This Monday marked the 26th annual World AIDS Day, a commemoration first observed in 1988.
Countries from around the globe celebrated the successes in antiretroviral treatment and prevention, mourned the just over a million deaths from HIV/AIDS every year, and called for further bridging the gap in identifying undiagnosed sufferers and providing universal treatment access, especially in developing countries in Africa, where HIV is most prevalent.
There is much to celebrate: According to the CDC, since 2001, there’s been a 38 percent decline in new HIV infections globally, and for those able to receive treatment, advances have made it possible to suppress the virus past the point of detection, securing a lengthy life and rendering transmission almost impossible. The UN’s Millenium Development goal of halting and reversing the spread of the disease by 2015 has been reached early and plans to fully stop the epidemic by 2030 are still underway.
There’s undoubtedly been progress in dealing with one of the most feared viruses to ever come into existence, and still much more to accomplish, but what shouldn’t be lost in the shuffle today is our acknowledgement of the long history of stigma that followed in the wake of the HIV/AIDS crisis. That stigma has played out in ways large and small, from exclusion to suspicion. From our schools to our hospital rooms. And it’s continued to cast a shameful shadow over the most charitable of acts: blood donation. For little more than 30 years, a lifetime ban from donating blood for men who have ever had sex with another man has been in place in the United States, explicitly because of the fear that HIV could end up in the blood supply. But it’s a fear that’s no longer grounded in science and we need to end it. Now.
Tumblr users photoshop the 2002 anti-racism PSA by EMMA to account for homophobia.
In 1983, the FDA enacted a lifetime deferral policy for men who have engaged in sexual intercourse with another man since 1977, covering openly gay and bisexual men and those reluctant/unable to admit their orientation. At the time, no reliable testing for HIV existed and it was indeed infecting those who regularly relied on blood donation such as hemophiliacs. Even today, the highest risk group of HIV transmission in the U.S. remains, as it did back then, men who engage in sex with other men, representing 63 percent of new infections. The policy, drastic as it was, made sense given our desperation in stopping a mysterious disease we had little hope of fighting, until we discovered the virus responsible just a year later. It would take another four years before the first antiretroviral was released to the public.
But the policy was also crafted in a time of rampant discrimination towards LGBTQ individuals and while there were brave doctors and medical workers who advocated for a broader understanding of HIV as an universal health crisis — especially as cases began popping up among Haitian immigrants — we were all too eager to treat the disease as a consequence of the gay or drug-using (another population with disproportionate rates of infection) “lifestyle.” Headlines from The New York Times in 1982 proclaimedit a “new homosexual disorder,” and one of the original designations for the condition we now know as HIV was Gay-Related Immunodeficiency (GRID), even as doctors were already aware by that time that it infected heterosexual women as well. Politically, the two-term Reagan administration stayed silent for six years on the issue; Reagan’s first public statement in 1985, while signaling federal funds would be diverted to HIV research, also affirmed the right for people to treat a hypothetical child with AIDS as an “outcast”.
In 1985, we finally developed a method for screening blood for HIV, adding it to the list of infectious diseases tested for in all blood donations. The HIV nucleic acid amplification test (NAT) is able to accurately detect HIV infection a week after first contact, and is used today as a highly accurate screening method. Coupled with other safeguards, the lifetime ban now makes little sense to maintain. While there is the remote possibility of transmission in the time before a test can find trace amounts of HIV, a so-called window period, that’s a possibility that could easily be accounted for by a shorter deferral time. Countries such as Australia and the UK have already lifted their lifetime deferral bans in place of one-year deferrals, still a generous overestimation of the time needed to assure safety (The Australian Red Cross says a six-month deferral would work just as well). Yet there’s a reflexive startle at the thought of abolishing the ban.
The association of homeosexuality as disease rather than identity rears its ugly head when push comes to shove. As impartial as the FDA tries to portray itself, unblinking in its concern for the greater good, you’ll notice the inherent distrust in its screening questions. Rather than asking potential male donors if they’ve ever engaged in unsafe sex with another men, the actual risk factor in STD transmission, the blanket assumption in their lifetime deferral is either that bumping uglies with a man is enough to spoil your blood for all eternity or that such a man would obviously lie about his sexual behavior. The former makes no scientific sense, the latter plays to the long trotted-out tropes of deception by LGTBQ individuals against heterosexuality. It was only October this year that a state, California, formally banned the use of a “gay/trans panic” defense during criminal trials — a legal strategy of claiming the defendant was so taken aback at being confronted, often romantically, with their victim’s orientation or sexual identity that they flew into an insane murderous rage, one that has occasionally worked to lessen criminal charges for its users.
Of course, that doesn’t mean we shouldn’t take precautions in blood donation. Or even that these precautions couldn’t be harsher than absolutely needed. A lifetime ban also exists for those who lived or visited the UK from a certain time period because of the (incredibly) rare possibility they could transmit an incurable brain disorder called Creutzfeldt-Jakob Disease. A year-long deferral currently exists for women who have ever engaged in sex with a man who has had sex with men, so the idea of a similar one for men isn’t without precedent and wouldn’t necessarily come off as blatantly discriminatory.
But sensible public health requires balancing out the concerns of all populations in an area, of understanding the communities and subcultures that make up our country, and influencing policy that ensures the best safety for everyone. For many, the memory of the HIV/AIDS epidemic, especially as it went unchecked throughout the ‘80s, is still fresh on our minds, but with that memory comes prepackaged biases. Even the less strict guidelines of the U.K. and other nations require the year-long celibacy of male donors, as if they’d need to be cleansed of their gay cooties before a nurse dare tap their veins for a valuable health resource.
Only by playing straight can gay men be considered safe, and that’s a dangerous perception that’s reenacted itself both culturally and scientifically far too often. As Jay Michaelson pointed out in a op-ed for the Daily Beast last month, that mentality also leaves us with even higher risk donations, with men who choose not to disclose having had sex with other men in order to slip under the requirement. It’s important for public health organizations to fight back against these prejudices, every bit as much as they fight to secure our blood banks.”The monogamous or safe-only gay man is a far safer bet than the unprotected hetero swinger,” Michaelson rightly notes. By tightening up the screening questions and allowing men who practice safe sex, even with other men, to donate after a short period of deferral, we can have the best of both worlds.
Last month, the HHS Advisory Committee on Blood Tissue Safety and Availability (ACBTSA) convened to discuss the current state of evidence regarding HIV blood testing and screening policies, including comparisons to other nations’ programs. Following in the footsteps of many organizations over the past decade, including the American Red Cross, they voted to recommend a one-year deferral period to the FDA, who are prepared to issue proposed changes, if any, to the blood donation policy later today. While there’s certainly room for argument in shortening that deferral, the very least the FDA should do is affirm the committee’s guidelines and see where things go from there.
There will always be risks. In the past 15 years in the U.S., there have been exactly three cases of HIV transmission traced back to a blood donation, against a backdrop of four million donations given every year. How many perfectly healthy men have we turned away in that same time? According to a 2014 research paper from the Williams Institute at UCLA, anywhere from 360,600 to 172,000 more men would decide to donate blood in a given year, depending on the length of the donation deferral. We make choices what to accept from our society every day. I think it’s time we stop accepting the exclusion of those willing to offer life.