Should I Forgo Gay Sex to Donate Blood?

The magazine’s Ethicist columnist on whether prohibitions are necessarily discriminatory and balancing personal fulfillment against altruism.

Comments: 90

  1. This is an interesting philosophical one, as it pits personal pleasure against a self-impose duty to help fellow man. First, I'd like to commend the blood donor for his commitment to the cause. I doubt most of us would put our own pleasure on hold (not just in the chronological vicinity of the donation, but effectively indefinitely) to stay eligible for donating blood. It is also nice to read that he is not seeking permission to lie on the questionnaire, as many others might. Taking the view that giving blood saves lives, and interpreting it to say that every donation is critical to saving a life, not donating would be thus result in not saving a life. This can be twisted to say that to not donate when eligible, or to make oneself ineligible, would be akin to taking a life. Of course, donations are voluntary in the first place, and this logic could be applied to other situations to make us all murderers (by omission?). All that said, I'm really not sure what to make of this one. In the meantime, keep up the donations!

  2. Of course every single pint of blood that is donated does not save one life. Many are used for treatment of ongoing illnesses, and some are discarded. I think it could be said that monetary donations to Doctors Without Borders have a greater likelihood of immediately saving a life.

  3. @Jim Casey I agree that every donation is not critical. Some are used for research (which may be considered indirectly critical if life-saving treatments are developed), some are simply not used at all in the event there's a surplus and the blood expires (not sure how common this is), and some are used for accelerated recovery. However, even if used to treat ongoing illnesses, they may be life-saving (i.e. patient would die without it). I was merely pointing out that if giving blood is said to save lives, withholding such donation could be construed as taking a life. The donor in question seems to think of it that way. Oh, and a single pint of blood can be used in multiple patients - it's usually separated before being given to patients. I'm not sure on the frequency of patients needing red cells, plasma, and platelets (the main components transfused) simultaneously.

  4. Such an interesting question. And well answered by the Ethicist. Here is some advice to the letter writer: If having sex only puts you out of the running for giving blood for 12 months, then why not give it a try? It's easier to make a decision about giving blood versus having sex when you're fully informed.

  5. Men can donate blood with a hematocrit down to 11.5; women (even postmenopausal) must have a hematocrit of 12.5. After several times testing at 12.3 or 12.4, I gave up. You can help people in other ways. You should see a therapist to consider whether you are simply avoiding sex, for other reasons.

  6. Do not give up. Two weeks before planned donation a bit of chili/steak/any iron rich food and/or some additional iron pills will put you over.

  7. @hs Thanks for this tip. I've been rejected for a low level before (12.3) so this is helpful.

  8. @hs Excellent advice. Would you have any suggestions about needed weight gain for blood donation? (My weight slipped below 110 lbs during a spate of digestive troubles and though i am feeling better now, thank goodness, the scale seems to have stuck there. Would love to resume donating but can't at this skinniness. )

  9. Monogamous people avoid STD by being tested before entering a relationship and then staying monogamous. Just in case you had not heard.

  10. @Penseur Monogamous MSM are still barred from donating blood. Data is not collected on relationship status of a person who contracts HIV, so no one can check the numbers on non-monogamous vs monogamous infection rates. If we could, maybe monogamous MSM could donate.

  11. This must be a completely invented scenario, i.e. a prank, OR the writer is a total and complete weirdo with way too much time on his hands. Dude, get a Job and/or find some meaningful volunteer work. Seriously.

  12. @Phyliss Dalmatian I think he has a lot of anxiety. He's young. He's struggling. Compassion, please.

  13. I have extreme compassion for sick, abused, starving children and animals. I am, however, depleted of patience with those lacking common sense, and their enablers. THIS is exactly how Democrats get labeled as snowflakes and are mocked for political correctness. If someone is technically old enough to donate blood, he should be able to request help for his personal problems in an appropriate manner. This is NOT an ethical dilemma.

