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Opinion

I'm an HIV Activist, and I Support the FDA Gay Blood Ban

January 19, 2016

Matt Ebert

Matt Ebert

There's been a lot of talk about the U.S. Food and Drug Administration (FDA) ban on gay blood, and it's time to set the record straight. The blood ban for sexually active gay men and other men who have sex with men (MSM) is necessary. It's not a question of discrimination; it's a question of public health.

The nation needs a safe blood supply, and there are too many sexually transmitted infections (STIs) in the MSM community to merit its inclusion without a celibacy requirement (even though the twelve-month celibacy requirement is longer than it needs to be -- more on that in a bit).

The good news is that it doesn't have to stay this way. But before we storm the gates of the FDA, MSM must reduce STIs within our own community. We have the tools, but do we have a strategy?

MSM have a higher incidence of nearly every sexually transmitted infection, including syphilis, gonorrhea, hepatitis and HIV. Not just slightly higher, dramatically higher. In New York City, for every case of syphilis in women, there are 38 cases in men. Since it's been estimated that MSM have a whopping 140-fold higher risk for newly diagnosed HIV and syphilis compared with heterosexual men in NYC, it's not hard to guess who those men are. And while gay men represent an estimated 4% of the total U.S. population, we have more than two-thirds the number of new HIV infections.

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I've heard arguments that MSM in relationships should be able to donate. But while gay men in relationships may be less likely to acquire STIs than their single gay friends, they aren't immune from the need for a celibacy requirement. Committed gay men have substantially higher rates of STIs than (married or single) heterosexuals. And there is ample evidence that gay men in relationships have a higher incidence of transmitting HIV to their partners than gay men to their casual sex partners.

But what if I told you that the 12-month celibacy waiting period before donating gay blood was overkill? I'm not skilled enough to create a complex mathematical model to show it, but my partner and fellow AIDS activist James Krellenstein did in a rough, preliminary analysis of the data. James' model hasn't been peer reviewed; he needs more data and perhaps a better understanding of viral kinetics.

James' analysis affirms the need for a community-wide celibacy ban. But it shows that, after the window period for early infection and adjusting for a safe buffer, a two-month celibacy regulation is very nearly as effective as 12 months. If he's right, where gay blood is concerned, two is the new 12.

Two months does seem a better alternative than 12, and the FDA should consider revising its policy once the model passes review. But are bloggers and organizations like Gay Men's Health Crisis (GMHC) and HIV Equal, and movements like #bloodequality wasting time and financial resources over the FDA ban for the sake of political correctness, rather than fighting the real problem of discrimination in the health care system?

Last year I went to a doctor in a rural state who literally put her index fingers in her ears when I told her I had HIV. She replied that her mind was filled up, and she didn't want to learn new things like HIV. I told her HIV wasn't a new thing; people have been dealing with it for decades. She didn't refer me to an infectious disease doctor -- she said I would have to find an infectious disease doctor. When I did, the clinic didn't have an appointment for six more weeks. Still, she wouldn't refill my prescriptions.

I was able to find medication elsewhere, but this got me thinking about our priorities. My experience in a rural county hospital wasn't my first encounter with HIV discrimination -- it was in the Los Angeles County Jail. In jails and prisons you're lucky to get water for your thirst let alone to wash down your medication. In Los Angeles County Jail, I never received any medication at all.

MSM are incarcerated without medication across the nation, and you never hear about it or even get an honest pulse on the death toll. It's time we recognize the difference between a necessary ban on gay blood and real medical discrimination. The latter is a barrier to lifesaving care; the former is a canary in our collective coal mine, telling us we have a long way to go to get our community drug and disease free.

HIV is still treated as a biohazard, a feared medical anomaly requiring segregation. Across the nation treatment hasn't caught up with science. Perhaps the FDA (and the Centers for Disease Control and Prevention [CDC]) can get on board with Anthony S. Fauci, Director of the National Institute of Allergies and Infectious Diseases (NIAID) who opines in the Washington Post that "more than 1.2 million people in the United States are at substantial risk of HIV infection and could benefit from PrEP [pre-exposure prophylaxis]; however, less than 5 percent of these people are taking it. To make matters worse, one-third of primary-care doctors and nurses are unaware of PrEP and its potential health advantages. This must change."

The stigma, racism, classism, homophobia and discrimination inherent in the reality of Fauci's statement -- the one about the absence of a national strategy to end new HIV infection -- is far worse than the FDA blood ban. I can support a fight to lower the ban's celibacy limits from 12 to two months, but that fight and the money and time needed to do it come in far second place to lowering the incidence of STIs in our community.

Instead of fighting the blood ban, we should fight the homophobia inherent in a system that keeps 19 states Medicaid-free zones. Fight every Republican candidate who rails against the Affordable Care Act and expanded access to health care. Fight a city public health commissioner like Mary Bassett, who closed the largest STI clinic in New York City at a time when new infections continue to skyrocket. Fight to overcome the socioeconomic barriers that keep HIV care and prevention out of reach for Southern, black MSM. Fight for transgender women to be designated as such by the CDC, not lumped together with MSM. And fight your own shame over gay sex. Shame erodes our ability to speak honestly with each other and our health care providers.

HIV is still here -- over 3000 MSM die and 30,000 more are infected every year. Southern, black MSM are losing their sight to syphilis. Thousands of people with hepatitis C are viremic and can't afford treatment. And by every metric, meth abuse is an epidemic in the gay community with no effective strategy to end it on deck.

To improve our bloodline, let's raise our community health standards. In all populations, let's address the behavioral and medical problems of drug abuse and STIs. If we achieve zero HIV transmission and lower STI rates by putting our power behind ending the systemic homophobia in the health care system, the FDA celibacy requirement on gay blood will take care of itself.

