Sounds crazy, right? But we already exclude blood on the basis of African origin. In 1983, the FDA ruled out donations from anyone who had lived in Haiti after 1977. Then it extended this prohibition to sub-Saharan Africa. Today, the Red Cross informs prospective donors that under FDA rules, "Persons who were born in or lived in Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger and Nigeria since 1977 cannot be blood donors."
This isn't racial animus. It's just blunt math, based on the increased risk of a particular HIV type in these populations. The FDA has a similarly coarse rule against blood from anyone who has spent half a year in the United Kingdom, based on the threat of mad-cow disease. The problem isn't racism; it's the crudity of treating individuals according to group membership. Where does it end? When the FDA barred Haitian blood, Haitian groups asked why black Americans, whose HIV rate was higher than that of Haitians, weren't similarly excluded. It was a good question, and it was never answered. (For an excellent analysis of similarities between the Haitian blood ban and the MSM blood ban, see Charlene Galarneau's article, "Blood Donation, Deferral, and Discrimination," in the American Journal of Bioethics.)
We don't have to keep going down this road. Instead of rejecting people based on group membership, we can assess them as individuals. It's fine to ask them about factors known to affect the risk of infection: travel, promiscuity, condom use, drug abuse, piercings, tattoos, whatever. But the evaluation of these factors has to be more nuanced than a categorical exclusion. And the surest measure of each individual's risk is a blood test. Even the FDA concedes that "today's highly sensitive tests fail to detect less than one in a million HIV-infected donors."
In its latest recommendations, posted Friday, the FDA's advisory committee on blood suggests further research and acknowledges that current screening policy is "suboptimal in permitting some potentially high risk donations while preventing some potentially low risk donations." But since it's unclear which "alternative policy" would be better, the panel recommends that the "indefinite deferral for men who have had sex with another man even one time since 1977 not be changed at the present time."
So the gay blood ban will continue. And that's OK, according to the American Plasma Users Coalition, whose testimony strongly influenced the FDA committee. "By their very nature, blood donor screening and deferral criteria are discriminatory; however, they are justifiable when they provide increased protection to public health," the coalition argues. "Criteria for donor deferrals must put safety of the recipient first and be based on scientific and epidemiological evidence about large groups of people."
That kind of group judgment was popular in the 19th century. It may have been necessary in the worst epidemics of the 20th. But in the 21st, we can do better.
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