The Doctor is In (the Closet)

"Saving the world isn't easy," proclaims a recent ad for the American Red Cross. "Saving a life is. Just one pint of blood can save up to three lives. Give blood."

There's no doubt that donating blood is a noble, selfless act -- one that every eligible American should consider. But the delicate issue of eligibility is trickier than you may think. And an important detail omitted from this ad is the fact that one criterion for blood-donation eligibility stems more from bias than medicine or science. The donor eligibility guidelines exclude men who have had sex with men (MSM) -- even if they have never had unprotected sex. But the guidelines don't exclude straight people who have had unprotected sex. Scientifically sound and unbiased guidelines would be based on risk-taking behavior -- not sexual orientation.

Unfortunately, exclusion based on sexual orientation has emerged as a trend in the medical field. Several medical services have been denied to gay and lesbian people because of bias rather than science, extending beyond blood donation to sperm donation and assisted reproductive technology.

Denied at the Bank "Sadly, this denial of services is something that lesbian and gay people have to deal with as a fact of life."

Last week, students at Stanford University rallied in front of a campus blood drive van, carrying signs with slogans such as "AIDS doesn't discriminate, blood centers do." It was the latest in a wave of college demonstrations launched in protest of Food and Drug Administration (FDA) blood donation guidelines that forbid blood centers from accepting blood from any male donor "who has had sexual contact with another male, even once, since 1977."

Despite repeated objections from both health officials and gay rights advocates who believe the donation guidelines are biased and scientifically unsound, the FDA has refused to reconsider the 23-year-old ban -- even in the face of ongoing blood shortages. Moreover, when developing new guidelines for sperm donor eligibility in May 2005, the FDA advised sperm donation centers to reject anonymous sperm donations from men who've had sex with men in the past five years.

The FDA's "guidance document" for sperm donor eligibility recommends -- rather than mandates -- the exclusion of anonymous MSM donors, but many sperm banks have put the ban into place. The FDA considers MSM a high-risk group for HIV and other sexually transmitted infections.

While condoms are not 100 percent effective, MSM who correctly and consistently use condoms are at a low risk for getting HIV. On the other hand, men who have unprotected vaginal or anal sex with women are at a much higher risk for getting HIV -- yet the FDA guidelines do not advise barring this group from eligibility.

Sperm banks test all anonymous donor semen for HIV, as well as for chlamydia, CMV (cytomegalovirus), gonorrhea, hepatitis B and C, and syphilis. Samples are quarantined for six months, and new samples are collected and tested.

Because of the rigorous testing process -- and the exclusion of MSM but not risk-taking people who've only had opposite-sex partners -- many groups have called the FDA guidelines unnecessarily restrictive -- and biased. "They're asking all the wrong questions," Assemblyman Mark Leno (D-San Francisco) told the San Francisco Chronicle. "It's not with whom you are having sex, it's what kind of sex you are having. Heterosexual men engaging in risky heterosexual behavior are not denied the opportunity to donate sperm. ... This is not about protecting the public."

The FDA's move to exclude MSM donors might simply be chalked up to a case of "better safe than sorry," were it not for its failure to exclude risk-taking straight people from donor eligibility. And the FDA's blood donor FAQs, which refer to sexual "preference" and single out MSM as having "evidence of a lifestyle that potentially exposes them to HIV," further erodes the benefit of the doubt.