Sunday, April 21, 2013

HIV Discrimination in Blood Donation Policy

I've donated blood once in my life.  Truth be told, a large part of my motivation was the excused absence from PE class, but also at work was my personal conception of "altruism."  In filling out the questionnaire detailing various risk factors associated with my blood, I had to lie about my sexual history; the FDA provides a lifetime blood donation "deferral" for any man who has had sexual contact with another man--even once--since 1977.  At the time, I didn't think much of my having to erroneously complete a legal and medical document in order to fulfill what many consider an act of "social solidarity."  Since then, though, my frustration has mounted at the seeming injustice of effectively banning all gay men from donating blood in the United States.

Charlene Galarneau breaks down this "form of discrimination leading to social marginalization and stigmatization" in her American Journal of Bioethics article, "Blood donation, deferral, and discrimination: FDA donor deferral policy for men who have sex with men."  Galarneau attributes the FDA deferral for MSM to blatant homophobia, but rather to five distinct and subtle features of the policy: "assumed data justification, an ethically challenged regulatory process, stereotypes about sex, gender and the sexual behaviors of both men and women, a tacit notion of acceptable risk in the blood supply, and a double standard in risk tolerance" (29).  The article is well thought-out and expertly supported, so I will just highlight a few of the most pertinent points to our discussion of LGBT civil rights and the history of HIV/AIDS in the gay community:
  • The policy dates to March 1983, when the FDA's Office of Biologics deferred blood donations by certain high-risk groups "until the AIDS problem is resolved or definitive tests become available" (30).  Though AIDS has not yet been "resolved," there are now (and long have been) tests to determine wether an individual is HIV+.  This test is indeed part of the FDA's "five overlapping layers of safeguards" (30).
  • Over the last ten years, criticism of the policy has mounted because of the social stigma to which it contributes.  Critics of the FDA's policy include government officials, medical professionals, universities, gay rights groups, and blood banks themselves.  
  • The wholesale exclusion of one group based on sexual behavior is an ineffective approach to targeting infection risk in the nation's blood supply.  Galarneau quotes from a 2000 meeting to consider changes to the policy: "A man who had oral sex with another man in 1979 would be excluded whereas a woman who had unprotected anal sex with the same man thirteen months ago would be allowed in the donor pool" (35). 
This article, by virtue of its epistemological focus, deals more with decision making in public health policy than the politics behind LGBT civil rights.  Nonetheless, the current deferral of MSM from donating blood is grounded in uncertain scientific data and a foregone historical moment.  Alongside the banner issue of marriage equality, advocates of LGBT rights should be greatly concerned by the social stigma against gay men perpetuated by the FDA's current policy. 

Galarneau, Charlene. "Blood donation, deferral, and discrimination: FDA donor deferral policy for men who have sex with men." The American Journal of Bioethics 10, no. 2 (2010): 29-39.


  1. This is really fascinating; thanks for posting. It seems like the current rules aren't so much based in science as they are in the stereotype of gay men as promiscuous and likely to have unprotected sex. It seems a bit ridiculous that a man that has had even one sexual encounter with another man can never donate blood, but that a woman who has had a sexual encounter with an infected man is only deferred for a year. To me, that's plain homophobic. Instead of asking men if they've ever had a sexual encounter with another man, shouldn't the FDA just be asking all potential donors if they practice safe sex? That said, since all donated blood is carefully tested, why can't we just trust the blood drive to scan all blood for possible diseases including HIV?


    This L.A. Times article illuminates two opposing medical views on the ban of gay men's blood donation. The one that opposes these blood donations argues that changing the policy would increase the risk to blood recipients; the one in favor contends that the ban is outdated and that current research has shown that "there is no detectable increased risk of HIV entering the blood supply by allowing gay and bisexual men to donate."