Editor's note: On April 2, the U.S. Food and Drug Administration updated its rule to a 3-month deferral for men who have sex with men to donate blood, down from a full year. It also reduces the ban for people with recent tatoos and piercings, sex workers, and injection drug users to 3 months as well.
Our original article, published on April 1, continues below.
Lawmakers and LGBTQ and HIV advocates are renewing the call for the U.S. Food and Drug Administration (FDA) to eliminate the current deferral period for gay men and other men who have sex with men (MSM) who want to donate blood. U.S. Surgeon General Jerome Adams, M.D., M.P.H., urged people to donate blood in mid-March, fearing shortages due to COVID-19. And yet the FDA still maintains that gay men and MSMs who want to donate must have abstained from sexual activity for 12 months. That’s the “relaxed” rule; before 2015, there was a complete ban on gay men and MSMs donating blood, for fear of contaminating the supply with HIV.
When Surgeon General Adams urged healthy Americans to give blood during the COVID-19 crisis, GLAAD President and CEO Sarah Kate Ellis spoke out, saying the FDA should put “science above stigma” and that “Gay and bisexual men, and men who have sex with men, want to give blood and should be able to contribute to help their fellow Americans.”
On Thursday, March 26, U.S. Sen. Tammy Baldwin (D-WI) and a dozen other Democratic senators sent a letter to FDA Commissioner Stephen Hahn, M.D., urging him to “shift away from antiquated and stigmatizing donation policies.”
The senators brought up the current blood shortage as an important time to overturn the gay donor ban: “In light of this shortage, we urge you to swiftly update blood donor deferral policies in favor of ones that are grounded in science, are based on individual risk factors, do not unfairly single out one group of individuals, and allow all healthy Americans to donate. We strongly encourage you to consider this critical solution as you work to develop a comprehensive response to the COVID-19 outbreak and ensure that Americans have access to life-saving blood transfusions.”
Earlier in March, GLAAD started a petition calling for a reversal of the policy, which the organization calls “discriminatory.”
Mathew Lasky, a spokesperson for GLAAD, told TheBodyPro that the 12-month deferral on gay and MSM blood donation based on sexual activity is absurd, “because it amounts to a ban on almost all gay men and MSMs. There are so few people that meet that standard.”
Lasky said that GLAAD and other organizations, including GMHC, will continue putting pressure on the FDA to revise the regulation during the current public health crisis of COVID-19.
“This is a good time for public education about this public health policy,” said Jason Cianciotto, senior managing director of institutional development and strategy at GMHC. “We’ve been amazed to see that in social media, so many people, especially younger ones, are surprised when they learn that [this policy] exists.”
“We need leadership at all levels to understand that this policy not only stereotypes HIV as a gay disease, but that it’s at odds with science. Modern testing can detect HIV in the blood a week after a person has been infected.”
Cianciotto, who testified at FDA hearings on the ban on blood donations in 2015, said the FDA is maintaining its 12-month waiting period because of flawed statistical analysis in determining the likelihood of contracting HIV from blood supplies. “They use a pooled sample of blood supplies, for one, and they ruled out the best available testing [for HIV] that’s in use today.”
Brian Custer, Ph.D., M.P.H., director of epidemiology and health policy science at U.S. blood research institute Vitalant, said the FDA could reduce the deferral period for gay men and MSM right now—but is not likely to do it.
“The FDA is very risk averse, and even moving to a three- or four-month deferral, like Canada and other countries, is not likely to happen during the current public health crisis, even though they recognize blood is needed,” he said.
In a statement to the Washington Blade on March 19, a spokesperson from the FDA stated that its recommendations regarding blood donor deferral for men who have sex with men “have not changed, but we will continue to reevaluate the situation as the outbreak progresses.”
In an email statement, a spokesperson for the Red Cross said they have “reached out to the FDA on this issue as we continue to collaborate with them and other industry stakeholders to ensure a sufficient supply of blood during this unprecedented health crisis.”
The FDA’s 12-month deferral policy for gay men and MSM is at odds with health organizations, including the American Public Health Association, which has argued that it’s “not based in science but appears to be modeled after other countries’ choices and fears.” The American Red Cross has also decried the policy but has recommended shortening the deferral time for MSM from 12 months to three months, as countries like Canada and the United Kingdom have, rather than eliminating deferral altogether.
A 2014 study by the Williams Institute estimated that if the FDA allowed gay men and MSM to donate blood without a long waiting period, an additional 360,000 men would likely donate, which could help save the lives of more than a million people.
U.S. Slow to Change Its Blood Donation Policy for Gay Men
Several countries have shortened their waiting periods for gay men to donate blood. Canada moved to a three-month abstinence period last year. France, Denmark, and the Netherlands have approved four-month abstinence periods. Only Spain and Italy have used individualized risk assessments (IRAs)—which screen people based on high-risk behaviors only, not sexual identity—since 2000 and 2001, respectively.
In November 2017, England, Scotland, and Wales shortened the sexual abstention time for gay and bisexual men and other MSMs to three months, on the advice of the UK’s Advisory Committee on the Safety of Blood, Tissues, and Organs. Studies have shown that shortening the waiting time, and even using IRAs, as Spain and Italy do, have not compromised the blood supplies.
Custer is contracted with the FDA to develop studies to determine whether IRA questionnaires could be effective and safe alternatives to the blanket policy now in place in the U.S. But the studies are only in the planning stages, and even if they show conclusively that IRAs are just as effective, or even more effective, in keeping the blood supply safe, the FDA might still be slow to implement them.
“In Italy, IRAs are conducted by medical doctors, and they make the decisions about who can donate on a case-by-case basis,” Custer said. “In the U.S., we have donor health historians who review questionnaires, not doctors. So moving to IRAs would be a profound change in the way this country assesses risk. Even if the FDA is impressed with the data on risk assessment, they probably won’t be inclined to change their policy right away.”
Custer added that more than 99% of infectious diseases are caught by testing donor blood, but that questionnaires, whether they’re IRAs or like the ones the U.S. is currently using, could add an extra layer of safety, although there have not been any conclusive studies on that. “It’s possible that someone had been infected with HIV less than a week ago, before antibodies would show up. But a questionnaire could screen for that behavior,” he said.
In the UK, the FAIR (For the Assessment of Individualized Risk) steering group of the UK Blood Services is exploring whether individual blood donation risk assessments could be safely introduced, and will report its findings to the government in late 2020.
Some activists aren’t waiting. Last year, a UK group opened an illegal blood bank to protest the ban on gay and bisexual men and MSM from donating blood.