In the aftermath of the Pulse nightclub shooting
in Orlando, Fla., 53 people were alive but wounded, many in desperate
need of blood. Blood banks in the area put out a call for donors.
Gay
men were ready to volunteer. Rumors even went around that blood centers
in Orlando had relaxed a ban on donations from sexually active gay men.
But the rumors were false. The ban, imposed by the Food and Drug Administration, remains in place, infuriating some gay rights activists.
The agency does not permit
a man who has had sex with another man in the past year to donate
blood. Loosening that restriction, officials say, would greatly increase
the chances of contaminating the blood supply with H.I.V. and other sexually transmitted infections.
Many gay rights activists have protested the rule,
arguing that demanding a year’s celibacy is unreasonable and that the
ban perpetuates homophobic stigma. Mass murder in a gay nightclub has
brought the debate to the fore.
Kelsey
Louie, the chief executive officer of GMHC, the Gay Men’s Health
Crisis, described the restriction as “adding insult to this nightmare”
and called for “a blood donation policy that is inclusive and based on
science, not stigma.”
The
F.D.A. says its position is based on science and notes that its
one-year waiting period is in line with policies in Britain and Australia. (France dropped its ban on donations from gay men last year.)
The
health authorities must balance the demand for blood against the
inevitable consequences. Despite elaborate screening criteria and modern
blood testing, F.D.A. officials note, every year some of the 3.5
million patients who receive transfusions are infected with various
diseases.
For example, after the agency approved a test in 2007 for Chagas’ disease,
which can be lethal, it found more than 5,000 donors with it, not all
of them first-time donors. Even with current testing, the agency
estimates that about one donation in 1.5 million transmits H.I.V. to the
recipient.
Lifting
the restriction on sexually active gay men would raise the risk of
H.I.V. infection to one per 375,000 donations, which the agency
considers unacceptably high, Dr. Peter W. Marks, the deputy director of
its Center for Biologics Evaluation and Research, said in December.
Donation screening policies are based on a combination of trust in human nature and hard science, both of which are fallible.
All
communicable diseases have window periods during which the infection is
so new that the virus, parasite or spirochete can be in the blood and
actively replicating, but at such low levels that even the most
sensitive tests cannot detect it.
For
H.I.V., the window period is nine to 11 days after infection — but that
assumes the most rigorous test and a typical patient. In some, it takes
longer to detect.
Gay men over all are at higher risk for syphilis, gonorrhea, hepatitis C and chlamydia. Gonorrhea and chlamydia are detectable in urine in about a week, according to the STD Project, a website that fights stigmas surrounding sexually transmitted diseases.
But
the window period for hepatitis C is four weeks at minimum, and the
tests are more accurate at six to nine weeks. The shortest window for
syphilis is one to two weeks, but detection is more likely after six
weeks.
Donor-screening
methods used by American blood banks presume that unpaid donors are
unlikely to lie, since they experience some discomfort and typically
receive nothing in return — except gratitude, a sense of satisfaction
and sometimes movie tickets, although that practice is controversial.
But it is well known that some donors do lie. Some gay men opposed to the F.D.A. policy have said in public meetings and online forums that they have pretended be heterosexual in order to donate to help a friend.
It does not help that exclusion criteria are complex and often misunderstood.
Potential
donors are asked long lists of detailed personal questions about
injecting drugs, paying or being paid for sex, having syphilis, visiting
countries with malaria or mad cow disease, and being tattooed in certain cities.
And
the rules change. Currently, anyone who has recently visited one of 48
countries or territories where the Zika virus has been circulating, or
who has had sex with a man who has recently traveled to one of them, is
barred from donating for a month.
The
F.D.A. has looked at ways to eliminate both misunderstandings and
falsehoods. At blood banks in the United States, donors go down a
checklist alone or answer questions from a technician.
In
South Africa, interviewers try to ascertain how promiscuous each donor
is, regardless of sexual orientation. In Italy, doctors do the
screening. No method eliminates all high-risk donors, Dr. Marks said.
The
F.D.A. has emphasized that many blood recipients are very vulnerable —
they include not just victims of shootings or car accidents, but also
premature infants, mothers hemorrhaging after birth, children with hemophilia, and organ transplant patients taking immune-suppression drugs.
Gay rights advocates argue that much more blood would be available if men in monogamous relationships, men who always use condoms,
or men who take the drug Truvada to prevent H.I.V. transmission were
allowed to donate. At a minimum, the advocates argue, no sex in a month
would be a more reasonable barrier.
Combined
with testing, the risk of infections would be low enough to be
acceptable — and considerably more acceptable during crises like the
Orlando shooting, when the risk of dying from a gunshot wound greatly
outweighs the risk of catching a treatable disease from a gay man who is
eager to donate.
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