South Africa’s Terrible Solution to the Gay Blood Donation Ban

The widespread ban on blood donations by men who have sex with men is idiotic not because it’s homophobic—which it is—but because it’s based on bad science. Ignore the FDA’s panicky anti-gay animus for a moment and consider its stated rationale: to “maximally protect the recipients of blood products” from diseases, namely HIV. The problem here is that the FDA already maximally protects recipients by running all blood through an incredibly thorough and highly accurate two-part test for HIV. These tests can detect the virus from essentially its first moment of infectiousness—whether or not the blood belonged to a gay man. A group ban against men who have sex with men isn’t just founded in antiquated notions of HIV as a gay disease; it vastly underestimates the accuracy of modern HIV testing.

That’s why South Africa’s new “solution” to the gay blood donation ban isn’t really a solution at all. Until recently, the country forbade men who have sex with men from donating blood unless they’d been celibate for the past six months. (That’s much more generous than the FDA’s policy, which bars men for life if they have sex with men—“even once.”) Following widespread protest, the country’s National Blood Service recently revised its policy: Now, both men and women, gay or straight, are barred from blood donation if they’ve had a new sexual partner within the last six months.

In other words, the new policy shifts its underlying discriminatory assumptions from gay people to all non-monogamous sexually active people. It’ll almost certainly prohibit vast swaths of the South African population from giving blood, and it sends a prudish, slut-shaming message to all would-be donors. Worst of all, the policy doesn’t make much scientific sense: Even if the South African National Blood Service is stuck with the most obsolete HIV testing technology still in use, it could still detect HIV around a month after infection. A two-month window would constitute extreme caution, three months would be excessive—and six months is just absurd.

I’m glad, of course, that the country is moving away from the kind of blunt, blanket group discrimination that the FDA still puzzlingly employs. But its new metric for potentially diseased blood isn’t much of an improvement. If the National Blood Service truly has that little faith in its blood-testing technology, it should ask donors whether they’ve had unprotected sex with a person of unknown HIV status in the last three months. Yes, three months is still too long, but it factors in a huge margin of error for those with hazy memories. The FDA should embrace the same standard. Our HIV testing technology has grown by leaps and bounds over the last three decades. It’s time for our blood donation guidelines to catch up.

by Mark Joseph Stern
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