Conway: A policy in cold blood

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.


  • Hieronymus

    Interesting: This online version seems to have been edited to delete the author’s initial, bold, and personal self-proclamation. Too provocative? I dunno.

    The comments seem reasonable: it does seem rather arbitrary to exclude a population that engaged or suffered MSM just once in a lifetime (I say “suffered” to include actions that may take place in, say, prisons, where MSM may not be voluntary).

    Looking into the research reveals some telling quotes:

    “One model [advocated by the American Association of Blood Banks]suggested that this change [to a one-year deferral period post any MSM] would result in one additional case of HIV transmitted by transfusion every 32.8 years.

    “Opponents of donation restrictions in certain groups believe that this is an acceptable risk.”

    But “[the American Plasma Users Coalition] said, “It’s not about blood supply; it’s about blood safety … Ultimately the end-user bears 100 percent of the risk… The fact that [the policy] is discriminatory does not mean it’s wrong if it’s in the interest of public health.’’

    “Added Corey Dubin, a hemophiliac infected with HIV from a tainted blood product [with no time frame given for his infection]: ‘This is daily question of survival.'”

    Now… this does bring me to a question (and I am not advocating unethical behavior): If someone who meets the definition of an excluded person due to MSM *and* that person has refrained for a year and been tested for HIV, why doesn’t that person simply… revise the truth? Again, I am not advocating lying, I am just wondering why the politics are so important.

    If changing the policy will bring in new blood, as it were, it seems to me that those interested have a venue available to them (albeit one that may compromise one’s values or ethics–but I somehow doubt that that is a too much of a real issue; feel free to disagree). Is it more of a normative movement, a la same-sex marriage? Just wondering.

    In any case, it does seem a bit hypocritical to employ a blanket exclusion for one group when, as you note, such an exclusion may not exist for certain other groups. (One also wonders: Which is more likely to lie, the man who visited a prostitute or the man who had sex with another man…)

    Grammar note: Nice try on the who/whom distinction (at least you know such a distinction exists) in the second sentence. Does the YDN no longer employ editors?

  • FailBoat

    According to the CDC, one in four males who have engaged in sex with males are HIV positive, accounting for 71% of male HIV cases in the US today (48% of , along with 53% of total new diagnoses in the US.

    Overall HIV rate for American men: 0.038%, overall HIV rate for American women: 0.013%

    Due to biological reasons, transmission rates from regular intercourse are also much lower than transmission rates from MSM. (1000x)

    **Hence, ceteris paribus, a single incident of MSM more of a HIV risk factor than a man sleeping with ten, twenty, or even fifty women. These are statistics, not value judgments.**

    Mr. Conway suggests that black women have an infection rate 15x that of white women. Well, MSM have an infection rate **1000x** that of the general population. It is the **most effective** criterion for HIV.

    Until Mr. Conway cites a single source to back up his appalling claim that the policies of the global health professionals in countries around the world (including Britain, Netherlands, Canada, Denmark, Finland, Iceland, Ireland, France, and Germany) are run by the Ghost of Jerry Falwell, I can’t take his claims that seriously.

  • FailBoat

    And since when did the Westboro Baptist Church become a “right wing group”? They protest soldiers’ funerals (not something the right is known for). Fred Phelps’ last political affiliation was as a Democrat, when he supported Al Gore in 1988.

    Opposing gay marriage is the only thing the WBC and the Republican Party have in common, which is a bit like saying that Hitler was a hipster because he was a vegetarian.