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"Bad Blood" - a scholarly diatribe against the FDA's gay men's blood donation policies amidst COVID

Updated: May 23

You got blood on your hands.

Look! It’s actually dripping from your fingertips.

And now, you want more…actually, you NEED more.

Well, if you want my blood, in the words of Ricky Ricardo from “I Love Lucy,” you got some splainin’ to do.

Food and Drug Administration (FDA), I am talking to you. You have a lot of gall. How dare you only now, amidst a catastrophic pandemic, relax the standards for accepting blood donations from Men-who-have-Sex-with-Men (MSM)? The sheer temerity of having waited so long and then to only now (putting aside the 2015 switch from a lifetime ban to a 1-year of abstinence rule) begin working with medical professionals to supplicate my community, the gay community, to give our precious blood when you still have decades of our blood on your hands for which you have yet to make restitution.

Where in the world were you for the past 3 decades when we were the ones who were needing you? Where in the world were you when we were suffering and entreating you to help mitigate societal stigma directed towards us as a result of your discriminatory guidelines proscribing us from donating blood, a public health policy predicated on the antiquated, unsubstantiated, and unscientific notion that the blood of MSM inherently carries elevated risk compared to that of non-MSM, without appropriate regard for other factors for robust, empirical consideration (e.g. number of sex partners, risk factors among those sex partners, frequency of sexual intercourse, type of sexual activity, safe sex practices, prophylactic HIV medications being taken, other HIV exposures)?

The audacity of your orientationism is astounding. And if you are wondering what I mean by “orientationism,” it is a protologism I created to discuss the systemic and societal prejudicial beliefs and discriminatory actions directed towards individuals based on their sexual orientation with the goal of establishing a currently non-existent (but much needed and long overdue) lexical, sociocultural, and political equivalent to other similarly established concepts like racism, sexism, ageism, and ableism in order to confer the requisite gravity and formality to gay discrimination that the term “homophobia” simply does not adequately encompass.

Moreover, in the context of discussing the FDA’s controversial track record, the term “orientationism” is germane and necessary because what I am talking about is not just an irrational, inexplicable fear of gay people, but what I see as a subconscious sense of animus, revulsion, and even superiority exacerbated by the 1980s AIDS epidemic that bleeds into differential societal treatment of us that results in second-class citizenship and patently inequitable national policies in medicine. So it is the historically orientationist policies of the FDA that LGBTQIAP+ advocates like myself believe have perpetuated enmity towards and discrimination of gay people.

Recently, after extensive advocacy from medical professionals who recognized the concern around a potential dearth in blood supply amidst COVID-19, the FDA softened its stipulations to respond to this burgeoning crisis by reducing the mandate of a year of abstinence from “gay sex” to just 3 months.

Reflexively, there appeared to be some displays of exultation amongst LGBTQIAP+ advocates in the online community in the aftermath of this latest move by the FDA, touting it as a step in the right direction and de facto a leap for the gay community. But hold up. There cannot be exoneration until there is a complete, and not just a partial, overhaul of this stigmatizing and invidious policy. In fact, there needs to be an acknowledgement of wrongdoing as a way to atone and demonstrate true contrition.

So as you can imagine, there was no revelry here. As much as I would have liked this piece to be an encomium about the progress of contemporary gay civil rights as reflected by the FDA’s latest move, I had to ask myself, “cui bono?” I cannot in good conscience express gratitude when the FDA procures a double win: they get our blood, and on top of that, they get to continue to use an unfounded, prejudicial, and erroneous travesty of a policy to guide public health practices that will continue to fortify one of the greatest canards in modern history: that HIV/AIDS is a “gay man’s disease.”

Furthermore, of paramount significance should be the consideration that people can always lie about their sexual orientation, their sexual activity, their use of IV drugs, and more prior to donating blood. Additionally, heterosexual men, heterosexual women, and every other combination of sex, gender, sexuality, and sexual orientation can have HIV and not know it as a result of a myriad of factors (e.g. they have not been tested recently, false-negatives/not enough time has elapsed for HIV antibodies or viral RNA to appear sufficiently in blood, etc.).

This should compel everyone to ask, “Is this truly a good-faith-based public health policy informed and corroborated by science and aimed at protecting the health of our nation, or is it actually just insidiously surreptitious discrimination masqueraded as a convincing pseudo-earnest desire to promote our general welfare?” If the proof is in the pudding, show us the pudding. Otherwise, you do not get to be an oppressor of the gay community and then be the beneficiary of something you did nothing to deserve.

You want our blood? You will have to work for it. You need to have some skin in the game. And you need to have made palpable, proactive, and personal efforts to express compunction and reverse the colossal damage you have already done.

You can start by doing away with blanket proscriptions that guide the rules of blood donation and instead, treating gay men and MSM as equals to heterosexuals. More importantly, if your true concern lies in the protection of our country’s health and welfare, and you are brazenly disregarding the potential for people to fabricate information, you should instate a policy and system of comprehensive and streamlined individualized review, taking into consideration factors that would more accurately assess risk of receiving HIV-positive blood, such as number of distinct sex partners in the past 3 months, known risk factors among those sex partners, the extent to which safe sex is (or is not) adhered to, whether pre-exposure prophylaxis is being consistently taken, date of and result of the last HIV test, and the like.

But until all of that happens, FDA, you don’t need our blood. Because it’s already all over your hands.


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