Bad Blood An Investigation of the MSM Ban

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 (v. CJD). 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