Sample opinion column 1

by Rachel Robson. Copyright 2003.

Some issues just won’t die. But the people they impact will.

Take, for instance, the tortured question of whether practicing gay men should be allowed to donate blood.

My answer is a qualified no, and becoming less clear every day.

When I last wrote about this issue, in the March 1999 Kansan, the answer was much clearer. The HIV test used by most blood banks at that time tested not for the virus itself, but for antibodies to the virus. As a result, there was a “window period” after infection, during which time potential blood donors could test negative for HIV even if they were infected and capable of passing the disease to others. Because of that window period—which was often many months long—it was essential for blood banks to make decisions about whether to accept a donor’s blood based in part on which risk groups that donor belonged to.

That meant asking a lot of nosy questions about sexual behavior, among other things. Answering “yes” to most questions meant a one-year deferral.

But one question was different: “Male donors: Have you had sex with another man, even one time, since 1977?” Saying yes to that one wouldn’t get you banned from donating blood for a year, but for the rest of your life.

Gay rights groups protested that such a lifetime deferral was unfair. “I can see their point, but blood donation is not a matter of equal opportunity,” Dr. William Dixon, a Watkins Health Center physician told a Kansan reporter in 1999. “It is both reasonable and good public policy that men who have had sex with other men not be allowed to donate blood,” I chimed in, in a March 12, 1999 column.

And I still think that, sort of.

But since 1999, things have changed. Our ability to detect HIV in blood has improved dramatically, and three separate tests for the virus are now routinely used to screen donations. The demographics of the HIV epidemic are slowly shifting. Gay men are still the group most at risk for new HIV infection, accounting for 42 percent of all incident HIV cases while representing a mere five percent of the total U.S. population, the Centers for Disease Control reports. But in 1999 gay men accounted for 49 percent of new HIV cases—so their fraction of the total American HIV burden is, happily, down.

Scientists who study the safety of our blood supply have similarly mixed feelings. The Food and Drug Administration, the agency which mandates what questions all volunteer blood centers must ask donors, commissioned a study in 2000 to determine whether allowing gay men to donate would compromise the blood supply. That study found that permitting men who had not had a homosexual encounter in five years to give would add an average of 1.7 additional HIV-contaminated units to the blood supply every year. Removing the ban on gay male blood donors entirely would mean about six additional HIV-infected units going to unsuspecting patients every year.

That study has since been confirmed by other researchers.

Even with improved tests to detect HIV, a change to FDA rules that would allow gay men who have abstained from sex for the past year to donate blood would result in about one additional HIV-infected unit entering the blood supply in the United States every year, research in the journal Transfusion showed in January 2003. Affording this high-risk group the privilege of giving blood would increase the total number of blood donors by just two percent.

So is it worth it? Is a two percent increase in blood donations and the knowledge that we’re no longer discriminating against gay men worth the handful of new, transfusion-borne HIV cases that would inevitably result from a change to FDA policy? Are those lives worth more, or less, than our longing for equality?

I think those lives are worth more. I think the FDA policy should remain unchanged. But I no longer know.

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