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Top Stories This Week in the Chronicle.
August 26, 2005

Blood donation ban puts the Red Cross in a hot spot

The American Red Cross is finding itself being compared to the Boy Scouts and Salvation Army as an anti-gay organization for barring blood donations by men who have sex with men.

The “MSM deferral” prohibits any man who has had sex with another man since 1977 from being a blood donor, for the rest of his life. It was put in place in 1983, at the beginning of the AIDS epidemic.

The rule originates in federal Food and Drug Administration policies for blood collection, most of which is done by the American Red Cross.

But the permanent deferral is coming under increased fire as unnecessary and discriminatory. Other nations, such as Australia and the Netherlands, are backing away from similar policies as blood testing is further refined.

While barring gay men, even those in long-term monogamous relationships, the policy allows blood donation by heterosexual men and women who have unprotected oral, vaginal or anal sex with multiple sex partners, and who have unknown HIV status.

Donated blood is always tested for HIV and other pathogens. The first HIV blood test was used in 1985, and there have been many improvements to the tests since.

Red Cross chapters in Ohio, including Cleveland and Columbus, report that an increasing number of gay-affirming churches and civic organizations are refusing to host bloodmobiles, to avoid the appearance of supporting discrimination. Red Cross organizations also say the policy is souring some volunteers who might otherwise assist with disaster relief and public service programs.

In addition to its role as the major blood collector in the United States, the Red Cross is also the leading HIV prevention educator.

The Red Cross of Southern California has taken a leadership role in defending the blood policy, and has produced a pamphlet explaining their position.

The brochure is available to all local Red Cross chapters. But some, including the Columbus chapter, don’t use it because they feel it is condescending to gay men, said Gail Dickert of the chapter’s blood unit.

“The American Red Cross does not discriminate against anyone,” the pamphlet reads. “Politics has nothing to do with it. Prohibiting men who have sex with men from donating blood is about safety.”

“The interests of vulnerable patients must take precedence over the pride of any perspective donor,” it continues. “Protests aimed at decreasing blood donations threaten innocent and ill people,”

The pamphlet then discusses the Red Cross’ seven organizational principles and attempts to recruit volunteers.

The brochure was prepared by Marc Jackson, who is the Southern California chapter’s Blood Services communications director. He did not respond to numerous calls for comment.

Public affairs manager Stephen Whitburn did, and said the pamphlet was developed as a response to criticism over the MSM policy.

“Its intent was not to be offensive,” said Whitburn.

“The Red Cross is willing to explore inclusionary means of ensuring a safe blood supply,” said Whitburn.

Rule can be easily changed

The MSM deferral is commonly believed to be a law, but it isn’t. It is only a “guidance” by the Food and Drug Administration.

Guidances differ from regulations at federal agencies. They are not law, and do not require going through the extensive regulatory process to be changed. Guidances typically instruct agencies on how to carry out laws and regulations. They are proffered by committees of experts; in this case, the FDA’s Blood Products Advisory Committee.

The guidance is careful to use the term “men who have sex with men” for legal reasons.

Using the word “gay” would create a class of individuals who could bring a suit under two U.S. Supreme Court rulings, Romer v. Evans and Lawrence v. Texas. The first is a 1997 decision that said gays and lesbians could not be singled out for discrimination or denial of due process due to animus by rulemakers. The second struck down state sodomy laws in 2003.

The term “MSM” allows the FDA and blood collecting agencies to focus on the behavior of individuals they want to exclude.

“It’s not about sexual orientation or gay people,” said Whitburn, “Lesbians can donate blood, and we want them to, and gay men who have abstained since 1977 can donate, too.”

According to Whitburn, gay men who have only engaged in sexual conduct deemed safe, including mutual masturbation and kissing, can also donate blood.

In September of 2000, the Red Cross opposed efforts by other blood collectors, the American Association of Blood Banks and America’s Blood Centers, to change the guidance to allow donor eligibility for gay men with one year since their last sexual contact.

The Red Cross argued that changing the guidance would elevate the risk of HIV infection by blood “even if only slightly.”

At their behest, the FDA’s advisory committee voted 8 to 7 to continue the lifetime MSM deferral.

Whitburn said that the odds of HIV infection through blood are currently one in two million, and that changing the rules could lead to an additional two infections a year.

Other high-risk groups not barred

Red Cross literature defending the MSM deferral consistently points to Centers for Disease Control data from 2002 showing that this group represents 44 percent of all new HIV diagnoses in the United States.

However, they don’t notice statistics about other groups disproportionately infected.

CDC data from 2003 show that 40 percent of all U.S. AIDS cases since the disease was discovered have been among African Americans. Information for years between 2000 and 2003 shows that African American women are 19 times more likely than white women and five times more likely than Hispanic women to be infected. This exceeds the infection rates for males of all racial and ethnic groups except other African Americans.

The figures also show that poor Americans and those with less education are more likely to become infected.

There are no permanent deferrals for members of any of those groups.

“The point of the MSM exclusion is because MSMs represent a group that is more likely to be exposed to HIV than other groups on a per capita basis,” said Whitburn, adding that there is a “window period” where a recent HIV infection is not detectable by testing.

Asked if that “window period” only pertains to blood donated by gay men and not others at risk, Whitburn replied, “There are inequities in the system, no doubt about it.”

“You can’t defend against the inequities,” said Whitburn. “The point is not with the inequities. The point is whether or not the argument to defer MSMs makes sense.”

Article defends policy

The Southern California Red Cross touts a 2004 article to make its point that it does.

The article, titled “Blood Supply Safety: A discussion of the policy that maintains indefinite ineligibility for blood donations from men who have had sex with men since 1977,” was written by Jackson, who has no medical credential, and Matt Pekerol, M.D., a Los Angeles infectious disease specialist who treats patients with AIDS.

Whitburn quickly points out that Pekerol is gay.

“There can’t be any discrimination. The author is gay,” said Whitburn.

Whitburn also described that article as “a scientific work in a scientific journal.”

It is neither. It is published in the Journal of Blood, which is the Southern California Red Cross’ own publication.

The American Society of Professional Communicators awarded the article an Honorable Mention among its 2005 Masters Communication Award winners for opinion and editorial writing.

The article begins by telling transfusion professionals that MSMs have “unique social relations, behavior patterns and experiences which relate to disease processes that could affect the blood supply.”

The piece then goes on to make its case by talking about circuit parties, alcohol and drug use and anecdotal claims that gay men aren’t interested in monogamy.

“We know of no scientifically conducted surveys demonstrating a significant proportion of MSM engage in long-term sexually monogamous relationships,” wrote Jackson and Pekerol, backing it up with a 1978 study claiming that gay men have “100 or more sexual partners in their lifetime,” and a 1984 Los Angeles survey claiming that gay men average 20 partners per year.

“Researchers have found that fidelity within MSM relationships is often not defined in terms of sexual behavior but rather by emotional commitment,” they wrote.

Pekerol also did not respond to numerous requests for interview for this report.

“The safety of the blood supply is paramount,” wrote Jackson and Pekerol. “If we are to err, we must err on the side of caution. Until it is assured that the safety of the blood supply will not be compromised, the MSM blood donation deferral policy should not be altered.”

 

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