Indeed, Spain and Italy do not bar blood donations from men who have had sex with men, but ask donors instead how many sexual partners they have had in the past six months. If the answer is one, they may donate. If it is more, then the donation is deferred. Mexico has also moved to allow gay men to donate blood.
Testing for viruses and pathogens in blood is far more sophisticated today than it was in 1983, when we did not yet have a test for the AIDS virus, and when the tainted blood scandal erupted in Canada and many other nations. We have more sophisticated means at our disposal for selecting donors judiciously: testing their blood, asking questions to eliminate those with risky behaviours, and so forth. But much like the decisions to prevent American blacks from donating blood destined for use by white U.S. troops during World War II. I would argue that the blanket ban on blood donations from sexually active gay men in Canada, the United States, France, the U.K., Japan, and many other countries is no longer based on science, but rather on lingering public bias that considers homosexuality inherently wrong and unsafe.
When it was announced in May 2013 that Canadian Blood Services and Héma-Québec would begin to accept donations from gay men who had been celibate for five years, nobody pretended that it would increase the quantity of blood donated, and nobody offered a rigorous scientific argument explaining the magic number of five years. It is time to stop creating rules that give credence to antiquated thinking about the inherent dangers of gay sex. A promiscuous heterosexual who does not practise safe sex is likely to pose more risks to the safe blood supply than a gay male in a long-term monogamous relationship. Federal health officials should give serious thought to a new policy that would take every reasonable step to ensure the safety of our blood supply, while not alienating and insulting potential gay donors. Rather than rejecting the safety of any blood donated by a gay male, people running blood clinics could give gays the same opportunities offered to heterosexuals. They should be asked clear questions about risky sexual behaviours. They should be screened out if their answers are unsatisfactory. Their blood should be tested, very carefully.
To refuse to allow blood donations from sexually active gay men has several negative consequences. It perpetuates stereotypes against homosexuality and robs the blood supply of vital donations. It runs the risk of discouraging heterosexuals who are sympathetic to gays from donating. It creates a system in which people who are desperate to donate might lie about their sexual orientation as a sort of act of political resistance. Indeed, in 2010 Canadian Blood Services won a lawsuit against a gay man named Kyle Freeman, who lied about his sexual orientation and donated blood several times between 1990 and 2002 as a protest against what he felt was an unfair exclusion. Although Freeman took blood donation rules into his own hands, others have opted for more concrete and open protests by staging campus demonstrations against blood drives.
Durhane Wong-Rieger, a former board member of Canadian Blood Services who has spent some twenty years working in areas related to blood policy, has decried the five-year deferral period. She says it perpetuates negative stereotypes about gay people and the safety of their blood — and has nothing to do with scientific evidence. From the standpoint of a recipient’s health, the difference in risk between blood donated by a man who has had sex with a man and another donor is “absolutely infinitesimal,” she said in a radio interview in May 2013. “The greater risk will be that someone who needs blood will not be able to have access to it,” because of insufficient supply.
The American Red Cross could have taken a stand during World War II, by arguing that there was no reason to impede blacks from donating blood to white military personnel. Perhaps this would have helped the United States tackle serious problems of segregation and racial discrimination in an era when these issues were crippling the country. Today, federal officials in Canada, as well as Canadian Blood Services and the American Red Cross — where a lifetime deferral for men who have sex with men is still in effect — could show the same leadership with regard to blood from gay donors.
In June 2013, the American Medical Association (AMA) voted to oppose the ban by the U.S. Food and Drug Administration, which refuses blood donations from gay men. “The lifetime ban on blood donation for men who have sex with men is discriminatory and not based on sound science,” AMA board member William Kobler said in a statement. The AMA argued that decisions to ban blood donations should be based on individual risk and not on sexual orientation alone. In July 2013, Arthur Caplan, who leads the Division of Medical Ethics at the New York University Langone Medical Center, also argued in favour of eliminating “an outdated, non-scientific regulation that bans [blood donations by] anyone who has had sex ‘even once’ with another man since 1977. Although many people died in the 1980s after they received blood donations that were infected with the HIV virus, much improved HIV testing has made the ban on gay blood donors obsolete,” Caplan wrote. “The Food and Drug Administration acknowledges that HIV tests are highly accurate, with the risk from a unit of blood reduced to about one per 2-million units in the U.S. The worry is from the risk during the ‘window period’ which occurs very early after being infected with HIV when even current testing methods can’t detect antibodies. But the Red Cross, America’s Blood Centers and the AABB (a blood donation advocacy group) all support throwing out the ban.”
