For two decades, the Food and Drug Administration has prohibited gay and bisexual men from giving blood as a precaution against AIDS. But three major blood collection agencies, including the American Red Cross, argue the practice is no longer warranted. The FDA disagrees. Joel Ginsberg, head of the Gay and Lesbian Medical Association, says the ban unfairly discriminates.
In a moment, former U.S. Surgeon General Joycelyn Elders shares her thoughts about America’s sexual health and education. It’s our Wisdom Watch, coming up next.
But first, summer is near, and it’s the time when the nation’s blood supply typically runs low. Many community groups will be running blood drives to fill the void. But one group is officially not welcomed to participate – gay men. Men who have had sex with other men even once since 1977 have been permanently barred from donating blood. The policy began in 1983 in the first years of the AIDS crisis.
Now, with new techniques available to screen the blood supply for HIV/AIDS, the American Association of Blood Banks, America’s blood centers and the American Red Cross say the ban is, quote, “medically and scientifically unwarranted,” end quote.
But the Food and Drug Administration – or the FDA, which monitors the country’s blood supply – recently announced it will continue to uphold the ban. With me to talk about this is Joel Ginsberg, head of the Gay and Lesbian Medical Association. Mr. Ginsberg, welcome.
Dr. JOEL GINSBERG (Director, Gay and Lesbian Medical Association): Hi. Thanks for having me.
MARTIN: Now, I should start by saying we invited the FDA to join our conversation. They declined, but they have an extensive discussion of this question on their Web site when they posted their decision to continue the ban. They say that men who have had sex with men since 1977 have an HIV prevalence rate of 60 times higher than the general population. They also say that men who have had sex with men account for the largest single group of blood donors who are found to be HIV-positive by blood donor testing.
Given just those two issues, why would we even consider allowing gay men to begin donating again?
Dr. GINSBERG: Well, I first want to say that we support the FDA’s intention to try to make the blood supply as safe as possible. And we’re really just looking to make sure that the same criteria are applied to different groups. Our concern is that there isn’t a scientific justification for excluding low-risk gay men while accepting high-risk heterosexuals.
So to give you an example, take a gay male couple that’s been together for 20 years, and they have a monogamous relationship and they have tested negative for HIV. They actually pose no threat to the blood supply if they donate their blood. Whereas, if you’re a heterosexual woman and you’ve been in a long-term relationship with somebody who has AIDS, you could still give blood as long as you haven’t had sex with that man for a year. We don’t think that makes a lot of sense.
MARTIN: Really? That seems like a very distinct set of circumstances. Are there others?
Dr. GINSBERG: Also, if you’re a man who’s been with a female prostitute, but it was more than a year ago, it’s fine. You can give blood. If you’re a person who’s had sex with a hemophiliac, as long as you haven’t had sex with a hemophiliac within the previous year, you’re fine. And there – a 1992 study found that 12 percent of female partners of hemophiliacs actually had HIV. HIV among heterosexuals is growing and significant now.
So I think they just found it to be a convenient way of screening, and haven’t yet found a better way to screen that out. Now, I do think that there are other approaches, such as designing questionnaires that focus on behavioral risks rather than belonging to a particular group.
MARTIN: Do you think the FDA is being discriminatory, or do you think that their science just hasn’t caught up with the new realities of the way AIDS is being transmitted to the rest of the population?
Dr. GINSBERG: Well, there are certainly many people who feel that it’s discriminatory. I’m concerned that they haven’t perhaps made as much effort as they should have to make sure that the policy is science based, because the subject here is gay men.
MARTIN: That if perhaps there were another group who was being barred from donating, that there might be more interests in revisiting this policy?
Dr. GINSBERG: They also would not have been as quick to bar other groups, as they have been to bar gay men. I’ll just giving you an example. Dr. Ronald Bayer of Columbia University, he was one of the participants in a workshop in 2006 that the FDA put on to examine this issue. He said, quote, “in New York City today, 20 percent of African-American men of a certain age group are positive for HIV. The risk of a woman who is black being infected is about 20 times higher than the risk of a white woman being infected.”
Would anyone propose that we bar all black men in New York City from donating blood, or that all black women should be deferred or rejected from the donor pool? I don’t think so. Why not? Because somehow moving down that path in terms of human cost would be unacceptable, and I wonder why we don’t have the same standards for gay men.
