Five Quarts: A Personal and Natural History of Blood (23 page)

“Calling all able-bodied volunteers: Superman needs a blood transfusion!”
(“Action Comics” #403 © 1971 DC Comics. All Rights Reserved. Used with Permission.)

I joined the ranks of real-world blood donors as soon as I was age-eligible, sixteen. In fact, in my wallet I still carry my original Spokane Blood Bank donor card, Type A, Rh+, on the back of which my record of regular “deposits” throughout high school and college remains legible in indelible ink. Nowadays, though, I only keep the card on me should I ever need blood in a medical emergency, not because I regularly give it. The last time I tried was in 1984 during an employee blood drive at a large Seattle company. Together with co-workers, I lined up outside the humming bloodmobile in the parking lot and was at last ushered inside. As I sat to fill out the standard form, my eye fell upon a question I’d not seen before, one directed at men: “Have you ever gone down on a guy?” Well, that may not have been the exact wording, but the query’s intent was clear.
Why, yes, I have,
I thought, with none of the nascent pride that, in a more intimate situation, might have accompanied this declaration. (I wasn’t out to my boss, who was capable of scaring me into stunned silence first thing Monday mornings with his “So, didja get any snatch this weekend?”) Perplexed at first, I quickly gathered that the questionnaire was fishing for gay men who might have AIDS, which seemed sensible, given the infections transmitted through blood products and the lack of a blood test to prevent such accidents. Still, I felt unaccountably ashamed of myself. Suddenly squeamish at the sight of blood, or so I claimed, I handed back the form, covered my unbandaged arm, and slipped back into the office. A purloined doughnut provided the phony proof that I’d gone through with it.

Fifteen years later, during the Bay Area’s 1999 blood drought, I looked forward to rolling up my sleeve again and this time doing the deed. Since all blood banks had begun using the ELISA-HIV test (which detects antibodies to the virus) shortly after it was introduced in 1985, I assumed that the gay restriction had been eased. I myself had tested for HIV half a dozen times since then and had always come up negative. Twice shy, though, I went online to scan the donor guidelines before making the trip to the blood bank. Good thing. The restriction hadn’t changed. It was easy to imagine the red rush of embarrassment at being told in person, “No, sir, you do not qualify.”

The question in question, number 9, hasn’t changed in wording since then, a fact I confirmed on my recent tour of San Francisco’s blood center. Under current FDA rules, all potential male blood donors must be asked verbally during the screening interview if they’ve had sex, “even once,” with another man since 1977, the year identified as the start of America’s AIDS epidemic. If the answer is yes, regardless of whether the sex was safe or the partner HIV negative, he is barred for life from donating blood (
permanently deferred
is the official term). It so happens that my first homosexual encounter was in 1977 at age sixteen; even if I’d sworn off men right then, I still couldn’t give blood today. To be considered a qualified donor, a healthy gay man needs to have been celibate for the past twenty-seven years, a prerequisite that leaves me pondering: Can a guy who’s not had sex in over a quarter century rightly be called “healthy”?

For the sake of argument, I can set aside the fact that the majority of gay men are HIV negative and committed to remaining that way. I can also ignore the assertion that, should gays be welcomed, blood centers will be misused as HIV testing sites, the presumption being that, illogically, fearful individuals would prefer a test site that demands documentation of who you are and is answerable to the federal government. At the same time, I fully accept that gay men in general are considered a high-risk donor pool. But why is there such inconsistency between what’s required of gay donors and other groups? Straight men who’ve had sex with a prostitute, for instance, are barred from giving blood for just twelve months after that encounter. The FDA, I’ve learned, has argued that a data deficit is what keeps them from giving gay men this same “temporary deferral.” The agency simply has no solid statistics on HIV infection rates among gay men who’ve abstained from sex for a year or more, a statement that begs the question, Do they really have comparable data on straight johns? The yes-or-no format of the donor questionnaire is also problematic. It doesn’t elicit an elaboration of an individual’s history of unsafe sex or multiple partners, which many public health experts consider a more effective means of determining genuine risk. Under current criteria, a woman who’s had unprotected anal intercourse with numerous partners of unknown HIV status could technically donate blood (though obviously such a person shouldn’t do so) while a young, HIV-negative gay man who’s had nothing but safe sex could not.

Of course, quizzing people about their sexual histories isn’t foolproof. Having worked in AIDS education, I know that people don’t necessarily tell the truth about their sexual past or may genuinely not realize if they’ve put themselves at risk. And with practices such as unprotected oral sex, there isn’t consensus about what is safe. Ultimately, experts agree, the best test is blood testing itself. That being said, the ELISA, an effective test, does come with a problem: the “window period.” According to the FDA, “up to two months” may elapse between the time of infection and the body’s production of the antibodies the ELISA detects. If the ELISA were the only HIV test performed today, I could understand the FDA’s erring on the side of extreme caution. But the fact is, three separate HIV tests are now performed on all blood donations—the ELISA, plus HIV antigen and nucleic acid tests, the latter two effectively detecting the virus itself immediately after infection. If done correctly, these tests are accurate.

Louder voices than mine have taken up the cause. Like many people, gay and straight alike, California State Assembly member Mark Leno finds the ongoing ban “blatantly discriminatory,” and he has fought to change it for more than four years. Assemblyman Leno told me that back in January 2000, when he was a member of the San Francisco Board of Supervisors, he gathered six men like himself—gay and HIV negative—alerted the media, and headed to the local branch of Blood Centers of the Pacific, the same facility I visited. On camera, standing on the blood bank’s steps along with its administrator, Leno called for a change in the policy.

