The Public Policy

Gay Behaviors vs. Public Health

Misplaced victimhood as a basis for FDA policy.

By 6.29.06

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"Are you a male who has had sex, even once, with another male since 1977?"

This is one of the questions that all U.S. blood collection facilities must ask when they administer the pre-donation questionnaire to screen potential donors. Anyone answering yes to this question is "indefinitely deferred," or in plain language, banned for life from donating blood. Despite pressure from gay advocates to change it, the Food and Drug Administration (FDA) has maintained this policy for 22 years. However, the pressure has intensified lately with gay activists successfully stopping college blood drives with cries of "discrimination."

Thus, this past March, the FDA held yet another workshop to review the male-sex-with-male (MSM) policy, and will convene the Blood Product Advisory Committee (BPAC) in mid-July to render an official decision. Based on recommendations made at the workshop, it is very likely that BPAC will finally recommend a modified policy. If they do, gays will claim a victory over "discrimination," and that is all that will be reported in the sound-bite media.

Although the idea that the FDA has been arbitrarily discriminating against gays is nonsense, no one in the biomedical establishment will attempt to counter this assertion because the very purpose of the change is to allay the "perception of discrimination." Whichever new policy is enacted could still essentially be a lifetime ban.

Once we delve below the headlines, we find that far from discriminating against homosexuals, our biomedical establishment has gone out of its way to mollify them, even to the point of compromising public health. While the medical literature on the dangers of homosexual behavior is massive, and readily available on the web if you search for it, it is omitted from literature directed specifically to the public. That the FDA now finds itself in the awkward position of repealing a successful blood-safety policy in order to ward off hysteria over "discrimination," is largely due to the fact that our public health officials have always failed to state plainly that the gay lifestyle is dangerous.

The Policy Debate
Since the late 1990s, responding to pressure from gay advocates, some experts have proposed that the ban could be safely reduced to a rolling five-year period or even a rolling 12-month period. What this means is that the question would be changed to "Are you a male who has had sex, even once, with another male in the past five years [or 12 months]?" A 'yes' answer would result in another five-year [or 12-month] deferral. But this debate only underscores the serious risks of homosexual behavior.

First of all, it reflects a unanimous agreement that at least a rolling 12-month deferral is necessary. Second, even the least stringent form of the ban is essentially a life-time ban: With a rolling 12-month deferral, a man who wished to donate blood on a regular basis would have to refrain from homosexual relations for years at a time. Third, the proposals to narrow the ban are based entirely on improvements in blood-testing technology. Proponents of the five-year and 12-month deferrals argue that the window of time when infection could be present but not detected by a laboratory test has been sufficiently reduced to allow for a lower limit. No one has posited that MSM sex is less risky than previously thought.

Yet, despite the political volatility of the subject, the ban has heretofore been retained in its most stringent form. Why? Because, while every version of the deferral offers some protection against circumstances under which a laboratory test may not detect a known pathogen; the longer the deferral, the better the protection against an unknown pathogen. To appreciate this concern, we have to address the question that is never publicly discussed:

What Do Homosexuals Do That Is So Dangerous?
The over-emphasis on condom use for "safe sex" has created the false impression that all sexual behaviors are equally risky. Yet homosexual men use condoms more than heterosexual couples. Nonetheless, homosexuals are a high risk group for a host of illnesses, while among heterosexuals, only prostitutes are considered at high risk.

The cause of concern is the typical behavior in the gay culture. Characteristic behaviors include extreme promiscuity, anal intercourse, and anal-oral contact. Each of these alone is a high risk behavior. Combined, they expose participants to an immeasurable number of viral and bacterial infections.

The media constantly portray the gay lifestyle as parallel to normal heterosexual life, but the lifestyles are not remotely the same. For example, extreme promiscuity occurs in only a small percentage of the general population. According to the National Health and Social Life survey, the average number of lifetime sex partners in the general population is four (six for men, two for women). By comparison, numerous studies show that gay men typically have hundreds of sex partners. The well-known Bell/Weinberg study found that 74 percent of gay men reported having more than 100 partners, 41 percent more than 500 partners, and 28 percent more than 1,000 partners.

As a result of these activities, men who have sex with men (MSM) constitute a high risk group for syphilis, gonorrhea, Hepatitis A, Hepatitis B, and AIDS. Human Papilloma Virus (HPV), which causes anal warts, is almost universal among MSM, and make MSM the highest risk group for anal cancer, with incidence 39 times greater than the general population. MSM are also almost uniquely at risk for a cluster of painful gastrointestinal ailments known collectively as Gay Bowel Syndrome. And this list of ailments peculiar to the gay lifestyle is far from exhaustive.

