1985, in fact, that the first HIV test was licensed by the FDA and not until 1987 that the first antiretroviral drug, AZT, received approval.)

Certainly at the time, with gay men comprising the majority of HIV cases, many in the public had profound doubts as to the accuracy of HIV tests when screening blood supplies. Those fears were largely exacerbated when Ryan White, an Indiana teenager, was banned from attending public school in 1985 after it was discovered he acquired HIV from a blood transfusion.

In 1990, the FDA also made the decision to ban Haitians—also hard hit by the early epidemic—arguing that since HIV was primarily transmitted through heterosexual sex in this population, it would be harder for them to identify high-risk individuals. That banned was lifted less than a year following angry protests from 50,000 activists in New York City.

By the late 1990s, following the advent of combination antiretroviral therapy and the introduction of newer-generation HIV tests, critics began to question the validity of the ban when in 1995 the estimated risk of acquiring HIV from blood transfusions was roughly one out of 600,000 cases. By 2003, that risk was seen to be around 1 in 1.8 million.

Furthermore, from 1999 to 2003, only three Americans out of estimated 2.5 million blood recipients were confirmed to have acquired HIV the from transfusion of bloods following a false negative HIV screening.

Responses For and Against the Gay Blood Ban

To date, a significant number of countries have policies similar to that of the U.S., including Argentina, Australia, Brazil, Japan, Sweden and the United Kingdom. Many others have maintained indefinite deferrals, among them Belgium, Denmark, France, Greece and Germany.

Supporters of the FDA policy (including the U.S. Department of Health and Human Services, which unanimously recommended the one-year deferral) cite the continuing high rates of HIV among gay and bisexual men in the U.S., the population of which accounts for around 63% of all new infections every year.

While acknowledging the statistics, opponents have countered that gay and bisexual men, including those who acquired HIV through injecting drug use, represent little more than half (57%) of the 1.1 million Americans infected with HIV, making the a gay-specific ban all the more slanted and unreasonable.

They further point to the irrationality of the FDA ruling, questioning how a deferral of one year—confirmed with a simple questionnaire—can provide the all-clear sign when compared to, say, a gay man living in a committed, monogamous relationship? Does this suggest that gay men are somehow more likely to lie about their sexual activities than heterosexuals?

Moreover, recommendations that gay and bisexual men be banned if they've had a tattoo, ear or body piercing in the past year—suggesting that those activity pose the same relative risk as sex—has been met with almost universal derision. Despite a theoretic (albeit negligible) risk, there has not been a single reported case of transmission by any of these means, according to data from the Centers for Disease Control and Prevention.

Civil rights groups have long argued that the FDA policy places the emphasis of risk identification not so much on sexual behavior as it does sexual orientation. In doing so, it suggests that gay men, as individuals, are inherently more likely to engage in high-risk activities, making case-by-case assessments somehow less necessary than in heterosexuals.

Others, meanwhile, question whether the FDA recommendation is actually a relaxing of policy or simply another way to enact a de facto lifetime ban simply because a gay man is sexually active.

While FDA officials have countered that heterosexuals who inject drugs or have sex with a commercial sex workers are also subject to a one-year deferral, neither of these groups are required to remain celibate for that period of time.

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