The Food and Drug Administration’s ban on blood donations from men who have had sex with men even once since 1977 will remain on the books, if the Health and Human Services’s advisory committee has its way. The rationale for keeping the iron wall up? Because gay men “are, as a group, at increased risk for HIV, hepatitis B and certain other infections.” But if it’s just about math, and not discrimination, why isn’t HHS advising the FDA stop accepting blood donations from, say, blacks?
Looking into the FDA’s rationale, William Saletan observes:
The FDA bases its MSM policy on simple math. “Men who have had sex with men since 1977 have an HIV prevalence … 60 times higher than the general population,” the agency observes. “Even taking into account that 75% of HIV infected men who have sex with men already know they are HIV positive and would be unlikely to donate blood,” that leaves a population of MSM blood-donor applicants whose HIV prevalence is “over 15 fold higher than the general population.”
So surely the FDA wants to keep the population safe from high risk donors, right? Then ban blacks!
So a 15-fold difference is good enough to warrant group exclusion. How about a nine-fold difference? According to the Centers for Disease Control, HIV prevalence is eight to nine times higher among blacks than among whites, and HIV incidence (the rate of new infections in a given year) is seven times higher. For black women, HIV prevalence is 18 times higher than for white women.
And these numbers understate the likely difference in risk to the blood supply. A recent CDC analysis of MSM [men who have sex with men] in five cities found that while only 18 percent of the HIV-infected white men were unaware of their infections, 67 percent of the infected black men were unaware. If the awareness gap between blacks and whites overall is even half as great as it was among the men in this study—i.e., if blacks are twice as likely as whites to be unaware that they’re infected, and therefore more likely to try to donate infected blood—then theoretically, black donors are just as risky as MSM donors.
That wouldn’t be discrimination, right? That would just be doing what’s best for America’s blood supply — red-lining entire demographics of people with immutable characteristics.
Is race a less legitimate basis for exclusion than sexual orientation is? Race is immutable, but plenty of evidence suggests that homosexuality is immutable, too. Technically, the MSM exclusion isn’t a gay exclusion: You can be gay as long as you don’t have sex with other men. A parallel policy, applied to race, would be that you can be black as long as you don’t have sex with other blacks. After all, the No. 1 reason you’re more likely to get infected by a gay man than by a straight one is the already high prevalence of HIV among gay men. The same is true of the higher infection risk among blacks.