Restrictions on who should donate should be based on science, on tests, and on meaningful questions designed to avoid donations from people who engage in risky behaviour. Even in an era of advanced medicine, when nucleic acid tests can reveal whether a donor has been exposed to HIV or hepatitis C before antibodies even show up in the blood, we rely on the honour system. When people give their blood so that others may regain their health, we still count on donors to tell us the truth about the most intimate parts of their lives.
In the world of blood donation, the safety of the blood supply depends on two key factors, which must be combined to maximize the benefits of synergy. We must use the best science in our laboratories, and we must ask many questions. As always, we will have to make wise decisions about blood donations. As for whether we deem it wise to accept the offer of blood, it will come down to three questions: How badly do we need it? What are the benefits? And what are the risks?
JUST AS WE COUNT ON the truthfulness and honour of blood donors, we also require it of the famous athletes whom we so revere, and from whom we draw hope and inspiration. Any superstar athlete who claims that his or her blood is clean, when it is not, runs the risk of creating a mighty scandal. At the intersection of honour and blood, we hold people to account. And so we should. If someone lies about blood being donated, people could die. If someone lies about racing clean on a bicycle or on the track, people will be shocked to the core. It is a matter fundamental to our sense of right and wrong.
Some eight years before he would be stripped of his victories and finally admit to Oprah Winfrey that he had repeatedly used performance-enhancing drugs and blood transfusions, Lance Armstrong was well en route to his unprecedented sixth consecutive victory in the Tour de France. On this particular day in July 2004, Armstrong and his teammates were riding in a bus on an isolated road after completing a mountain stage of the twenty-one-day race. One of the most gruelling sports events in the world, the Tour de France requires riders to race thousands of kilometres at high speeds, including several days climbing up and racing down the Alps and the Pyrenees. Needless to say, a race like that beats up your blood. Among other things, it drives down your natural red blood cell count, as well as your testosterone. Unless you resort to trickery, your body will deteriorate throughout the race — with some athletes deteriorating more than others. Cheating by such means as boosting the blood or adding to the testosterone count has become so widespread that to ride without chemical assistance is described, in the parlance of tour riders, as riding pan y agua, which is Spanish for “bread and water.” Riding without chemical assistance is likened, thus, to toughing it out on
the diet of a malnourished prison inmate.
On the day in question, Armstrong and his teammates pulled off a stunt so brazen that even teammate Floyd Landis — who would win the Tour two years later, only to have his title stripped when he was found to have used testosterone — would admit later that he had never seen such a thing. The bus driver pulled over to the side of the road, feigning engine trouble. For an hour, every single rider on the team — Armstrong, Landis, and seven others — remained in the bus and underwent blood transfusions.
You cannot transfuse the blood of nine cyclists in a bus on a remote mountain road without meticulous planning involving numerous people, including athletes, coaches, doctor, and driver. Each cyclist needs to go somewhere — often travelling from one country to another and meeting secretly in a hotel room — to meet with a doctor who will withdraw about half a litre of his blood. The blood must be mixed with anticoagulant, preserved, and stored. It must be labelled carefully, so that each athlete’s blood is kept distinct from that of the others. The blood must be refrigerated, with no electrical blackouts, thank you very much. (In 2003, one year before the group transfusion on the bus in the mountains of France, Lance Armstrong had to travel away from his apartment in Gerona, Spain, and worried about the possibility of a blackout in his absence. The blood might be compromised without Armstrong’s even knowing it. The simplest solution was to hire a blood-sitter. Armstrong summoned Landis to his apartment to keep watch over blood bags stored in a refrigerator hidden in the master bedroom, checking the blood temperature daily to ensure that there had been no inconsistency in the supply of electricity. Landis came and provided the service, and later described the incident to the United States Anti-Doping Agency.) Machines must be purchased that can test the athlete’s blood and see when it is ready for the transfusion — the receipt of his own blood back into his system. One machine, for example, monitors hemoglobin levels, and another is a centrifuge used to assess one’s hematocrit (the percentage of red blood cells in the blood).
