When 17-year-old Brian Gacek headed for school on March 13, he had no intention of turning into an activist. Centennial High in Circle Pines, an outer-ring suburb a half hour's drive north of the Twin Cities, was holding its annual blood drive, and Gacek, a junior with dreams of becoming a medical researcher, had signed up to donate. At 8:30 a.m., he and several buddies he'd talked into joining him straggled into the school auditorium, rolled up their sleeves, and braced themselves for the needle. But first a Red Cross staffer guided the students one-by-one to step onto a scale, have their iron levels checked, and run through a quick screening interview.
After Gacek weighed in, he sat down with a Red Cross nurse who ticked off a handful of questions about his drug use and sexual history. Have you ever used a needle to shoot drugs? No. Ever had sex with a man? Gacek, who came out to his family and friends last year about his bisexuality, didn't hesitate. "I told her that I'd had receptive oral sex with a barrier," he says, echoing the safe-sex terminology he'd learned in health class. Rather than praise him for his candor, Gacek says, the nurse instructed him to step out of the line. Red Cross regulations prohibit men who've had sex with other men from donating blood, she explained. Thinking he might be worried about what his friends would conclude, she advised him to lie. "She told me to tell my friends that I was being turned down because my iron was too low," he recalls. Furious, but not wanting to cause a scene, he left the auditorium without a word.
After school that day, Gacek phoned the Minneapolis chapter of the American Red Cross. This was the first time he'd tried to give blood, Gacek explained to the public-relations staffer who took his call, and he didn't understand exactly why he'd been turned down. As far as he knew, he was in good health and had been diligent about practicing safe sex. Gacek was told that the screening nurse was just following orders handed down by the Food and Drug Administration, the federal agency that regulates blood banks in the U.S.--Red Cross is the largest--and dictates who can and can't give blood.
In 1982, when the first reports of AIDS-like symptoms in hemophiliacs surfaced, health-care experts began to fear that HIV had contaminated the nation's blood supply. Three years later, after the virus had been found to be blood-borne and tests had been developed to screen for it, the FDA set guidelines for blood banks that excluded certain people from donating. Among those classified as running the highest risk for contracting the virus, and therefore permanently ineligible as blood donors, were intravenous drug users, hemophiliacs, anyone who had tested positive for HIV/AIDS or exchanged sex for drugs or money in the past two decades, and men who had had sexual contact, condom or not, with other men since 1977.
Gacek, who has studied the history and pathology of the AIDS epidemic, maintains that in light of current medical knowledge, the FDA's ban on gay and bisexual male donors is obsolete, and based on homophobia rather than scientific findings. "If I'd had unprotected sex with a female IV drug user 12 months ago," he contends, "I could donate." But because his partner was a man, Gacek is off-limits as a donor, now and forever. "The policy is discriminatory," he concludes. In protest he started his own one-man crusade by circulating a petition among his classmates calling for a change in the agency's guidelines.
Not surprisingly, Gacek isn't the first local would-be donor to find himself on the FDA's list of permanent pariahs, nor is he the first to protest the agency's policies. In late 1995 a group of gay and bisexual students at the University of Minnesota found themselves in similar straits when they tried to donate blood at a campus drive and were turned away. Initially, recalls Dr. Edward Ehlinger of the university's Boynton Health Services, the students wanted to restrict all future blood drives from campus. "I convinced them instead to form a task force, study the risks involved with blood donation, and look at technological advances," he says.
Early on, the students got Richard Danila, supervisor for the HIV and Emerging Infections Unit at the Minnesota Department of Health, to join their ranks. Danila and his team track the incidence of HIV/AIDS infections in Minnesota; according to their research, the incidence of AIDS in Minnesota peaked in 1992 at 423 cases and has since declined steadily. The number of infections resulting from male-to-male sexual contact (MSM in FDA shorthand) has also been on the decline for the past six years. In the first eight years of the epidemic, Danila says, MSM accounted for 81 percent of the infections. But in the past two years, this ratio has dropped to 60 percent, a reduction he attributes to better education and a higher rate of condom use. At present researchers attribute the majority of HIV infections to unprotected anal sex. "The individual at greatest risk is the recipient of anal intercourse--estimates put [the figure] as high as one in 100," he says, stressing that heterosexuals who engage in anal sex are as at-risk of contracting the virus as homosexuals. Danila says the risk of infection through oral sex is substantially lower than through any type of intercourse--anywhere from one in 500 to one in 1,000--and adds that he wouldn't characterize as a high-risk candidate someone who has only engaged in protected oral sex with a man.