Matthew Ebert is an American writer who most recently lived and worked on a dairy farm in Sheshequin, Pennsylvania. In 1987, at the age of 22, he joined the AIDS activist group ACT UP, and has remained committed to a cure for AIDS ever since. In 1995 he tested positive for HIV, and received an AIDS diagnosis later that year.


Copyright © 2016 Remedy Health Media, LLC. All rights reserved.


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Reader Comments:

Comment by: Scott Parrish (Boston MA) Thu., May. 12, 2016 at 12:39 pm UTC
How can we reduce diseases in th gay community?I have absolutely no control on what other gay men do.
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Comment by: Javier (Santa Barbara) Mon., Jan. 25, 2016 at 5:41 pm UTC
Let's agree to disagree.
I believe that to fight the HOMOFOBIA that Matthew Ebert is pointing, is also important to keep fighting the fight with the blood donation system, HOMOSEXUALS/ HETHEROSEXUALS statistics go up and down, at some times there are more heterosexual with HIV/ STI's, so to assume that just for being homosexuals we can't donate blood means cutting their own blood supplies. I wish I can donate blood myself, since I have the international blood type, but I do not donate because in part they do make you feel like you are a disease, and they do not care if you are using or not drugs, or if you are monogamous, discouraging Monogamous gay healthy couples from helping their communities.
I'm looking forwards for the day that I can walk in to a blood donation center knowing that they will treat me with the same respect that they treat any other blood donor.
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Comment by: Charles (Kinston , NY) Mon., Jan. 25, 2016 at 9:12 am UTC
if there's a ban it should be everyone. hetrosexual people have risks for infections as well
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Replies to this comment:
Comment by: Chris (Philly, PA) Wed., Jan. 27, 2016 at 11:26 pm UTC
Did you actually read this piece before dogmatically lashing out on your poor keyboard/screen? Key 'graph here:
"MSM have a higher incidence of nearly every sexually transmitted infection, including syphilis, gonorrhea, hepatitis and HIV. Not just slightly higher, dramatically higher. In New York City, for every case of syphilis in women, there are 38 cases in men. Since it's been estimated that MSM have a whopping 140-fold higher risk for newly diagnosed HIV and syphilis compared with heterosexual men in NYC, it's not hard to guess who those men are. And while gay men represent an estimated 4% of the total U.S. population, we have more than two-thirds the number of new HIV infections."
Heterosexuals (as well as Lesbians) that have EVER used IV needles for non-prescription drugs are permanently banned from donating. Heterosexuals (as well as Lesbians) that have EVER received payment for sex are permanently banned. Heterosexuals (as well as Lesbians) that have received DIY tattoos/piercings (or tattoos in unregulated states) are banned for 12 months. Heterosexuals (as well as Lesbians) that have spent 72+ hours in jail are banned for 12 months.
Do you see pattern here? Some behavior poses a greater risk of transmission than other behavior. There is a reason that male-to-male sex is deemed risky whereas female-to-female is not (and no, it's not because our heteronormative society is more comfortable watching Ladies Prison movies than Brokeback Mountain).


Comment by: James (Australia) Thu., Jan. 21, 2016 at 6:11 pm UTC
Brilliant piece, Matt. As a health care professional in Melbourne, Australia I can tell you we have some awful discriminatory practices here (not least being our relationship inequality laws)... BUT one thing we don't have is a botched and lethal health noncare system like you have in America. Our access to medication (at least here in Melbourne) is totally free of charge and there are some great initiatives which are aimed at increasing health professional awareness and reducing stigma. We've dome SOME things very well down under (whilst others remaining dark age material!)
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Comment by: Joseph Shore-Goss (North Hollywood CA) Thu., Jan. 21, 2016 at 2:36 pm UTC
sorry but singling out gay men is discrimination you should screen out all sexually active people! there is no difference all who are sexually active are at risk of exposure...singling out gay men nothing more than stigmatizing and WRONG
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Comment by: Anonymous Wed., Jan. 20, 2016 at 9:08 am UTC
Another gay man here, and I want to thank you for writing this. Far too much of our effort has been dedicated to overturning the blood ban while real disparities in health care and differences in the incidence of bloodborne diseases make it totally sensible public policy.

I don't know when the wheels started to come of the vehicle here, but I think it was undeniable the moment "HIV activists" started denying the reality of who gets and is at risk of bloodborne diseases, in deference to the egos of some gay men. Having a gay blood ban is not "discrimination", it's a sensible public health policy. Being offended by this policy indicates the attachment of a moral judgement to bloodborne diseases, which is the only truly offensive thing that I see.
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Comment by: Josh Robbins (Nashville, TN ) Tue., Jan. 19, 2016 at 8:17 pm UTC
The fight with the FDA over the ban had little to do with the actual blood ban. Sure, some people were vested as ever on this issue. But, the fight was about getting the FDA to finally start acknowledging anal sex, and gay men. I'm all for rallying the troops. And keeping our focus tight. But know that we have the FDA talking about anal sex-- can we ask them to approve a condom to be used for that sexual activity they are keeping banned?
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Comment by: Thank you Matt (Red State, Oklahoma) Tue., Jan. 19, 2016 at 3:59 pm UTC
Thank you for your courage, Matt. I am a gay man living with HIV, and I, too, feel that the current guidelines for blood donation are reasonable and justifiable for the reasons you state. Those who feel strongly against the ban seem so passionate about it, but they do not speak for everyone. I know that the chances of passing HIV and other infections through the blood supply is rare, but having lived for this virus for nearly two decades has convince me that even rare is too risky - especially when it involves what would otherwise be a lifesaving procedure (receiving donated blood). I appreciate your being open and honest about this controversial subject, especially when it does not seem to match the majority of my gay friends.
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