  14. @Ellen Tabor Young?? He's at least out of college.

  15. Don’t donate they don’t deserve the help. They have banned gay men for way too long.

  16. @Gay male Who is this "they" who doesn't deserve the help? A child? A hemophiliac? A gay man who requires a blood donation after surgery?

  17. If LW1 decided to donate blood after having sexual relations with another man, how would he rationalize endangering others, someone such as Ryan White for example. For those of short memories, Ryan White was a hemophiliac who contracted AIDS and died from a tainted blood transfusion. With all of LW1's rationalizing, it comes down to a simple binary choice: If I want to donate blood, then I won't engage in sex with another man; If I want to have sex with another man, then I won't donate blood. I can't do both and thereby risk the health and life of others whom I supposedly wanted to help.

  18. This is the depth of entitlement syndrome. Blood tests do not always capture all indicators of diseases (including AIDS). The rights of the general public to not receive tainted blood must not be ignored so the few can feel "normal." Seriously, who in G-D's green earth feels infringed upon if they cannot donate blood? I've been seriously ill since childhood and do not donate because I take a lengthy regimen of drugs to keep my illness at bay. If I were told that this would prohibit me from donating, I wouldn't bat an eyelash. Similarly, I've had blood transfusions in the 1980's--I have a right to untainted blood. The letter writer comes off as self-centered and shallow. Where are the rights of the majority?!

  19. @Uncommon Wisdom, Let's have a little compassion for this LW, even if we agree that his question comes across as a more than a little self-important. He's obviously young. Who among us can't recall dozens of things our youthful selves did that now make us cringe? Seems unfair to treat an insecure kid's plea for affirmation as a serious affront to anyone else. Taking it that personally would sound a little self-important, don't you think?

  20. @Uncommon Wisdom Slight clarification - you don't have the right to someone else's blood. Such a right would imply an obligation on the donor's part. HOWEVER, if you are receiving blood, you do have the right to assume that it is safe. Safe meaning that to a reasonable degree of certainty, it is the right type, still good, and free from contamination/infection. The donor in question may come off as self centered in the sense that he is asking about what he should do, but he is NOT suggesting that he would violate the MSM restriction. He is actually considering abstinence so that he may continue to donate blood - so you and others can continue to have safe blood available for transfusions. But yeah, he's just thinking about himself...

  21. @American AbroadYour "plea for affirmation" is a threat to the healthy blood supply for millions. When I was injured, I relied upon uncontaminated blood to stay alive. This end goal is more important than some "plea for affirmation." Some things in life are more important than others. He needs to get himself to psychological counseling and off of the ethicist's page. The only reason this question got here is to disparage the sensible policy of excluding people who are at high-risk for blood borne illnesses.

  22. Crux of answer in Mr. Appiahs last 3 sentences. I think the LW is just creating some sort of diversion for himself in order not to face his sexuality.

  23. There is a crucial misunderstanding about why this "discriminatory" policy exists. Tests, such as an HIV blood test, are not perfect. They have an inherent sensitivity and specificity that helps guide us as to how effective they are, but the doesn't tell us their "negative predictive value" (the likelihood a test will correctly denote as "HIV-negative" a person that is truly HIV negative, without being a "false negative"). This value depends on the pre-test likelihood that a person does not have HIV. For example, an negative HIV test for a celibate nun is more likely to be correct than a negative HIV test for a promiscuous gay male. The latter is much more likely to be a false negative. Therefore, when determining who can donate blood, we must decrease the likelihood of "false negatives". The best way to do this is to screen out people who, even before tested, are most likely to have HIV. This, by definition, is gay men. Now, one might ask - why not just ask questions about promiscuity? Number of partners, etc? First - people are terrible at accurately describing how many people they've had sex with, when, how, etc. - whereas simply just asking if you ever have had sex with a man is a more accurate answer. Second - it ignores the fact that heterosexual men acquiring HIV from heterosexual sex is extremely rare and physiologically difficult. Quite simply, a promiscuous heterosexual male is much less likely to have HIV than a gay male who has even had a few partners.

