After the attacks on the World Trade Center and the Pentagon, Steve Jones (a pseudonym), like many Americans, yearned to do whatever he could to help. For those without specialized search-and-rescue skills, it seemed there were only two answers: give money or give blood. Jones wanted to do both. The 37-year-old sales manager sent off checks to the American Red Cross and United Way and took time off from work so he could donate blood at the LifeSource center on Fullerton. After having his pulse checked and a finger pricked--a test for anemia--Jones followed a LifeSource technician to a cubicle and answered a series of personal questions. At one point, the technician asked Jones if he'd had sex with any men since 1977--even once. When he was in college, nearly 20 years ago, Jones briefly experimented with gay sex. He answered the question truthfully. The technician then politely informed him that his blood would not be needed.
"I looked at the guy, stunned," Jones says. We were in a national crisis, the country was supposed to come together, all the networks were urging people to give blood--and we were turning away donors because of remote sexual experiences? Regardless of their HIV status? "I'm absolutely negative," Jones says. "I get tested every six months. I'm a single guy. I don't want to catch anything or pass anything on."
The technician said that the rejection wasn't intended as a value judgment, but Jones was offended nonetheless: "What they're basically saying is anybody who has experimented in the past is unfit to help America."
The Food and Drug Administration, which regulates the blood industry, began excluding gay and bisexual men from the donor pool in 1985, after thousands of people contracted HIV through blood transfusions. Back then, the ban seemed to make sense: AIDS was still widely considered a gay disease, little was known about its epidemiology, blood screening for HIV was brand-new and of undetermined effectiveness, and the virus could escape detection for almost two months.
But in 16 years much has changed, and representatives of some blood centers and gay-advocacy groups say that the policy barring men who've slept with men is outdated and discriminatory and that it could be changed without compromising the safety of the blood supply.
The chance of contracting HIV through a transfusion is now exceedingly small--about 1 in 1.5 million, according to the Red Cross. The first line of defense is the questionnaire, which is intended to weed out donors who are at high risk of infectious diseases. Among those turned away, or deferred, as the FDA calls it, are people who admit to intravenous drug use or to trading sex for money or drugs. Deferral periods vary according to perceived risks. Health-care workers who've recently come into contact with HIV-infected blood are deferred for one year, while men who've slept with men in the last quarter century are banned for life.
Curiously, no in-depth scrutiny is applied to sexual history and behavior. As a result, the ban against gay donors "doesn't reflect real risk issues," says Heather Sawyer, a senior staff attorney for the Lambda Legal Defense and Education Fund. Under the current policy, a woman who has had unprotected anal sex with multiple partners and doesn't know her HIV status is eligible to donate, while an HIV-negative gay man who has been in a monogamous relationship for five years isn't.
The policy isn't just hypocritical, according to some critics, it's hysterical, given that blood centers screen--and rescreen--every unit of blood. Three of the twelve tests on each donation look for HIV: a serological test, a p24 antigen test, and, since April of 1999, the highly sensitive nucleic acid test (NAT), which is capable of spotting the genetic material of the virus even before the body starts producing antibodies to it. Of the 13 to 14 million donations each year, the tests catch about 1,000 that are HIV positive. Test failure is essentially zero, according to the FDA. "We catch just about everything," says Melissa McMillan, of America's Blood Centers, a national network of community blood centers. The NAT test has shortened the average window during which HIV can go undetected from 16 to 11 days. But on rare occasions, infected blood does slip into the blood supply. When it happens, according to the FDA, it's probably due to undetectable strains of the virus, window-period donations, or blood bank errors.
Last year--in response to criticism from gay and lesbian groups, demonstrations on college campuses, and the redundancy and sophistication of modern HIV testing--the FDA's blood products advisory committee held a hearing to reexamine the donor ban against men who've slept with men. Acknowledging that there were many variables and unknowns and that it was "hard to come up with good statistics," the FDA's Dr. Andrew Dayton gave a presentation in which he deliberately overestimated the impact of allowing donations from straight men who'd experimented with gay sex or gay men who had been abstinent for long periods.
In a worst-case scenario, he said, with a five-year deferral of men who've had sex with men, an additional 1.7 units of HIV-infected blood could find their way into the nation's supply each year. With a one-year deferral, he said, that number could rise to 3.1.
The American Association of Blood Banks and America's Blood Centers urged the FDA to treat gay men like people in some other high-risk groups and relax the deferral period to one year.
Dr. Celso Bianco, executive vice president of America's Blood Centers, testified that the "logic of the current deferral is difficult to justify" and told the committee, "In our opinion, the change in deferral will not increase risk." Bianco believes that HIV is not communicable during the first 11 days of infection and that therefore the NAT test has effectively closed the window period. A one-year deferral of men who've slept with men, he says, is "more than enough time to protect the blood supply."
Dr. Adrienne Smith, of the Gay and Lesbian Medical Association, also testified before the committee, pointing out what she called the "central flaw" in the donor policy: that it "tolerates a wide range of risks associated with heterosexual sex while imposing a zero-tolerance attitude" toward gay men "regardless of the risk associated with individual behavior."
The strongest voice against modifying the deferral came from Dr. Rebecca Haley, chief medical officer of the Red Cross, which operates the country's largest blood center. Haley indicated that it was better to be safe than sorry and said the Red Cross could not support a change in policy that would increase the "possibility that infectious blood might be released."
In a seven-to-six vote the advisory committee decided against relaxing the lifetime ban on gay and bisexual male donors.
Luis Vera, director of litigation at the AIDS Legal Council of Chicago, would like to see the deferral issue revisited in the near future. "You never want to be in a position of arguing for less stringent safety standards," he says, but the FDA is "creating a false sense of security by asking a specific group a question that doesn't really prove anything." To people who say it's better not to take any chances, Vera says that we already are taking chances--that the risks aren't meaningfully assessed and that we're counting on people who might be ashamed of their pasts to tell the truth. "We're willing to accept risks as long as they're hidden heterosexual risks," he says, "but not if they're gay risks--even if the gay risks are no greater or even much smaller than the heterosexual risks."
Vera believes the current policy is "more about 'gay blood is icky' than any responsible public health response." He says that heterosexual rates of HIV transmission are skyrocketing and that it now disproportionately affects people of color. "Are you going to say if you're black you can't give blood?" Banning a whole group of people from donating is not only discriminatory, he says, it's irresponsible--especially when there are nationwide blood shortages, as there were until September 11.
Last summer, as a result of those shortages, elective surgeries were being postponed all over the country, according to Cheryl Balough, a spokesperson for LifeSource, the largest blood center in metropolitan Chicago. Blood centers were nervous. "It was touch and go at times," she says. "Sometimes we were looking at a day's inventory, which is not good. We like to have a three- to five day supply."
September 11 changed that. Donors have come out of the woodwork, but "there's still a huge need for everyone to pitch in and support the blood supply at a time like this," says Mark Shields, of the Red Cross. Anyone who is ineligible to donate blood could always sponsor blood drives or volunteer at them, he says.
The blood industry, however, might have a tough time luring back healthy donors who feel alienated. Steve Jones saw the LifeSource technician jot down the reason for his deferral and knows that the information is now stored in the blood center's computer database. Should Jones ever attempt to give blood at a LifeSource center again, he will automatically be turned away--unless the FDA changes its policy.
Jones arrived at LifeSource filled with the desire to help his fellow citizens and left "feeling like a dirty person" and completely disheartened. "I kept thinking, wow, how not far we've come." He scoffs at the suggestion that he ought to "pitch in and support" the blood supply in some other way. He has only one thing to say to the industry that treated him like a pariah, and that's "Bite me."