Welcome back to Nat’s civic issues blog! This week, we are going to discuss an issue that is very close to my heart. As many of us probably know, the FDA has very strict requirements for anyone interested in donating blood, and there is one antiquated rule that is directly discriminatory against a protected class. Since the HIV/AIDS crisis in the 1980s and 1990s, the FDA has barred gay men from donating blood. In recent years, the rules have relaxed a bit, but men who have had sex with another man in the last 3 months are still barred from donating blood. This is a heavily nuanced topic involving both civil rights and public health concerns, and there is no easy answer in this situation. That said, let’s get into it.
First, we need to have a good understanding of the history behind this policy. The CDC first reported a potentially significant cluster of diseases in 5 different gay men in 1981, and within a few days of publishing, a pattern of mysterious illnesses began to emerge across the country. Given its prevalence in the gay community, health officials began calling it the gay-related immune deficiency, or GRID. While the name was officially changed to AIDS a few years, the public referred to it as the “gay plague” for years after the initial crisis. HIV/AIDS is a virus that weakens the patient’s immune system until they no longer have the strength to fight certain cancers or infections. It was a devastating diagnosis in the 1980s and 1990s, but it is much more manageable today. There are even medications that can prevent transmissibility and symptoms for chronic patients. HIV is spread mainly through four methods: sexual contact, used needles, maternity, or blood, which is what we are most interested in today.
The public was terrified of getting AIDS, since a diagnosis was considered a death sentence. When the HIV/AIDS epidemic was in its infancy, there was no test for the disease, so there were many concerns about potentially tainting the national blood supply. After a young boy, Ryan White, received HIV positive blood through a transfusion, which eventually led to his death, the FDA banned gay men from donating blood to prevent any more infections. He was a hemophiliac, which is a condition that requires frequent blood transfusions. Before there was a test that could reliably detect HIV, many hemophiliacs were receiving tainted blood and were being diagnosed with AIDS shortly after. The first antibody test for HIV wasn’t available until 1985, which meant that there was no way of telling whether or not blood products contained HIV. The proposed solution to this was to prevent the population carrying the disease from donating blood, which theoretically would have removed the risk. However, now that science has developed further and we understand the incidence rate of HIV nationally, we know that this disease is not carried by one population, but instead can be contracted by anyone.
A major factor of this issue is that sexual orientation is a protected class under the 14th Amendment, according to the Supreme Court case Bostock vs. Clayton County (2020). This means that you cannot discriminate against anyone based on their sexual orientation. In fact, the FDA’s rule created a stigma against the gay community, labeling them as unclean or potentially dangerous, which led to even further discrimination. This policy directly targets gay and bisexual men, which seems to directly contradict this ruling. However, this brings up a fundamental issue in law today: is such discrimination warranted when the protected class is a carrier of a deadly disease? Medically speaking, about 55% of AIDS cases occur in gay or bisexual men, which is significant considering that they make up only roughly 2% of the population. Statistically, blood products from gay donors would be much more likely to carry HIV antigens than units from straight donors. From a public health perspective, it is not unrealistic to ban the class of high-risk carriers. However, all blood products regardless of donor are screened for HIV when they are received at the donation facilities. With a highly accurate (although not perfect) test, blood centers can discard any tainted products and notify the donor of their HIV status.
Also, in all my research about this topic, I cannot find any medically significant reason why it is more appropriate for gay men to wait three months after having sex to donate than not. That is not an epidemiologically significant time frame, especially considering that all untreated HIV cases, regardless of when the person contracted the disease, are infectious. It is clear that the FDA is receiving pressure from both LGBTQ+ advocacy groups and public health officials, and this was their compromise.
All-in-all, there is no easy answer to this question. As someone interested in pursuing a career in public health, I fully understand the precautions taken by the FDA to reduce the spread. However, as a member of the LGBTQ+ community, I am outraged at the blatant discrimination given our enhanced testing capabilities now, especially given the lack of regulation around other populations vulnerable to HIV/AIDS. With our blood shortage at critical levels, allowing a larger population to donate blood can help alleviate some of the strain on blood banks around the country. The COVID-19 pandemic has decimated our national blood supply, with the Red Cross reporting that it can only fulfill about 75% of blood product requests nationally, due to a severe lack of donors. The Red Cross declared that we are currently suffering through the worst blood shortage in over a decade. Given that the main factor in the shortage is a lack of donors, allowing gay men to donate will free up millions of new donors. With HIV cases declining nationwide and its incidence spread over a larger demographic, it is time to revise the FDA restrictions to address the discrimination and combat the shortage.
Side note: if you want to learn more about this topic, I highly recommend watching the movie And the Band Played On. It is a fantastic representation of both the political and health perspectives of the AIDS crisis, and it is just generally a really good movie.
Resources:
https://stanfordhealthcare.org/medical-conditions/sexual-and-reproductive-health/hiv-aids/causes.html#:~:text=Sexual%20contact%20%2D%20HIV%20is%20spread,through%20contact%20with%20infected%20blood.
https://www.history.com/topics/1980s/history-of-aids
https://www.natlawreview.com/article/supreme-court-holds-sexual-orientation-and-gender-identity-are-protected-title-vii#:~:text=Supreme%20Court%20Holds%20that%20Sexual,Are%20Protected%20by%20Title%20VII&text=Title%20VII%20of%20the%20Civil,%2C%20sex%2C%20and%20national%20origin.
https://www.hrc.org/resources/hrc-issue-brief-hiv-aids-and-the-lgbt-community
This is a very interesting topic to cover, and as it includes policy, it could be a good subject for your issue brief. However, it is a rather large-scale issue which would require a feasible solution that can be implemented on a national scale. This was a great civic issue post!
This is such an interesting topic of discussion and I very much agree that with advance testing there shouldn’t be a restriction on gay men donating blood. If these men are able to help people, then they should be able to do that.
I think that now that we have testing that can identify HIV / AIDS in donated blood, I really don’t see the point in not allowing gay men to donate blood with these limitations. If the blood testing does its job, there should be no issue whatsoever, leaving this law extremely outdated. I also agree that there’s really no point to the three month wait time- if you have HIV, you’re going to have HIV after those three months. Not to mention, not being sexually active doesn’t mean you don’t have HIV. There are other ways to get the disease.
Oops, I forgot to say that I think this would be a good idea for public policy – however, like Aimee said, this is on the national scale so it would be difficult to cover. I guess you could try to narrow it down to a specific state or county, but I’m not super sure how it would be any different there, and I don’t think there would be anything to distinguish a state’s handling of blood donation from the country’s- I don’t know enough about that.
I thought this was a very interesting topic to write about. I think sometimes science moves faster than politics and even though that’s not how it should be, it can be a long time until policy in America catches up with thee new science.
I definitely agree that this policy needs to be changed. It is not fair at all, nor giving any real benefits to society. Also, this is really well-written! Keep it up!