But the FDA's blood-donor policies don't distinguish between unprotected and protected MSM sex, or, for that matter, between intercourse, oral sex, and kissing. Nor does the rule that disqualified Brian Gacek as a donor take into account whether a potential donor has tested negative for the virus. "I've had two HIV tests, and both of them were negative," says Gacek. "I can't imagine what more they need from me."
What blood banks and the FDA need, Ehlinger and Danila agree, is a virtual guarantee of the blood pool's purity. Since the U.S. blood-banking industry was born in the 1940s, the federal government has set up strict regulations meant to achieve just that. At the time, syphilis was a full-blown epidemic; within a decade the FDA began requiring that all donated blood be screened for the disease. In 1971 scientists developed a test to detect hepatitis B, and the FDA listed carriers as the first permanently banned donors. Within 12 years, that list grew to include carriers of all strains of hepatitis, as well as other viruses and infections known to be fatal. In 1983 blood banks began "passively screening" donors by informing them about individuals who, by agency standards, ought to voluntarily excuse themselves--a sort of pre-emptive screening directed mainly at sexually transmitted diseases. "If they fell into any of the high-risk categories," explains Joe Siess, a spokesman for the Minneapolis chapter of the Red Cross, "they were supposed to self-exclude."
The advent of the AIDS epidemic changed all that. In July 1982 three hemophiliacs were reported to have been infected by tainted blood products. In response, the Centers for Disease Control and the National Institutes of Health stepped up research on HIV transmission and testing. According to the CDC, in the early 1980s more than half of the nation's 16,000 hemophiliacs were infected with the virus through contaminated blood products, resulting in more than 2,500 deaths and a $600 million class-action lawsuit against four major pharmaceutical companies accused of distributing impure blood and plasma. In that suit, which was settled out of court this past May, the FDA was harshly criticized for failing to issue warnings about HIV as a potentially deadly contaminant.
Both Danila and Ehlinger contend that the most effective safeguard against contamination is cutting-edge technology used to test and screen for the virus: While early HIV testing had a "window period" of up to six months, during which the virus escaped detection, today HIV can be detected as early as 18 days after exposure--either by testing donors or donated blood. These technological advances, says Ehlinger, should bring the FDA's exclusion of gay male donors into question. "The FDA isn't applying scientific knowledge consistently," he argues. "And because of this, their policy is discriminatory."
Two years after forming, the university's student task force mailed off a series of proposed policy changes to the FDA. Among the suggestions in the December 2, 1997 letter was that the MSM exclusion be modified to read, "Any individual who has had anal intercourse even one time within the last 12 calendar months."
The FDA has so far failed to respond. But by coincidence, just days after receiving the group's letter the agency held a public hearing to consider changes to the MSM exclusion. According to minutes of the FDA's Blood Products Advisory Committee meeting, the majority of its panel agreed that the MSM prohibition is "discriminatory." Still, committee members temporarily shelved the issue pending "further study."
Even if the FDA finds those risks to be negligible, Danila and other health professionals predict the agency is unlikely to put itself out on a limb. "It's about the public's perception of the safety of the blood pool," Danila reasons, "and whether giving blood is a right or a privilege." In the FDA's view, he says, donating blood is still a privilege--one the federal agency is in no hurry to extend to men who've had sex with men.
In the month since he was turned away at Centennial High's blood drive, Brian Gacek has been making the rounds with his petition denouncing the blanket rule that excludes gay and bisexual men as donors. He has just put the finishing touches on his own Web site, complete with a copy of the document. And though he fears it may wind up gathering dust on a bureaucrat's desk or getting lost in cyberspace, he intends to keep collecting signatures. "It's better than keeping silent," Gacek says. "And if they don't change the rules, then I at least educated a couple hundred people."
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