On Sunday, Omar Mateen killed 49 people and wounded dozens more in a massacre at Pulse, a gay night club in Orlando, Florida. As is often the case after tragedies, many Americans rallied to support the victims and their families, with LGBT communities and allies standing in solidarity.
One of the ways people in Orlando tried to help victims was through blood donations. Many potential donors, however, found themselves blocked at blood centers. Specifically, men who have had sex with men in the past year are still barred from donating blood because of a rule from the Food and Drug Administration.* Even after the most deadly act against gays, lesbians, bisexual, and transgender people in American history, the built-in homophobia of American public health keeps the country from mounting the most effective possible response.
The original blood-donation rules for men who have sex with men, or MSM––a designation designed to encapsulate sexual activity instead of orientation––were actually less restrictive than current rules. The MSM population was the epicenter of the HIV panic of the mid-80s. After the mode of transmission was fully understood by the medical community, the FDA’s 1983 guidelines asked men who had sex with multiple male partners to refrain from donation. In 1986, the guidelines became de facto mandatory exclusions of men who had sex with men in the previous 10 years. In 1992, the FDA finally recommended the lifetime ban for MSM that became the American and global standard for over 20 years. Despite a 2015 move by the FDA to change the deferral for MSM from a lifetime ban to a year without sexual contact with another man, at least 20 other countries have followed the United States’ lead and implemented lifetime bans.
These bans progressed not with scientific understanding of HIV, but against it. The original 1983 ban was an emergency protocol for an beleaguered public-health field that had no reliable way to test blood for HIV. In 1985, however, the FDA approved a new test, known as ELISA, that could detect antibodies produced against HIV. The Western Blot improved this process in 1987, and since then medicine has had the ability to correctly identify HIV-infected blood at close to a 100-percent success rate. The only issue was that HIV antibodies could remain latent for several months. Based on the science then, and doctors’ limited knowledge of risk, banning men who had sex with men within the last year was maybe a defensible policy. A lifetime ban was not.
Now, even that one-year ban is questionable. Since 2002, the FDA has approved blood testing that can identify the HIV virus within just a few weeks of exposure. Despite that technology, the lifetime ban somehow persisted until 2015, at which point it was replaced by a one-year deferral. The deferral is based on sex at birth, a unique handicap for transgender people that illustrates its ridiculousness. That same deferral is now keeping members of Orlando’s LGBT community and other potential donors across the country from supporting victims of the Pulse massacre in one of the most basic ways that Americans have always responded to violent tragedies. It is a restriction simply not based in science.
While MSM do still make up the majority of new and current HIV infections, the label itself says nothing about individual status, and blood donation centers have had the tools to actually assess that status for decades. Unprotected penetrative anal sex is the most common way of acquiring HIV, but its risks hinge on factors that make sex risky for everyone: sex with multiple partners, non-awareness of HIV status, and lack of protection. Orlando blood-donation clinics could assess the actual risk posed by gay donors based on the status, identity, and number of partners they have. To place the same restrictions on monogamous gay couples as those placed on straight men who have unprotected sex with multiple partners, or intravenous drug users, is simply inexcusable policy.
If not science, what’s the explanation for the ban? Occam’s razor would suggest homophobia, a factor in HIV-related medicine and policy since its foundations in an unmistakably homophobic panic. It was once not uncommon for elected politicians and medical professionals to openly profess that HIV was punishment for homosexuality, a view that has not entirely eroded today. The discrimination inherent in the blood ban is obvious; such a policy would be easily exposed as discriminatory if applied to other groups. Indeed, it already has: Bans against Haitian immigrants on similar grounds were overturned in the early 1990s. The refusal to look beyond a broad category of sexual behavior and investigate real risk is a backwards policy in a field that otherwise touts itself as being cutting-edge. It suggests that views of HIV have not entirely changed since the 1980s.
Short of lying about their sexual orientation, many members of Orlando’s LGBT community cannot donate blood in this time of crisis. Short of the kind of violence that took place at Pulse, being out still comes with a real risk of social and political exclusion. It is impossible to fully challenge Mateen’s violence with a system that further excludes LGBT people from its ranks.
* This article originally stated that the ban on gay blood donations is placed by the Federal Drug Administration, rather than the U.S. Food and Drug Administration. We regret the error.
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