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.
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.