When Stigma Trumps Science in Blood Donations

If you believe that two men in a committed, monogamous relationship – where neither partner is living with HIV – face the same risks as an individual who has heterosexual sex with a commercial sex worker or someone who they know is living with HIV then the recommendation on Thursday from an advisory committee of the U.S. Department of Health and Human Services (HHS) will make sense.  Otherwise, you might find yourself scratching your head.

First, some context.  The FDA has barred blood donations from men who have had sex with another man – even one time – since 1977.  The policy originated in the early days of the HIV/AIDS epidemic.  In the decades since, our understanding of HIV – how it is spread, how to test for it and treatment of those living with the disease – has significantly advanced.  The lifetime ban on blood donations from gay and bisexual men is clearly not reflective of what we now know from a scientific and medical standpoint.

Criteria for determining eligibility as a blood donor must be based on science, not outdated, discriminatory stereotypes and assumptions.  While there is no constitutional right to donate blood, government policy regulating the blood donation field must not discriminate on the basis of sexual orientation by adopting differing standards for conduct that poses similar (or greater) risks based solely on the identity of those engaging in such conduct.  In other words, gay and bisexual men cannot constitutionally be singled out for differential treatment solely because of their sexual relationships.

On Thursday, the HHS Advisory Committee on Blood and Tissue Safety and Availability recommended ending the current lifetime ban and replacing it with a one-year deferral period.  While this is a promising step forward, the policy would remain deeply flawed in that it relies on sexual orientation rather than risk assessments in determining blood donor eligibility.  Under the proposed policy, two men – neither of whom is living with HIV – who maintain a committed, monogamous relationship would never be eligible to donate blood.  In contrast, an individual who has heterosexual sex with a commercial sex worker or someone who they know is living with HIV would face a one-year deferral.  Suggesting that a sexual relationship between two men, in and of itself, poses a risk of HIV transmission is deeply stigmatizing.

Thankfully, the advisory committee’s recommendation is but one step in an ongoing process.  As it moves forward, hopefully we will see a shift away from focusing on the sexual orientation of prospective donors to a policy based on individual risk assessments. 

A recent study found that lifting the exclusion that keeps gay and bisexual men from donating blood would result in an estimated 360,000 men who would likely donate an additional 615,300 pints of blood each year helping to save the lives of 1.8 million people.  It is clear that we can safely permit gay and bisexual men to donate lifesaving blood provided the will exists to finally break with the past.

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