  24. @Abc123 The CDC does not say anything about "gay men." It uses MSM, which includes gay and bi men -- along with sex workers and inmates who are assaulted. That's why the rates are so high, and doesn't not accurately reflect gay men.

  25. I agree that LW should not worry about giving blood, or encouraging others to do so. There are plenty of other ways to give back. Find the charity (or more than one) that most matches your goals and make a donation. Or give your time if that is possible and practical. I can't give blood, and I have no problem with that.

  26. How is this a question of ethics? I have read this letter a number of times and I keep getting to: someone please help this young man sort out things i.e. a therapist,a counselor NOT an ethicist.

  27. There's a gent who writes a column devoted entirely to your sex quandary (not the blood donating issue). His name is Dan Savage. Google Savage Love. Perhaps he can help.

  28. Dear Name Withheld: I agree with the Ethicist. Try this test case on to see if it feels comfortable. I was a regular blood donor (and, in fact, as a college student was a Red Cross campus organizer) until I traveled to a malaria-endemic area. Should I have foregone the trip? As a volunteer organizing blood drives: *no *one ever knows if you are a donor. No one will “be suspicious” if you are organizing but not donating— you need never say anything. After all you can hardly be first in line every day. The Red Cross does a great job preserving privacy that way, precisely because people’s reasons for deferring donation are private. Our health is our own business and it isn’t just sexual health. As an organizer one of the most important things you do is assert everyone’s right to that privacy by putting away your own “one gallon” pin. I agree that for you this isn’t about an ethical obligation to the blood supply. I don’t think for a moment you’d have counseled me to skip a trip to Africa because I had an obligation to be a blood donor. This is about sex with men, and whether it’s right for you, and how you’ll work out the very complex feelings around feeling “tainted,” judged, or stigmatized, rightly or wrongly, if you follow your heart in that direction. That’s not an easy issue to wrestle with; but maybe easier if engaged directly.

  29. @Ace J There are all sorts of reasons not to donate. My doctor has told me not to donate because it causes my blood cells to become small, which is a pre-indicator of anemia apparently. So, yes, it's nobodies business why you don't donate and lots of people can't donate for all kinds of reasons. There's no need for judging.

  30. The CDC reports that the infection rate for the virus that causes aids is 99% for intravenous drug users and slightly less than that for receptive gay sex (81%). The transmission rate for heterosexual sex is far below either of these amounts (under 25%). Tests for AIDS do not capture the virus shortly after transmission--even though it is still dangerous. There is a need to keep the public safe from people who engage in this behavior and the LW knows this. He is just trying to advocate--albeit ineffectually--against the logical ban against blood donations from MSM (men who have sex with men).

  31. @Uncommon Wisdom Where are you getting your information? According to the CDC web site, the estimated per-act probability of acquiring HIV through receptive anal intercourse with an infected partner is 138 out of 10,000, or 1.38%. Also, the risk depends on the nature of the act, not the gender of the partners. Straight women who engage in receptive anal intercourse have the same risk of infection as gay men.

  32. @Anon. That's dishonest. The rate of women engaging in anal intercourse is far, far lower than that of gay men. Also, the fact remains that receptive anal sex has a similar risk profile than sharing intravenous drug needles. The infection rate is extremely high and given the risk--a lethal disease--the ban on gay men is justified. When anyone receives a pint of blood, they don't want to have to worry that it is contaminated with an undetectable terminal disease (albeit one that can be managed with costly and complicated medical regimens).

  33. @Uncommon Wisdom Costly and complicated? One pill, once a day, isn't complicated at all. In my case, two pills, once a day. Still not complicated. Most folks in the US and elsewhere don't have to pay for treatment, even for prevention. It adds to the overall costs of government but what disease doesn't? These opinions seem outdated, to me.

