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Homophobic bias in conditions for donating blood

Homophobic bias in conditions for donating blood

Prohibitions and restrictions on donating blood continue to affect homosexual males around the world. Why it is high time for future legal innovations to change the approach to this delicate matter.

Bans and restrictions on gay blood donors constitute incomprehensible discrimination on the grounds of sexual orientation, based more on unjustified fears than on scientific facts. At the same time, they increase significant risks to public health, being an incorrect method for ensuring that blood received for donation is safe for transfusion purposes.

As a preliminary consideration, it should be said that the most vital and essential instrument to guarantee the safety of blood used for transfusion purposes is the good practice of laboratory testing on samples of donor blood. The problem in this regard is that the HIV virus is characterized by the ‘window period’. The medical tests do not detect directly the HIV virus in the blood; instead, they try to reveal the presence of anti-HIV antibodies, which start to emerge and develop in the body only after the person has been infected by the HIV virus. Due to the fact that the human organism does not produce them immediately, there is a period of time (usually lasting some weeks) during which the medical tests are unable to detect the anti-HIV antibodies and so to correctly diagnose the infection: this is the HIV window period. So, it is totally understandable that there is a need - aimed at protecting public health - for additional mechanisms to evaluate and assess the eligibility of any blood donor: this is usually achieved by screening potential donors for high-risk behaviour through questionnaires and interviews.

I am profoundly convinced of the necessity of all measures that in some way are aimed at safeguarding public health. So the aim of this blog is not to question the very existence of such assessment mechanisms: rather, my criticism targets the content of the questions used, when these are based on the incorrect presupposition of a direct link between the idea of risky sexual behaviour and any sexual intercourse involving two men. The usual justification given by governments for such bans is that HIV has a higher rate of incidence among homosexual males compared to the rest of the population. If - prima facie - this sounds like a rational reason to justify such grounds for discrimination, by analysing the blood donation issue a little more in-depth, it becomes clear that this is way off the mark.

Medicine and law are often allied in strengthening the social stigma already existing against the male homosexual population: it suffices to remind readers of the designation of homosexuality among the psychopathologies, until depathologization occurred in 1973 by the American Psychiatric Association. Even more alarming, it was only in 1990 that the World Health Organization removed the diagnosis of homosexuality from the International Classification of Diseases. Bans on donor blood that target the gay population have their origin in the early 1980s: the explosion of the HIV pandemic induced public health authorities in many States to establish permanent prohibitions of donor blood from gay men, an assumption that masked a profound discriminatory bias.

The main aspect of discrimination lies in the fact that these bans are general, meaning that they apply in the same way to every gay man: not only to people who are actually HIV positive at the time of the blood donation, but also to those male homosexuals who - despite having had no sexual intercourse, or maybe having had only protected intercourse or intercourse in a monogamous relationship (and therefore having reasonable certainty of being HIV negative) - just declare their sexual orientation during the interview or in their written answers. At the same time, no restriction is applied to any risky sexual behaviour, as long as it is heterosexual. So these policies - in my opinion - de facto constitute a clear discrimination on the grounds of sexual orientation, based on anachronistic prejudice and not on any valid medical concern.

Moreover, the bans have multiple negative effects affecting not only the gay population but also heterosexuals and jeopardizing public health in general. As recently reported by Professor Dwayne J. Bensing (in his article Science or stigma: potential challenges to the FDA's ban on gay blood: https://scholarship.law.upenn.edu/jcl/vol14/iss2/4/), ‘they reinforce negative stereotypes that gay men are carriers of communicable diseases just because of their orientation, they undermine the need for potential blood donors by rejecting healthy gay donors, they provide false security to high-risk heterosexual donors ignoring risky heterosexual behaviours - such as multiple partners and unprotected sex - which potentially endanger one’s health and possibly the blood supply’.

A straight person with multiple sexual partners using no protection is an incomparably higher-risk donor than a gay or bisexual man who regularly uses protection: allowing the first to donate blood while prohibiting a priori the second to do the same is scientific nonsense jeopardizing public health (as well as irresponsibly decreasing the quantity of available healthy donated blood). Conversely, the benchmark to be taken into consideration - to avoid unjustified discrimination and to guarantee the safety of blood supplies - should be the risk level of the individual sexual behaviour: medical personnel should be fully entrusted with the task of identifying whether the potential donor, regardless of their sexual orientation, has engaged in sexual conduct that is dangerous either to themselves or to others.

The choice of every citizen to donate blood - with the aim of improving or saving other human lives - is an extremely important act of human responsibility and a civic duty. To deprive a person of this possibility on the basis of an anti-scientific, anachronistic prejudice is barbaric discrimination that slowly, but surely - as we are already seeing - will be erased inch by inch from history. That day - perhaps not so far away considering the rapidity of recent changes - our societies will be less discriminatory and more capable of protecting the health of all citizens.

3 Comments

Elroam

Francesco,

Thanks for your reply. I can understand your avoidance ( hectic medical description). Yet, that is the essence, otherwise, one wouldn't overcome wrong presumptions, or stigmas, or superstitious perceptions. So, it is warranted, at least briefly, or simply referring to links and external articles. But again, I can understand it.I was just wondering.

I didn't mean " normal " Vs. " abnormal " of course. That is why I have put it in quotation marks if you haven't noticed.

Thanks

Francesco Schmidt

Dear Eloram,
Before addressing the merit of your questions, I would point out that your sentence distinguishing <<[...] homosexuals, or , maybe a ‘normal’ one [...]>> is a very perplexing expression: there is not such a thing as ‘normal’ sexual orientation, there are instead just multiple ones all equally natural and normal (e.g. heterosexuality, homosexuality, bisexuality, asexuality...). As explained in the post, interviews are made to every potential blood donor: this is not contested. The contested is that often the main - if not the only - purpose of such questionnaires is the identification and consequent exclusion of MSM individuals (which could potentially include both homosexual males and bisexual males). The short space allowed to the writing of blog-posts (as well the absence of any personal educational background in Medicine) brought me to not express scientific considerations on how sexual diseases are transmitted. However, I want to clarify that the specific ‘friction act causing tiny injuries’ you refer is not at all a prerogative of MSM sex: conversely, it often takes place in heterosexual sex as well. Therefore, as a matter of fact, it is not necessarily connected to the sexual orientation of the concerned individual: again, the point is how you do it (e.g. is it protected sex or unprotected sex?) and not the gender of your partner.

Elroam

Interesting and important. But we couldn't really understand the fundamental issue here with all due respect. The respectable author of the post, rely upon the practice of questionnaires and interviews for suggesting discrimination. Yet:

We couldn't really understand it conclusively:

Is it done to every potential blood donor ? Is it made solely for identifying homosexuals, or , maybe a " normal " one, would be also be identified as risk ? This is very critical. The procedure itself, hasn't been so clear and conclusive.

But above all, the respectable author of the post, hasn't explained , the underlying medical assumption, for, identification of homosexuals as having or constituting greater risk. What I know for example, is that friction in sexual act, causing tiny injuries, can cause blood transition between one partner to the other. As such, this is one way , to transmit the virus. So, it is claimed, that the nature of homosexual act,per se, is putting greater risk in this regard, due simply to the nature of the act typically.

Now, to what extent it is relevant, we couldn't understand. Lacking some scientific basic description with all due respect, for really understanding the potential discrimination claimed here.

Thanks

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