Implications of the FDA Blood Donation Policy

Thanks to Wikimedia for the image.

Since 1977, the FDA has not allowed blood donations  from men who have sex with men (MSM). However, the FDA has just announced that it’s considering lifting the ban, and making an exception for men who have sex with men who’ve been celibate for one year.

On the one hand, it’s estimated that this will increase the U.S. blood supply by 2-4% annually. On the other hand, this policy sends a sex-negative, stigmatizing, and inaccurate message about sexual safety, sexual practices, and sexual orientation.

In a quotation from NPR’s coverage of the decision, the FDA said it will “take the necessary steps to recommend a change to the blood donor deferral period for men who have sex with men from indefinite deferral to one year since the last sexual contact.” But this leaves open the question: What kind of sexual contact? Sexual contact with whom? And under what circumstances?

Basically, the decision could be interpreted to still exclude a man who is monogamously having sex with one other man. This hypothetical couple, to be safe, waited to have both oral and penetrative sex with one another until both their STI tests (which included an HIV test) came back negative. Neither one is an intravenous drug user. And let’s say they still use condoms, too, rather than deciding to fluid-bond with one another. The combination of properly-spaced STI tests and monogamy is unarguably safe.

To take another hypothetical example, say a bisexual man has had safe sex with men, and is now in a relationship with a woman. This couple waited to have penetrative sex with one another until both their STI tests (including HIV) came back negative. And because the woman’s not on hormonal birth control, they’re using condoms. How is this example any different from the above one, other than that it’d be technically admissable under the new policy?

In an even more extreme example, let’s say that two young men are attracted to each other, and that they’re each other’s first sexual contact. They’re not intravenous drug users, and have no other risk factors for HIV transmission. And they get tested, just to be safe (…sorry to harp on this issue, but frequent STI testing when you’re sexually active is SO important!). Does it make any sense to exclude these guys from being eligible to donate blood?

These hypothetical examples show that the one-year-of-abstinence rule would exclude lots of potential donors who are exhibiting safe sex behavior. Hypocritically, the decision would also allow anyone who’s not a man having sex with men but practices other less-safe behaviors to donate.

Thus, the new policy conflates sexual orientation with sexual practices, which is a step backwards for sex education. It sends the message that it is identities – not behaviors – that make one safe or unsafe. I could spend more time deconstructing the way in which both new and old policy are homophobic, but I’ll settle for pointing out that according to the CDC, the rate of new infections among African-Americans is 8 times that of whites, but we aren’t banning blood donations by African-Americans, are we?

Additionally, the policy conveys an all-or-nothing paradigm regarding safe sex: abstinence and non-abstinence are constructed as a mutually exclusive dichotomy, rather than as poles on a spectrum. As we know from CDC studies, there are stark disparities in the teen pregnancy and STI transmission rates in regions that promote abstinence-only sex education and those that provide comprehensive evidence-based sex ed. In other words, abstinence-only sex ed is not as effective at preventing negative health outcomes. So… why would an agency that’s done any research promote an abstinence-based message?

Yes, the safest form of safe sex is complete abstinence, and from there, we can discuss safety in terms of degrees: monogamy, barrier use during sex, frequent STI testing and disclosure of one’s results to one’s partners, and so on. But promoting the all-or-nothing message of abstinence-only behavior generally is ineffective, whether we’re talking about sexual activity or dieting. Humans don’t seem to do absolutes very well, and so advice-giving agencies should recognize this and work with it.

I worry that this policy sends the following messages:

  • That same-sex sexual activity is never safe
  • That safer sex measures are no replacement for abstinence (so why bother?)
  • That sexual barriers (like condoms or dental dams) don’t matter (so why bother?)
  • That even sexual monogamy is not as safe as complete abstinence (so why bother?)
  • That one year of abstinence is a reliable measure of… well… anything other than the fact that you haven’t had sex for one year

While moving from a total ban on blood donations from men who have sex with men to anything less extreme is generally a step in the right direction, I believe the agency could (and should) provide a more clearly reasoned-out policy that doesn’t promote sex-negative and inaccurate messages. The policy has not yet been formally adopted, though, so I’m curious to see how it develops.

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