Transcript Investigating the Ban on MSM Blood Donation

Bad Blood? An Investigation of the MSM Ban on Blood Donation
Lauren Lacy
Abstract
In 1983, the Food and Drug
Administration (FDA), responding to the
AIDS epidemic, adopted a policy of
deferring men who have had sex with
men (MSM) at anytime since 1977 from
donating blood. The current policy,
adopted in 1992, continues to defer this
group indefinitely. This paper
investigates the societal implications of
the “deferred” status. I will first examine
the unique relationship gay and bisexual
men have with the AIDS epidemic in
American history.
I challenge the FDA’s claim that the
ban is solely rooted in behavioral
practices, using data on rates of
contraction, behavioral practices relevant
to MSM (condom use, amount of
partners, knowledge of partners’ AIDS
status, prevalence of UAI, other STIs,
etc.), and the rate of infection of black
and white MSM as compared to other
demographics that are deferred from
donating blood. In doing this, I intend to
address the overarching question: When,
if ever, is it justifiable to discriminate
against a demographic based on
statistical data, and what are the
implications in doing so?
The FDA cites other deferred
populations, such as intravenous drug
users and sex workers, in its MSM ban.
Does this conflation of sexual behavior
and demographic identity do a disservice
to MSM? Is it possible to extrapolate
which sexual practices or patterns
among MSM lead to HIV status, rather
than defer the entire population? I will
argue that the underlying factors of MSM
stereotypes have shaped the research
and conclusions on the MSM ban, and,
in turn, the deferred status of MSM
reinforces these stigmas.
Left: Protest at the National
Institute of Health, 1990.
Below left: New York Post
coverage on AIDS rally,
1988. Below: ACT UP
protest at Sixth International
Conference on AIDS in San
Francisco, CA, 1990.
The FDA claims MSM is a behavioral
demographic, ignoring the intersecting
narratives of anti-gay stigmas, HIV/AIDS
awareness, and AIDS activism.
Additionally, the conflation of AIDS and
homosexuality is often a theme of anti-gay
protests.
Right: Anti-gay protester at the AIDS Walk Los
Angeles, October 13, 2014. Below right:
Westboro Baptist Church member, 2013.
Below: Anti-gay protester, 2006.
The FDA on MSM:
What is FDA's policy on blood donations from men who
have sex with other men?
Men who have had sex with other men (MSM), at any time
since 1977 (the beginning of the AIDS epidemic in the United
States) are currently deferred as blood donors. This is because
MSM are, as a group, at increased risk for HIV, hepatitis B and
certain other infections that can be transmitted by transfusion.
Is FDA's policy of excluding MSM blood donors
discriminatory?
FDA's deferral policy is based on the documented increased
risk of certain transfusion transmissible infections, such as HIV,
associated with male-to-male sex and is not based on any
judgment concerning the donor's sexual orientation.
What about men who have had a low number of partners,
practice safe sex, or who are currently in monogamous
relationships?
Having had a low number of partners is known to decrease the
risk of HIV infection. However, to date, no donor eligibility
questions have been shown to reliably identify a subset of
MSM (e.g., based on monogamy or safe sexual practices) who
do not still have a substantially increased rate of HIV infection
compared to the general population or currently accepted
blood donors. In the future, improved questionnaires may be
helpful to better select safe donors, but this cannot be
assumed without evidence.
Are there other donors who have increased risks of HIV or
other infections who, as a result, are also excluded from
donating blood?
Intravenous drug abusers are excluded from giving blood
because they have prevalence rates of HIV, HBV, HCV and
HTLV that are much higher than the general population. People
who have received transplants of animal tissue or organs are
excluded from giving blood because of the still largely unknown
risks of transmitting unknown or emerging pathogens harbored
by the animal donors. People who have recently traveled to or
lived abroad in certain countries may be excluded because
they are at risk for transmitting agents such as malaria or
variant Creutzfeldt-Jakob disease (vCJD). People who have
engaged in sex in return for money or drugs are also excluded
because they are at increased risk for transmitting HIV and
other blood-borne infections.
Source: U.S. Administration Food and Drug. 2013. “Blood
Donations from Men Who Have Sex with Other Men Questions
and Answers.” FDA.gov