  34. One of the most fascinating aspects about the current Ethicist column is its propensity to engage in a complicated, sophist-philosophical discussion concerning a question which can easily be answered with plain and simple common sense -- Okay - Instead of donating blood - lets say the man wanted to express his altruism by volunteering to drive elderly home-bound people to their doctor appointments -- or -- volunteer to drive a van for the "Meals on Wheels" program - delivering hot and nutritious food to the sick and elderly -- Now - instead of never having had sex - the man explains that he's never drank a drop of alcohol in his life -- but is now considering it -- And not just like he wants to start going to bars and drinking at parties - he wants to explore the world of wine connoisseurs and become a very discriminating drinker -- However - he has learned that there are laws in place which "discriminate" against those who would drive a van for "Meals on Wheels" - while also indulging in the personal pleasures of drinking alcohol -- He could possibly encourage others to volunteer for those driving altruistic activities -- but would it be ethical to encourage his fellow drinking friends and associates - such as the people he sees at the wine-tasting events - or possibly his craft-beer friends -- ? Sometimes - just sometimes - life is like that -- You can either have this - or you can either have that -- but you can't have both -- No philosophy required...

  35. @Howard G: Your attempted analogy has no relevance to the issue at hand. Drivers can drink as long as they aren't drinking while on duty. The ethicist actually does a good job in explaining the reason for the ban and explaining that no rule can be perfect, because any rule will automatically be both over-inclusive and under-inclusive with respect to the problem the rule is addressing. However, generalizations are required when developing and implementing any rule. The bottom line is that this rule is discriminatory against a class of people (MSM). But there appears to be a "compelling government interest" that requires the discrimination, as indicated by the ethicist.

  36. I suggest you explore your sexual preferences and final alternative ways to give back to your community. You can always donate after the 12 month waiting period if you decide celibacy is right for you.

  37. Much ado about nothing. Don't have sex, give blood.Have sex, don't give blood.

  38. Exactly what I was going to say: Either warm up Grindr or Scruff and go out and find some lovin', or give blood 'till you're white. Whichever. I really don't care which, and I doubt anyone else here does either. Oh, and for the love of Pete, go out and find yourself a good shrink. Please.

  39. This letter should be answered - if it's real - by a therapist specializing in relationships and sex, not an ethicist.

  40. @common sense advocate The ethicist recommended he seek counselling. The young man wrote for help as he saw fit. Should the ethicist not have offered help because you don't approve. That doesn't seem like common sense to me!

  41. You place a high degree of trust and confidence in therapists, and you imply absolutely no one else can be helpful here. this is rubbish.

  42. @common sense advocate But the writer - and to speak about this we must accept he is real - is the one who was defining his indecision as an ethical dilemma. The Ethicist untangled his reasoning, which balanced sexual activity against giving blood, separating the decisions one makes to engage in sexual activity from acts one may engage in to help others. Pressuring others to give blood - in your behalf is odd - in that it means intruding on others' privacy. Also, it is a very symbolic sort of transaction when done in this way: give one's lifeblood to - what? do amends for sex? And the Ethicist did then point the writer in the direction of therapy to address his personal ambivalence about all of this. There is NO ethical issue in not being a blood donor if you are prohibited from doing so. That's a separate issue. Giving blood and lying about your background because you disagree with the rules would be a breach of ethics. The question of whether the rules governing donors should be changed is, here, a distraction from the question raised. Having sex ( consenting, with adults, etc)does not make anyone a better or worse person and is an important part of most, but not all lives, as is pointed out. I think the Ethicist did a fine job in this response.

  43. I'm not sure if this is still the practice, but as I understand it, a blood donation is not kept unto itself--one "bad" donation to one recipient. Instead, the donations are "mixed together" in some fashion such that a single bad donation can contaminate the blood received by many recipients. Given that a contaminated donation might not appear as such soon after infection, I can't imagine why anyone who could possibly infect others would want to donate--what kind of altruism is that?

