Sunday’s mass shooting in Orlando saddened and frightened me, as it did millions of other gay people. I immediately began grieving for those who were injured and killed in this anti-gay attack. As a physician, I also knew the emotions generated by the attack could be redirected into good deeds, like donating blood, that strengthen and heal others, as well as ourselves. Yet as a gay man who, like most men my age, is sexually active, I am categorically forbidden from donating blood. Despite being in a long-term relationship and being well-versed in safer sex practices, the FDA views my blood as linked to a particular virus.
Don’t get me wrong. We should be concerned about the human immunodeficiency virus (HIV) and AIDS, its deadly consequence if left untreated. But we should not be fearful of acquiring HIV through a blood transfusion. Thanks to highly sensitive blood tests, conservative estimates place the risk of acquiring HIV through a transfusion as at most 1 in 1,000,000.
Let’s put that risk in context. The drug warfarin can prevent potentially deadly blood clots, but carries with it a 3.8 percent annual risk of severe, difficult-to-control bleeding, which often leads to hospitalization or death. That’s 38,000 times higher than the risk of getting HIV from a blood transfusion. Yet the FDA does not ban its use, and millions of American take the drug without being paralyzed by fear.
A big difference is the associations that surround HIV/AIDS. It has been linked to a ghastly and deadly illness, taboo behaviors, and stigmatized social groups. Before the modern testing era, HIV infection through blood transfusion was a horrifying though common possibility. Although that is no longer the case, many of my patients still possess these outdated fears.
Gay men also worry about being infected with HIV. That’s actually a reasonable fear, since we are more likely to get the virus than any other group. We are appropriately respectful of the damage HIV can wreak. We’ve watched our friends, boyfriends, and partners suffer and even die from HIV/AIDS. We don’t take lightly the shared responsibility of protecting the US blood supply.
Public policy can have a profound affective role in our society. Law professor and bioethicist Dov Fox refers to this concept as the “expressive dimension” of public policy. He contends that a policy can be discriminatory and harmful if “the policy communicates a social meaning — independent of any bad intent or bad effect — that erodes worthy forms of public recognition.” Banning a stigmatized group from participating in the social good of blood donation, independent of any rational merits of the policy, signals to the public a sense of that group’s social undesirability.
An honest, ethical evaluation of our blood donation policy must acknowledge that gay men are far more likely to live with fears of HIV, violence, and ostracism than straight people. Instead of valuing the outsized fear that straight people have of homosexuals, we could instead reintegrate gay men into charitable society through a science-based blood donation policy. Until last year, gay men in the United States were permanently barred from donating blood. The current policy forbids gay men from donating blood if they have been sexually active in the last 12 months.
A better policy that places reasonable limits on blood donation should instead take into account the current HIV testing window of seven to 10 days and focus on specific risky behaviors rather than demographic groups. Less onerous restrictions would likely increase compliance with a screening process that relies on honest self-reporting. One possible alternative is a one-month deferral for people of all orientations after having unprotected sex or sex with a new partner. Policy makers may also want to incorporate whether someone is a first-time or repeat blood donor, as that can affect risk.
In the aftermath of the senseless killings in Orlando, the gay community rallied around its fallen brothers and sisters. The fear and alienation that many gay men felt of knowing that people like them were targeted by a mass murderer were amplified by being turned away from donating blood, a simple, selfless act that could benefit others.
It’s time for a more rational blood donation policy that communicates to gay men that we, too, can benefit others. We, too, can save lives. We are not viruses.
Benjamin Mazer, MD, is a pathology resident at Yale-New Haven Hospital. His opinions are his own and do not represent those of his employer or other affiliates.