This brings us back to the key reason why the 1977-to-life ban has been maintained: the concern about unknown pathogens. Just as HIV/AIDS entered the blood supply in the 1980s because it was impossible to have a laboratory test for an undiscovered virus; so it is continually possible that a new, as yet unidentified pathogen, could enter the blood supply. The etiology of transfusion-acquired AIDS was directly correlated with the number of homosexual men in a blood bank's donor base. Because the homosexual lifestyle continues to be characterized by the high risk behaviors described above, the question remains how a five-year rolling deferral could protect the blood supply from a currently unidentified pathogen that, like HIV, has a 10-15 year incubation period.

This concern has been validated on several occasions; most recently in July 2005, when a new, drug resistant, strain of HIV was discovered in gay men in New York and California. Hemophiliacs, who comprise the only organized group regularly dependent on blood products, remain vehemently opposed to modifying the MSM policy, specifically because of the concern about unknown pathogens. During the 1980s, as a result of transfusion-acquired HIV, life expectancy for hemophiliacs plummeted from 68 to 49 years. The introduction of the MSM donor deferral policy, two years before an HIV screening test could be developed, resulted in a 90 percent reduction in the risk of acquiring HIV by transfusion. Modifying the current policy compromises the most vulnerable transfusion recipients.

Sending the Wrong Message
Putting the transfusion question aside, the biomedical establishment is compromising a much larger group by failing to speak candidly about the dangers of MSM behavior. This failure is evident in the gross discrepancy between blood banking's internal literature, used to regulate the manufacture of blood products; and its external or public relations, literature, used to inform the public about risk and safety issues.

We would expect consistency in these two types of literature. If, for example, intravenous drug use is identified as a risk behavior in the regulatory literature, we would expect it to be identified as a risk behavior in the public relations literature as well. And in fact, it is. Yet this is not the case with regard to homosexual behavior. Here, instead, the dual literatures are in glaring contradiction to each other.

For example, in a Red Cross educational teen comic book, we are given the specific messages that intravenous drug use is a risk behavior, and that sex without condoms is a risk behavior, but homosexuality is not regarded as a behavior at all; it is "who you are"; and, as the comic book also makes clear, anyone who thinks otherwise is an ignorant bigot.

In the regulatory literature, on the other hand, MSM is defined as a "high risk behavior" and identity labeling is studiously avoided. Early on in the development of the questionnaire, the FDA discovered that many men who had had some same-sex contact, did not identify themselves as "gay" or "bi." Thus the questionnaire evolved to be strictly behavioral. It does not ask, "Are you gay?" It asks specifically about the behavior, the frequency of behavior ("even one time"), and the time frame in which the behavior occurred ("since 1977"). And, of course, the whole debate over the deferral policy is about time frame, which reflects the underlying knowledge that homosexual behavior, rather than inclination, is what is at issue.

With Hollywood glamorizing gay life, government and religious authorities endorsing it, and our biomedical establishment failing to issue the proper warnings, an increasing number of young men are being drawn to try this behavior. Insanely, the San Francisco Department of Public Health website offers instructions for "safely" engaging in anal intercourse, analingus, even "fisting."

The fact that young men are being sent the wrong message is evident in the continuous stream of Centers for Disease Control (CDC) reports that show sharp increases in AIDS, syphilis, gonorrhea, and other illnesses among MSM, after a brief period of decline during the AIDS panic of the 1980s. Despite two decades and billions spent in "AIDS awareness," risk behavior is again rampant; and not surprisingly, a disproportionate percentage occurs among youth ages 15 to 22.

Our public health officials now find themselves in the odd position of kowtowing to an identity group whose activists believe that in order to fulfill their identity they must engage in the very acts that health officials, and anyone with an ounce of common sense, know to be unhealthy. The only way to stop this madness is for our health institutions -- in particular the CDC, the FDA, and American Red Cross -- to launch an education program to inform the public of the high risks of homosexual behavior. Given the public mood, it's not an easy course. But this is the solid reality. To continue to indulge in the popular delusion of the activist homosexual lobby will only further erode the public health.

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About the Author

Robert Seidenberg worked as a technical writer at American Red Cross Blood Services, National Headquarters from 1994 to 2002.