  44. @Talbot I think they stopped doing that - partly to avoid what you describe. Whole blood is typically separated into its components (namely red cells, platelets, and plasma) before transfusion. A single transfusion "unit" may be made of multiple donation "units", but one donor's donation will only make it into as many transfusions as components (unless a double donation is made or something like that). The donor is question is not suggesting that he donate once compromised; he is considering staying abstinent to avoid compromising his blood!

  45. Your gentle & thoughtful response didn't address another possibility for this young person, that his issue with blood donation is an excuse to hide his fear of his own sexuality & of intimacy. Excluding himself from sexuality at 18 years old is the path to a life of self doubt & loneliness. He needs to at least explore a little bit & know what he's giving up before a "vow" of celibacy. Sympathetic counselling from a gay friendly source might save him from fear driven bad life decisions.

  46. How about. addressing the real ethical issue here; should sex be viewed a recreational activity?

  47. @John Wilson Yes.

  48. @John Wilson I'd call that a religious, or at least a moral issue....not an ethical one.

  49. @John Wilson -- Yes, if you are doing it right.

  50. I think it’s outrageous that an ‘Ethicist’ should appear to support upholding an (at best) morally dubious law like this one. So, for the sake of the Apologist for such a law, I thought I ought to make a few points about why this all belongs in another era. It does offend me very greatly that, in this regard, Gay men are treated like second-class citizens. I don’t get this opaque double-talk about ‘discrimination not being discriminatory’ - that is what the bloody word means! It is discrimination, plain and simple. And to what end? It exists as a knee-jerk response to an age-old moral panic, and one that serves little purpose other than to prevent blood, which is so badly needed (especially for people like me who belong to rarer blood types), from entering the supply. We know that screening is now very good - but the thing that frustrates me is that the whole basis upon which the law seems to exist is that gay people cannot be trusted to tell the truth about their HIV status. Accordingly, to suggest that gay men should not be able to give blood is a fundamentally homophobic position. A non-discriminatory system whereby people who have had multiple sexual partners are asked to provide negative confirmation of a recent HIV test, for example, would function far better. The writer points out that 16 year-olds probably would vote wisely - but they are still not allowed to vote. Guess what? In my country, we lowered the voting age. A similar response is required here.

  51. @Edward Jones, I got it when The Ethicists "discrimination not being discriminatory" so I don't understand why you don't. Perhaps because this particular subject is emotionally fraught for you. Just my guesd. The Ethicists also rightly mentioned that someone very recently infected with HIV would not produce antibodies that could be tested for. Please, for the greater good of all people, these discrimination that are not discriminatory exist. I had a severely premature baby in 1986. He had many blood transfusions. I can't even begin to tell you what this poor baby went through to survive or how psycho I was for several years worrying he would end up with AIDS. I think the blood ban is a good thing and I'm sorry you feel hurt by and discriminated against by it. I despise descrimination but understand this.

  52. @Edward Jones The older meaning of discrimination was to distinguish between two or more things, the author was making a play on words by using both meanings in one sentence. If a group of people have a 44-fold higher chance of a disease, then it is better not to risk having a false negative and giving an awful disease to someone. I'm sorry that it disturbs you, but it is rational.

  53. @Edward Jones, Did you not read this statistic cited in the ethicist's response: "the rate of new H.I.V. diagnoses among M.S.M. (men who have sex with men) is more than 44 times as high as it is among other men." More than 44 times as high - more than 44 times the risk to potential recipients. Also as cited here, very recent HIV infections cannot be detected yet. What do you not understand about these facts? Further, there are many other conditions or behaviors, several of which are noted, that also preclude people from donating blood. Are those conditions or behaviors "discriminatory" too? Whenever there's a blood drive in my neighborhood, about half the volunteers are declined due to a wide variety of reasons. Also, blood donations are disallowed from men who've had sex with other men in the last 12 months - i.e., not forever. This has nothing to do with discriminating against gay men because of who they are. The safety of our blood supply - based on sound data - is more important than your feeling offended.