What do you call a protest without a confrontation? Un-newsworthy? Well, no, for this story held a twist: “Even the administrator herself agreed that it was a foolish policy,” Leno recalled. “She was frustrated, too. The ban shrinks the available donor pool when instead we need to expand it.” In the time since, the problem has only worsened. According to the American Red Cross and America’s Blood Centers, which together represent virtually all U.S. blood banks (including Blood Centers of the Pacific), many facilities across the country routinely have less than a day’s supply on hand and can’t meet hospital demand. While the need for blood steadily increases each year, due in large part to the rise in heart and cancer surgeries, organ transplants, and other complex procedures requiring large transfusions, blood donations are on a steady decline. About 95 percent of qualified blood donors do not give, according to a recent statistic.

To bolster his argument, Leno and his staff did a rough analysis showing that if just one in twelve HIV-negative gay men in the United States donated regularly, their annual contribution would represent one-third of the blood needed every year by the nation’s hospitals. Joining forces with the Blood Centers of the Pacific and numerous medical experts, Leno helped lobby for a change in the FDA’s policy on gay donors, with the aim of shrinking the over-twenty-year abstinence period down to five years or, better yet, down to one. But the Red Cross fought hard against it. And when it came up for vote in September 2000, the FDA’s advisory panel voted seven to six to uphold the ban indefinitely. The years 2001, 2002, and 2003 passed without official debate on the issue. Over time the abstinence requirement, anchored in 1977, grows more punitive.

Shortly after the first vote, I spoke with FDA medical officer Andrew Dayton, a nice guy who carefully defended the agency’s position. “We have a strong congressional and public mandate for zero error,” he explained. “If we change the policy and something happens, it’s a very big issue. We have to be ultraconservative.”

Of course, I absolutely understood that great precautions must be taken with our blood supply, but what made sense in 1985 no longer does, given the triple HIV testing done on donated blood. To my mind, the ban perpetuates an early-AIDS-era myth that the blood of gay men is intrinsically different, dirty, or bad, a fallacy that harks back to the ancient belief that the blood contained the essence of a person. I recalled how this misconception had reared its ugly head early in the history of blood banking, during the early 1940s. Posters plastered across major East Coast cities called upon Americans to do their part for the war effort by donating blood—one powerful image showed a wounded GI using his rifle in an attempt to lift himself, with the headline “Your Blood Can Save Him”—except that there was some invisible fine print: Black blood wasn’t always welcome. In Red Cross blood drives carried out in the eleven months leading up to Pearl Harbor, all African Americans were expressly prohibited, as per a new policy established by the U.S. military. As journalist Douglas Starr explains in his book
Blood: An Epic History of Medicine and Commerce
(1998), the armed forces were segregated at the time and “its leaders thought it best for morale not to collect African American blood,” the assumption being that white soldiers would object to having “colored” blood put into their veins. The possibility that some black soldiers might not want Caucasian blood did not figure into this decision. As Starr continues, the policy was “liberalized” soon after December 7, 1941, when the Red Cross successfully lobbied the military to accept blood from black citizens, though it would be processed separately and labeled for use only in “Negroes.” Following the war, the institutionalized segregating of blood continued in many American hospitals, particularly in the South, into the late 1960s. Ignored throughout these turbulent times was the perspective of prominent scientists who, one after the other, declared that, in terms of race, blood is blood is blood. The practice was medically baseless.

World War II blood-drive poster
(Courtesy of the American Red Cross Museum. All rights reserved in all countries.)

I launched none of this heavy history at Andrew Dayton during my talk with him because, I must admit, I was hoping that he might have a surprise for me, some stunning revelation to turn my frustration with the gay ban 180 degrees. Well, he did turn it a few degrees. If the FDA policy were changed, Dayton told me, the biggest danger would not be gay donors per se but, instead, the workers handling the blood. The problem would be human beings making human mistakes—the employees who accidentally release HIV-infected blood instead of disposing of it. This already happens, he acknowledged. About ten units of tainted blood products are mistakenly okayed for release in the United States every year, causing two or three HIV infections. “The problem is not the large blood banks,” Dayton said, “but smaller blood collection facilities, typically in hospitals, which don’t have the staff or automated equipment. They do it manually and have the highest risk of error.”

When I asked what the FDA is doing to reduce such errors, Dayton admitted, “It’s not quite clear what direction to take.” He was unequivocal, however, on one point: “It’s important to keep high-risk donors from even giving a unit of blood.”

The ban on gay donors conceivably could change, he conceded, if specific research were done. “What we’re lacking is seroprevalence rates, the frequency of HIV infections in men who haven’t had sex with another man for one year versus five years versus twenty-three.” He added, “I think that if we got results that said rates are virtually the same as the general population, then that would put an end to the question.” While the FDA has encouraged the Centers for Disease Control and the National Institutes of Health to organize such studies, Dayton noted, none is currently planned, nor is there funding to support them. Even if data were presented and the policy changed, the best-case scenario, he posited, would likely be a five-year deferral for gay men following their last sexual encounter, still far beyond what’s required for other groups. In my case, I would never qualify as a blood donor so long as I’m with Steve—and definitely not so long as he has AIDS. And neither of those will change. In the FDA’s eyes, Steve’s and my realities are the same: My blood’s as bad as his.