While keeping the blood cold, you need a courier to haul it past fans, journalists, television cameras, doping control experts, and others, and bring it to that bus taking riders down the slopes of a mountain. And then you need to hang those bags of blood above nine riders — one of whom is the most famous in the history of cycling, having survived testicular cancer to go on to obliterate his competition in the world’s toughest cycling event for six years in a row, lying all the time about how he was riding clean. You need to hook it up, find a vein, and wait the hour or so it takes for the blood to drip into the riders’ systems. With thousands of fans crowding each leg of the Tour de France, you need to dispose of the blood bags and other medical paraphernalia without anybody noticing, pretend that the bus driver has fixed the engine, and get rolling again so the riders can eat, rest, profess their innocence in the face of persistent questions from the media and doping control agents about whether they are riding clean, and race another day.
Athletes have always looked for ways to get a leg up on their competitors. In 1980, Rosie Ruiz pulled off one of the greatest hoaxes in modern sport by winning the women’s category of the Boston Marathon in a record time of 2:31:56. This was about twenty-five minutes faster than a time she had earlier run to place eleventh in the New York City Marathon. In Boston, Ruiz finished the race three minutes ahead of the Canadian Jacqueline Gareau, the second woman to finish the race. American marathon legend Bill Rodgers noted that Ruiz looked unbelievably fresh at the Boston finish line. Ruiz was awarded the victory, but officials soon determined that she had taken the subway for part of the New York City marathon and had either taken the subway in Boston or found another way of getting herself close to the finish, so that she could run the last kilometre or so to “win” the world’s most famous marathon. Ruiz was stripped of her title. Gareau was brought back to Boston for a proper ceremony as the rightful winner, and as the first Canadian woman to win the race.
As the scholar Mario Thevis says in his book Mass Spectrometry in Sports Drug Testing, people have been taking substances to gain an advantage in sport for thousands of years. Thevis notes that in the third to second century BCE, the Greek philosopher Philostratus observed athletes taking bread spiked with the juice of the poppy plant, which contains opium. Swimmers apparently used doping agents as early as 1865 during races in the Amsterdam canals, although it’s beyond me why anyone would willingly swim in any Amsterdam canal in any century. Beginning in 1870, reports emerged about widespread abuse of narcotics, stimulants, and nitroglycerine by cyclists in six-day races. In the 1904 Olympic marathon held during the World’s Fair in St. Louis, Missouri, the first man to cross the finish line was disqualified because he was found to have ridden in a car for part of the race. The second finisher was a British-born American runner by the name of Thomas Hicks. Hicks had run out of gas (pardon the pun) after ten miles (slightly more than a third of the way through the race) and had wanted to give up. His trainers pushed him on. They gave him two doses of strychnine, which is rat poison, but which in low doses also serves as a stimulant. He was also given raw egg white and a shot of brandy. Hicks had to be carried across the finish line and revived by doctors afterwards. Under current rules, Hicks would have been disqualified. But at the 1904 Olympics, he was awarded the gold medal.