  54. My travel medicine physician who was board certified in Infectious Disease and now is the senior medical officer at a major investment bank (and gay) said he believes that as a matter of policy allowing men who have sex with men to donate blood would be detrimental. That’s good enough for me.

  55. @Ted You and your doctor are assuming that all or most gay men practice anal sex and do so without condoms and are very promiscuous. Only about 35% of gay men do so and 1/2 of them regularly use condoms. By far the most promiscuous people I know are hetero and a former roommate had sex with dozens of women in the few years we lived together. All donors' blood should be tested and no one should be denied unless it's KNOWN they're infected.

  56. @MorinMoss "All donors' blood should be tested ..." Yes and this is done currently. "... and no one should be denied unless it's KNOWN they're infected." This is very bad public policy since KNOWING infection is very difficult. The rights of individuals must always be balanced against the rights of other individuals. The right to give blood should not imply a right to put the recipient of that blood at risk.

  57. Very well reasoned. I hate people crying “discrimination” when there is none.

  58. This is an excellent, complete, very well thought out response. It looks reasonably at all sides, and even gets down to the inner issues and needs of the person who asked the question. I appreciate the nuances and thoroughness.

  59. I don't give blood because I have SLE. while this is no longer a disqualification for blood donation, what is of primary concern for me is that because of years of IV treatments, my blood vessels are now so delicate that even attempting to set an IV triggers a severe flare for me. I don't feel like I've deprived anyone of anything by not donating - I feel like I've supported myself physically. there are other ways of being giving and helpful - volunteering is an excellent one.

  60. @Judy Hill Autoimmune disease is no longer a disqualification?! I have it too, so that is interesting to know. However, I am sure the treatments still make one ineligible, unfortunately. I will have to go back and review the CDC recommendations. Thanks!

  61. A really wonderfully written article.

  62. Call me selfish, but I think my personal romantic relationships are WAY more important than my ability to donate blood.

  63. Why not just let anyone donate, and then make risk management decisions out of sight? Didn't they do that temporarily in the aftermath of the Orlando massacre?

  64. How would that work? By letting gay men donate blood only to have their donation dumped on the basis of an assessment by the blood tech that they "seemed gay"?

  65. @John Well, there is the cost incurred to accept, process, etc. the donation. There is also the small risk to the donor - mostly from the loss of blood.

  66. The author’s examples of other ‘discriminatory’ restrictions mostly revolve around age. That is different than a restriction for M.S.M. Everyone regardless of any other characteristic, at some point experiences an age-based restriction. Age-based restrictions affect everyone equally in their lives regardless of gender, sex, race, religion etc... A restriction for M.S.M. disproportionately effects the queer community because it indeed feeds into stigma. It implies that gay sex, by definition, is ‘risky’. Blood donations are tested, as the author writes and a restriction for ANYONE who participates in ‘risky’ sex (anonymous, unprotected, drug-infused, etc.) would be far more appropriate and egalitarian. Gay sex is not implicitly ‘risky’ sex. I agree with the advice given, but the author is wrong to imply a ban on M.S.M. is anything but discriminatory.

  67. @Mark There are restrictions for straight folks who engage in risky acts, too. Even though the blood is tested, sometimes a test won't catch bad blood, so restrictions are imposed based on available statistics. What matters is the blood, and the safety thereof. That cannot be sacrificed for the sake of avoiding hurt feelings. If the restrictions were on who could RECEIVE blood, it would be a different story...

  68. The letter writer is heartbreakingly ambivalent about the fact that he is gay. That's what this is all about. He's not the first to feel this way. I hope he finds an excellent therapist with experience in addressing issues of sexuality and sexual orientation. The next step would be to embrace the gay community. He needs supportive, well-adjusted gay friends and role models if he is to meet his human potential to live a fulfilled and authentic life.