MARTIN: But is the issue that perhaps the standard should be loosened for men who’ve had sex with men, or should they be tightened for other people in those other high-risk groups?
Dr. GINSBERG: I don’t feel prepared to say what the specific standards ought to be for every individual group. Our position is simply that the same criteria should be used for gay men as are used for other groups, and our sense is that that’s not the case now.
MARTIN: Would allowing gay men to donate blood really improve the supply and availability?
Mr. GINSBERG: It is true that earlier on, when gay men were allowed to donate, they donated in high numbers. There’s a lot of altruism in the gay male community, and folks want to be full members of society and do their part. So I don’t know how much additional blood the blood bank community would receive, but I imagine it’s not insignificant.
MARTIN: Given a number of other sort of social and health concerns that gay men already face, why is this an issue for you to take on, for your organization to take on? Why – I guess why does it matter?
Mr. GINSBERG: When gay men’s bodies are stigmatized as dirty, regardless of the behavior that they make, you’re sending the message that HIV risks and other risks of sexually transmitted diseases is not about your behavior. It’s about your status. So there’s nothing you can do about your status. And if your behavior is irrelevant, then you just throw out the window all of the safe sex education efforts that we try to do.
So one reason this matters is that the FDA is putting out a message around sexual behavior, which we think undermines the safe sex educational efforts that – and messages that ought to be put out there. It’s also making heterosexual people think that they’re at very low risk of contracting HIV, when that’s not the case. It’s the general stigmatization of gay men that causes lower quality of care to be delivered to gay men and causes gay men to avoid seeking care in the first place.
MARTIN: I think that the question that many people would have is – and I understand that you’re not a doctor – but do you believe that gay men who are engaged in safe sex practices consistently can safely donate blood?
Mr. GINSBERG: There’s no question that the answer to that question is yes. Of course. There’s absolutely no risk for a gay man who is HIV-negative and only have safe sex with other people who are HIV-negative or who has any kind of sex with men who are HIV negative – it’s scientifically impossible for that person to contract HIV or to spread it. The only question is how do you identify that group, and how do you single them out from other people who are higher-risk?
MARTIN: How do you account for this figure – that I assume you don’t dispute -that men who have had sex with men account for the largest single group of blood donors who are found to be HIV-positive by blood donor testing? How do you account for that statistic?
Mr. GINSBERG: I would like to know what percentage of those units that are found to be HIV-positive are attributable to men who have sex with men as opposed to other groups. The FDA says it’s the largest group, but it doesn’t say the percentages. If there’s a significant number of HIV-positive units coming from other groups, I’d say perhaps the screening criteria need to be reexamined.
MARTIN: It seems to me that one of the things that’s happened in recent years, particularly since the onset of the AIDS crisis, is there used to be a lot of pressure on people to donate blood. It was like this big community activity. And now it seems to me that one of the things that has happened is that the Red Cross and other groups that collect blood have gone a long way to remove the pressure from people to – you know, they’ve instituted screening procedures upfront to allow you to opt out without stigma, without shame. And it could be any number of reasons. Oh, you know, I traveled to England where they had, you know, mad cow disease or something. Given all the ways that people can opt out without stigma, is it still the case that gay men are singled out by their – by the decision to not allow them to donate as a group?
Mr. GINSBERG: Well, I think it’s good that the FDA has made these efforts to reduce the pressure in blood drives that take place in colleges and workplaces, but I do think that the stigma and pressure do continue. There are places out there that are still trying to, you know, win their, you know, gold watch and have the highest number of people who are participating, and there is pressure being put on people, which I think is encouraging people to lie about their status.
MARTIN: Okay, finally, what is – is this a priority for your organization, and are you going to continue to pursue getting the FDA to reconsider the ban?
Mr. GINSBERG: We will. We met with the Red Cross and the Association of Blood Banks about a year ago, and we’ve continued to write letters to the FDA, asking them to reexamine this issue. It’s extremely important to gay and bisexual men and lesbians and transgender folks. Everybody who’s involved in our movement cares very much about the government making unscientific decisions about the health of people. And so, yes, it’s a very high priority for us, and we’ll continue to focus on the issue.
MARTIN: Joel Ginsberg, thank you.
Mr. GINSBERG: You’re welcome.
MARTIN: Joel Ginsberg is executive director of the Gay and Lesbian Medical Association. He joined us from member station KQED in San Francisco. Thank you so much for joining us.
Mr. GINSBERG: Thank you for having me.