Canada, of course, has its own infamous history of cheating on the running track. It’s hard to imagine a single Canadian born before 1975 who does not know that in 1988, the sprinter Ben Johnson tested positive for anabolic steroids after winning the Olympic 100-metre dash in a record time of 9.79 seconds and trouncing his archrival, the American Carl Lewis, whom Johnson led from start to finish. To clarify, anabolic steroids do not alter blood composition per se, but they travel through the blood to enhance muscle strength and recovery. Although Ben Johnson did not alter the composition of his blood, his blood carried steroids to the muscles. News that Johnson had cheated by using performance-enhancing drugs shocked Canadians just as profoundly as Americans and others were troubled by the truth — when it finally came out — about Lance Armstrong.
Johnson was turned into a pariah, and he endured a massive shaming in Canada. The same television networks that had replayed his victorious race over and over in slow motion camped outside Johnson’s house and contributed, in a way, to his demonization in the public eye. I do not condone the use of performance-enhancing drugs by Ben Johnson or any other athlete, but it struck me then and it strikes me now that the man would not have attracted as much media attention if, instead of becoming a world-class athlete and cheating on the track, he had been convicted of murder. Having followed the world of track and field for years, and having been an entirely mediocre middle-distance and long-distance runner competing in dozens of races in high school, university, and afterwards, I remember being struck, and horrified, by suggestions from some quarters that Ben Johnson may have been too naive to know that he had been taking steroids. You don’t progress through year after year of workouts, massages, and consultations with coaches and nutrition experts without becoming intimately acquainted with your own body and what is happening to it.
I never won an important track, cross-country, or road race in my life, but I could tell you what my resting pulse was on any given morning, without touching my wrist. I could guess, quite accurately, my own heart rate after a race, without having to hold two fingers up to my carotid artery, look at my wristwatch, and count for fifteen seconds. Athletes are aware of their blood, their heart rates, and what is going into their bodies. To my way of thinking, it was a slight to Ben Johnson’s intelligence to suggest that he did not know what he was doing. Although Johnson initially issued vigorous denials, he had in fact been taking performance-enhancing drugs for the better part of a decade. He knew what he was doing, and he was fully aided by his doctor, Jamie Astaphan, and his coach, Charlie Francis, in his training and doping techniques. The truth came out later in the course of his testimony before the Dubin inquiry — a C
anadian federal investigation into the use of drugs and banned practices in sport. Two years after Johnson was dethroned, the Dubin inquiry released its report. Not surprisingly, it documented widespread cheating among Canadian track athletes, particularly those who had worked with Francis. At the inquiry, Francis admitted to encouraging many of his athletes to take performance-enhancing drugs. The inquiry named eleven Canadian track athletes who had done so. (It is worth noting that many other Canadian athletes were competing clean.) Many other athletes came forth to offer testimony about what they had done to boost their own performances artificially. And many of the international athletes against whom Ben Johnson had been competing on world stages were also nabbed for taking performance-enhancing drugs, although few were brought down with as much ceremony, hand-wringing, and concentrated media attention as Ben Johnson.
Johnson, a black man, had a nervous stutter. He came as a child to Canada, from Jamaica. He did not do well in school. He lived with his devoted mother in a modest home in Scarborough, a suburb of Toronto. He had been a mighty Canadian hero when he won the Olympic gold medal, but after his shaming, some in Canada began to refer to him only as a Jamaican, disowning all ties with him, his accomplishments, and his failures. Johnson did not fare well in the aftermath. He apologized and said he would go clean, but he tested positive twice more in the intervening years for the use of steroids and a diuretic that can be used to mask the presence of other drugs in the body. Eventually, he was banned for life from competing on the track. Some described him as a national disgrace, and urged him insultingly to move back to Jamaica. At a charity event in 1998 in Charlottetown, Prince Edward Island, Johnson raced against a horse and a car. (After the 1936 Berlin Olympics, Jesse Owens also raced against horses.) Although Johnson’s participation was voluntary, the pitting of a black man against an animal caused me to cringe. Among the most enduring and offensive racial stereotypes is that the black man lacks intelligence but has prodigious strength and sexual prowess. In Charlottetown, one decade after he ran a victory lap at the Seoul Olympics while Canadians cheered — for a few hours, until the music abruptly stopped — Ben Johnson had been equated with a horse.
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