  69. The ban is discriminatory in two ways. First, the statistics used to argue against donations references"MSM" which is what this response does. This category, as defined by the CDC, includes LGBT men as well as sex workers and inmates who are often the victims of assault. In essence, the category will say that a monogamous gay couple partnered for 30 years has the same risk as a sex worker, and both should be denied the opportunity to give blood. These statistics are then used to support certain attitudes toward the minority. Heterosexuals are not treated in this manner. They are only asked questions about specific high-risk actions, visiting malarial regions, sex with persons which particular diseases, etc. When orientation drives what questions are asked and how decisions are derived, then it's discrimination. Why not ask gay men the same questions as straight men and determine whether the person can give blood?

  70. @Jeffrey Jeffrey, do we really have to see discrimination lurking behind every bush? I am a straight male who has been giving blood for 61 years. Before the AIDS epidemic of the 1980s there were no special questions asked of gay potential donors. In fact, I can't even recall a questionnaire being filled out beyond basic identification information, but the increased monitoring was made necessary by inadvertent deaths of recipients caused by donations of HIV-tainted blood (most famously, of the great tennis star and totally straight Arthur Ashe). The questionnaire is now almost exceedingly long, but every two months when I donate I have to fill it out all over again. Since I am straight, I guess I could consider this insulting to or prejudicial against non-gays, but I don't because it is necessary to protect recipients. And if you're still not getting my point, it is that the questions are asked of EVERY donor without regard to sexual orientation. Your (and my) rights are subservient to the rights of the blood recipients at all times!

  71. I have now been a blood donor for 61 years (starting with a work-related blood drive in July 1957, shortly after I turned 18). As a straight male, I can assure Jeffrey that the questions asked of heterosexual men are exactly the same as those asked of homosexuals; indeed, every time I go to donate a pint (six times a year), the list of both questions and new qualification standards seems to grow. Some of the questions I see there are still vaguely shocking to a dullard like myself, but I still answer them, take the little blood pressure, pulse, temperature and iron count tests, and then fork over the red stuff. Did you know that when a donor turns 76, he/she needs an authorization letter to the blood bank from a physician to continue donating? Should this be considered age discrimination, or is it rather just a safeguard to insure that after donating a pint, I don't immediately need it back to save my own life? Stop seeing discrimination all around you. Some rules are simply dictated by common sense!

  72. I see this as a wise risk management decision, not discrimination. Similarly, if you have a bankruptcy you can't get a mortgage. It is an assessment of risk. In the case of blood it is a much more important risk decision. But, more research is needed to define sub populations that are truly risky. A gay couple in a monogamous relationship for many years is probably no more apt to have HIV than a similar straight couple.

  73. I agree with others that this may be more about subconsciously having an excuse to avoid sex rather than an overwhelming desire to donate blood. I’ve been rejected from donating blood multiple times, from a “lifetime ban” after living in Kenya (since rescinded) to travelling to malarial countries more’s too bad, but I recognize there are many ways to volunteer and do good in the world. In fact, I’d venture to say this young man might come to prefer the friendships he experiences while volunteering at, say, an LGBTQ youth group or similar than simply through blood donation. Having done both of those things, for me the youth group was far more meaningful than blood donation, just food for thought.

  74. ...Mr. Appiah should exclaim "Thank You, I Needed That" after a friendly slap on the face and go find himself some "Happy and Gay" sex.

  75. "the rate of new H.I.V. diagnoses among M.S.M. (men who have sex with men) is more than 44 times as high as it is among other men. "

  76. The writer went throught High School as well as College without experiencing any sexual enounter. The two that he did have are described by him with cold and, (almost), nightmare inducing reflections. What I'm really struck by in his letter is his 'PASSION', and that is not about sex, it is about donating blood. For whatever reasons that are best known to him, I believe he should simply follow his desire for 'happiness', which for him, is to donate blood. He simply will not be 'content', unless he follows his passion; it is his only one.

