Relax the Ban on Gay Blood Donors
If you are male and have had sex with another male since 1977--even if only once--you can’t give blood, not if you practice safe sex, not if you’re monogamous and not even if both you and your partner have lifelong records of perfect health. You still pose a risk for transmissible disease, according to the Federal Drug Administration’s outmoded standards, and you can’t donate blood for the rest of your life.
That’s bad, because we’re about to face a historic blood shortage. This year has been tough: Many hospitals had to get by with a one- or two-day blood reserve even during traditionally easy nonholiday periods. Los Angeles faced record shortages in January, when the flu, combined with a seasonal lag, lowered supplies to the point that some hospitals were forced to postpone elective surgeries. Yet, things will get worse. Within the next few years, demographic shifts--an aging population that uses more blood while donating less--will further lower the margin of safety. Increasingly, blood bankers will urge all Americans to overcome apathy and get out and give.
All, unless you are gay. Years ago, gays were known as enthusiastic blood donors, contributing significantly to the blood supply of such cities as Los Angeles, San Francisco and New York. But since the AIDS crisis, the community has been permanently deferred from giving blood. The reason for the ban, which was phased in during the mid-1980s, is that gays have high rates of AIDS and hepatitis and represent a threat to the nation’s blood supply.
That reasoning may have been valid 15 years ago, but current science doesn’t support it. When the first restrictions were imposed, no blood test for HIV existed. Blood bankers used questionnaires as blunt-object screening devices to rule out large segments of donors whom statistics showed were more vulnerable to AIDS. Regulators tightened the restrictions when they learned about the disease’s latency period, in which a person could become infected but show no signs of it for months. The early AIDS tests detected the body’s antibody response to HIV, which itself could take weeks to develop: the notorious “window period” that blood bankers worried about. Today’s tests, however, directly detect the virus’ genetic material without waiting for the immune system’s response. They reveal within a dozen days whether a donor has been exposed to the AIDS virus, making the long window period a thing of the past.
Nor have rules kept pace with changes in the gay population. AIDS rates, while still highest among gay men, have declined over the years, while climbing among women, youths and minorities. Numerous studies have shown that gay men’s sexual behavior becomes safer as they age. It’s true that young gay men tend to engage in such risky behavior as unprotected sex (as do young heterosexuals), but their aging, baby-boomer counterparts represent a stable population more likely engage in long-term, safe and monogamous relationships.
Ignoring these changes has resulted in a deferral system that’s socially unjust and scientifically out of whack. You can’t give blood for the rest of your life if you’ve ever had homosexual relations with a gay man--even with a condom--at any time in the past 23 years. But you can if it’s been a year plus one day when you last had unprotected sex with prostitutes, drug users or even with AIDS patients.
It’s time to modify the lifelong ban on gay blood donors and institute a one-year deferral policy instead. Many blood bankers quietly agree that such a change would be reasonable and safe. A year would be adequate time for biological signs of latent diseases to appear, especially with new technologies in place. Studies have shown that deferring gay men a year from their last homosexual contact would allow more than 100,000 new donors into the blood system, which would help avert the coming supply crisis. (Keep in mind that those surveys were based on men who abstained for a year: The numbers would increase greatly if authorities could find a way to safely include men who had practiced safe sex for many years or had closely monitored records of excellent health.)
Allowing gay men to give blood after a year’s abstinence would not ignore their risk of carrying HIV. It would merely shift them into the same one-year deferral category as other people who’ve exposed themselves to risk by traveling to malarial countries or had sex with high-risk partners. Like all blood donors, they’d be rigorously screened with questions and lab tests to protect the safety of the nation’s blood supply. But this screening would be based on sound public-health practice, not on residual condemnation or fear. *
