Conway: A policy in cold blood

Screen_shot_2010-09-09_at_2
Photo by Jake Conway.

Today and tomorrow many of you will donate blood at the American Red Cross sponsored blood drive here at Yale. But I can’t. I’m gay.

A definition of whom or what is a “man who has had sex with another man” is unnecessary. I will make no essentialist assumptions about men who have sex with men (MSM) and will make no civil rights argument against the ban’s discriminatory nature — even if the ban does, in effect, amount to the categorical exclusion of gay men. There is no protected right to donate blood, no hallowed liberty to platelet transfusion or plasma fractionation. The FDA has the right to administer and safeguard the blood supply and determine who can and cannot donate blood.

But it also has the duty to ensure that the public health policy it creates accords with fairness and rationality. The problem with the current ban on MSM is that it is neither fair nor rational. The policy — and the science behind it — is rooted in homophobic ideas about the health, sex practices and morality of gay men.

Such ideas portray homosexuals as diseased, mentally ill and morally dissolute. Such claims are still made today — take, for example, Jerry Falwell’s moniker for Ellen Degeneres, “Ellen Degenerate,” or the claims of right wing groups like the Westboro Baptist Church of the ”whoremongery” of depraved gay men. While they have lessened in recent years, if not in intensity, in frequency, they still influence our public health policy.

The association of homosexuality with public health emerged with the rise of modern social science.As a field of rational inquiry, social science led to an obsession in our culture with the “policing of sex,” to use Foucault’s words, “not the rigor of a taboo, but the necessity of regulating sex through useful and public discourses.” In medicine, this meant the pathologization of sexual conduct, the categorization of sexual populations, the fission of identities and then creation of new ones based on sex — what amounted to a “medico-sexual” regime bent on observing, isolating, analyzing and classifying our “perversions.”

It is no surprise then that homosexuality became stained by the stigma of mental illness. Since its historical inception in modern medical discourse when the German neurologist Carl Westphal wrote of “contrary sexual sensations” in reference to homosexuals in an article in 1870, homosexuality has become an inveterate marker of a person’s deviance in sexual life, in civil society, in morals.

The notion of homosexuality as aberration, as illness or as something to be cured, repeatedly appears in the medical discourse of the 20th century. The famous Kinsey report of 1948, Sexual Behavior in the Human Male, which found that 37 percent of those surveyed had engaged in at least one homosexual act since adolescence, rather than changing Americans perceptions of sexual norms to accept homosexuality in many ways hardened their views on its abnormality. As the psychiatrist Edmund Bergler wrote in response to the study: “If these figures are only approximately correct then ‘the homosexual outlet’ is the predominant national disease, overshadowing in number cancer, tuberculosis, heart failure, and infantile paralysis.”

The American Psychiatric Association officially declassified homosexuality as a mental illness in 1973, but the aftershocks of a century of homophobic notions continued to impact perceptions about gay people among the medical community and general public.

Nowhere was the public perception of homosexuality as disease made more unassailable — if by self-evident causality — than in the AIDS crisis of the 1980s and early 90s. The emergence of AIDS served as the ontological link between the abstract findings of psychosexual medical science and the reality of a devastating epidemic. References to the disease as the “gay plague,” “gay cancer” and, more formally, gay-related Immune Deficiency were just a few of the terms initially used to describe the mysterious disease. The total negligence of the Reagan administration toward the disease’s rapid growth issued from a public perception of AIDS as an exclusively gay disease.

Significant deaths in Hemophiliac populations, owing to HIV-contaminated blood used in transfusions, created a very reasonable fear about the safety of the blood supply. Theban was a natural response.

But the ban is outdated. When it was enacted in 1983, there were no screening tests for HIV-positive blood. Today, blood banks routinely screen donations. Current HIV-antigen screening and nucleic acid testing are incredibly sensitive. Though the tests still cannot detect HIV with 100 percent accuracy (a two-week window period still exists from the time of infection in which the tests cannot detect HIV), they fail less than one in a million times.

The ban is also arbitrary. Admittedly, the Centers for Disease Control and Prevention show that MSM account for 53 percent of new HIV infections in the U.S. But the CDC also notes that 45 percent of new infections are among African-Americans and that the incidence rate of HIV for black women is 15 times than that of white women. Certainly, the FDA does not plan on barring African-Americans from donating blood as well.

Furthermore, the ban makes no allowances to MSM who demonstrate safe sexual practices, such as those men in monogamous relationships. Indeed, it is easier for a heterosexual who has had sex with a prostitute or with a heterosexual HIV-positive partner to donate blood. Each requires that the donor wait one year from the time of sexual intercourse; MSM, in contrast, are banned for life. The ban exaggerates the notion that all homosexual men are higher risk donors than heterosexuals.

Even the Red Cross and the American Association of Blood Banks see the policy as irrational, calling it “medically and scientifically” unwarranted in a 2006 position paper presented to the FDA. These groups support changing the lifetime ban to a year-long deferral. Their proposals have largely fallen on deaf ears. In June an advisory committee to the Department of Health and Human Services upheld the ban.

The decision makes plain that the problem of our public policy is its historical insistence on gay men as dangers to public health, and, more broadly, a medical apparatus propped up by homophobia and perpetuated by the bigoted makers of flimsy, vestigial politics.

Jake Conway is a senior in Davenport College.

Comments