  77. Apart from the donating blood issue, this person's cavalier attitude toward having sex without protection is troubling. He never mentions his risk of contracting disease. He only worries that having sex with other men will make him ineligible to donate blood.

  78. @Brigid McAvey he never mentions protection because it isn’t germane to the discussion. Even men who have protected sex with men are ineligible to donate blood. I’m not sure where you get off thinking the take away of this letter is the man’s “cavalier attitude” since writing an ethicist to ask which decision is more prudent is anything but.

  79. @Brigid McAvey He doesn't suggest that he will have unprotected sex. The guidelines don't seem to differentiate between protected sex and unprotected sex.

  80. @Brigid McAvey The ban has nothing to do with safe sex or unsafe sex. His use of a condom would not make him eligible to donate. It's simply a ban on men who have sex with men (in the last 12 months). As far as I read, he is only concerned with whether to have sex rather than how he should go about it.

  81. I don't understand why people keep referring to this as a "homosexual" ban when it clearly doesn't apply to lesbians, meaning that it does not apply to homosexual behavior across the board. Are they not considered homosexual? Or do they just not count because they're women?

  82. No, they do not count just because they are women, but male sexuality usually assumes an exchange of bodily fluids that may contain the H.I.V. virus that can then be passed along long in the donated blood. This is not apparently considered a danger in female homosexual activity. You may want to recall that the great tennis star Arthur Ashe, a straight male, died of AIDS after inadvertently receiving an H.I.V.-tainted blood transfusion. This was one of the reasons these safeguards were instituted and it has nothing to do with gender prejudice.

  83. There is nothing wrong with being of service to the community in which you live. But, there is more than one way to achieve it. Remove your pre-determined attitudes of what you should or should not be. And apply the tools that you can give. Otherwise, you are measuring yourself by others, and not by yourself. Once you let go of others' predetermined checklist, I will bet you can be way more beneficial to others, than you ever dreamed.

  84. I think the letter writer's quandary is perfectly understandable. He is to be admired for understanding the importance of donating blood, and for even having some confusion as to whether he should engage in sexual activity if it means not giving blood. This is the question of an emerging humanitarian, and I am sure he will ultimately make a decision that is right for him. I wish I knew him because I am sure he will do great things in his life.

  85. I started giving blood in my 20s when there were blood drives at work. Had my ears pierced at age 27, so I was told I couldn't give for about a year. The next time, they turned me down and did not give a reason. I never tried to give blood again after that. I am a woman.

  86. I think if you're wondering about having "gay sex" and your immediate concern is blood donation - you really need to reevaluate your priorities. I think one of these should clearly be obvious, I wouldn't presume to say one is better than the other, however, this should NOT be an internally troubling decision -> all of course, my opinioin.

  87. This question raises issues that might be better explored in private with a therapist instead of the ethics column in the NYT.

  88. Good grief! There are SO many ways to contribute to society, why this fixation on giving blood as the only meaningful way to do that? This person should be serving in soup kitchens, reading to the blind, mentoring disadvantaged children in substandard schools, helping senior citizens with shopping or IT or an endless number of other productive options. This is a person who is centered on himself and I am glad I don't know him.

  89. I'm surprised that at the current level of science/technology/medical knowledge, fully functional artificial blood that meets every metric and doesn't introduce negative effects isn't in the picture. Can anyone with professional or research experience educate me wrt this? Obviously a complex and high risk bar to pass ...

  90. I get the impression that he has negative feelings about himself and unconsciously wants to do something good in a form of atonement, however sub-conscious. If he donates a pint while still in his abstemious period, he will see that one feels no different after the experience. Then, he can focus on the choice that is still facing him. "I think I like you, but I plan to donate blood..." will work for a while, but some other sense says donate it and get it over with and see how you feel.