Last year, the South African National Blood Services went through a particularly galling public relations crisis when it was forced to admit that it destroyed blood that was donated by black people, under the theory that black people were at a higher risk of being HIV positive than white people donating blood. That revelation was rightly met with public outcry, and at least as far as anyone knows, the agency has changed that policy.
There is much less outcry, however, over a policy just as blatantly discriminatory against another group: homosexuals. Among the questions asked of a male potential donor is whether or not he has had sex with another man in the last five years. If he answers yes, he is told he is not allowed to donate.
This is despite the fact that all blood donated to SANBS is tested for HIV as well as other dangerous blood-borne diseases. And it is in spite of the fact that the demographic with the highest rate of HIV infection in South Africa is not gay men, but women between the ages of 18 and 24 years old.
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In response, the South African Gay and Lesbian Alliance has announced a "blood flood" plan, under which their members will simply lie when asked if they have had sex with another man in the last five years.
In the US, of course, we have the same discriminatory restriction. In fact, the policy as determined by the FDA's Blood Products Advisory Committee is even more restrictive: any man who has had sex with another man, even once, since 1977 is told not to donate.
This policy dates from the early 1980s, when very little was known about the burgeoning HIV/AIDS crisis. There were reprehensible failings by public health officials and then-President Reagan to deal responsibly with the emerging disease in the early days, in large part because they attempted to dismiss or marginalize AIDS as a purely gay disease. Abhorrent as that attitude and their actions were, at least it is borderline understandable why the FDA would have thought at that time that prohibiting gay men from donating blood was the most efficient way of dealing with the threat of HIV/AIDS infections being spread through blood donations.
At this point, however, the continued restriction is no longer rational. Blood donations are tested before being distributed to people who need the transfusions--it's why there is a question on most donation checklists to make sure that you're not donating blood in order to get a free HIV test. And sexual orientation, or a single sexual act in the last three decades, is hardly an effective proxy for trying to prevent donation of HIV positive blood. Men who have sex with men are not the only Americans with HIV--the demographics of HIV infection continue to change, and at the moment the fastest growing rate of HIV infection is among African-American women.
Our knowledge about how to test for HIV, and when the test is accurate, has grown tremendously since the 1980s. The current FDA website FAQ section has an item about the prohibition on gay men donating blood, and spends a paragraph talking about how there is a 2-month window period between when a person might be exposed to the HIV virus and when an infection would conclusively be evident in test results. That isn't something most people don't know--when I volunteered at my undergraduate university's health center giving HIV tests, we told people there was a potential six month window, just to be as prudent as possible. But I still fail to see why even a six month window should preclude a person from donating blood on the basis of a sexual act that could have taken place 20 years ago.
Rather than a discriminatory and ineffective qualification like having had sexual contact with another man, why doesn't the FDA recommend asking questions that would actually assess risk of HIV infection in a meaningful and non-bigoted way? They could ask about whether a person has ever had an HIV test, or most directly and probably effectively, whether a potential donor has had unprotected sexual intercourse--with a partner of either gender--in the last year, or since their last HIV test, or even since 1977. Any of these options would be more effective at identifying risk factors for HIV, and not continue the prejudiced and extremely outdated presumption of HIV/AIDS as a gay man's disease.
The American restriction is being targeted for reform--it's a perpetual thorn in the side of activists for homosexual equality, particularly when everyone is aware of the shortage of blood donations. And perhaps the South African protest strategy--of lying about one's sexual activities, and publicizing that one is doing so--is a decent tactic. But especially after reading an excellent article on "covering," or trying to blend into the mainstream, by Professor Kenji Yoshino in this week's New York Times Magazine, that strategy strikes me as too passive--it's giving up. We all know that a sexually active gay man can walk into the Red Cross office nearest to him, lie on the questionnaire, and donate blood along with the rest of us. But why should he have to lie? Why should the price of this particular practice--something that we are exhorted to do as a matter of public service--be to deny his identity?
No one should be forced to make that choice. Homer Plessy, the man who challenged Louisiana's segregated railroad cars in 1896, was only one-eighth black, and could easily pass as white--that's how he got onto the white car in the first place. He could have continued to pass, continued to lie and buy the ticket for people with only white heritage. He didn't--and granted, he lost that case, instituting the shameful "separate but equal" constitutional standard as American practice until it was overturned over fifty years later. But at least he refused to compromise his own identity. If one cares enough about the community to donate blood, I can't say it is wrong to answer the bigotry-driven question with a lie--but without a few Homer Plessys, how many years will it be until this policy is reversed?
