Since 1983 the Food and Drug Administration (FDA) has rejected blood donations from men who have ever had sex with another man on the grounds that it is a high-risk behavior. But experts and LGBTQ rights activists say the policy fosters inequality and, after three decades of technological upgrades, it’s time for reform. Progress Illinois takes a closer look at the “outdated and discriminatory” policy.
Since 1983 the Food and Drug Administration (FDA) has rejected blood donations from men who have ever had sex with another man on the grounds that it is a high-risk behavior. But experts and LGBTQ rights activists say the policy fosters inequality and, after three decades of technological upgrades, it’s time for reform.
“They screen all of the blood, so an HIV-negative test is the same for a gay man’s blood as an HIV-negative test for a straight person’s blood,” said Justin Hayford, case manager with the AIDS Legal Council of Chicago (ALCC). “If you have confidence in your ability to test our blood, which either you do or you don’t, then this ban makes no sense.”
The FDA does not accept blood donations from any man who has had sex with another man, even once, after 1977, which the agency marks as the beginning of the AIDS epidemic in the U.S.
Gay and bisexual men are “at increased risk for HIV, hepatitis B and certain other infections that can be transmitted by transfusion”, according to the regulatory agency.
In the 1980s, more than 50 percent of hemophiliacs across the country, at least 10,000 people, contracted HIV during blood transfusions. It was in this “harrowing” atmosphere that the FDA and other health regulatory agencies implemented policies aimed to prevent further contamination of the nation’s blood supply.
“Prior to the development of any test, they had to find ways to reduce risk,” said Dr. Sally Campbell, associate professor of pathology and medical director of Transfusion Medicine at the University of Illinois at Chicago. “The initial method was through behavioral deferrals.”
But Hayford, a gay Chicagoan who called the regulation “antiquated,” said the FDA’s hesitation to reform the policy promotes the notion that gay men’s blood is inherently dangerous, and thus stigmatizes the LGBTQ community.
“Our government should realize there’s nothing different about our blood,” he said. “This is sending a really destructive message. We are not sick people, we are just people.”
According to the FDA’s blood donor history questionnaire, individuals can be eligible to donate blood if they have waited more than 12 months after treatment for syphilis or gonorrhea, sex with a prostitute, or sex with a person who has tested positive for HIV. Also, individuals who have allowed 12 months to pass since a non-sterile needle stick can qualify to give blood.
In Illinois, there is no deferral for would-be donors who have recently gotten a tattoo or piercing in a state-regulated establishment.
“The notion that gay men’s blood is somehow more dangerous than anybody else’s, including people who visit prostitutes, is completely nonsensical,” Hayford said.
Men who have had sex with other men represent just 2 percent of the U.S. population, the Center for Disease Control (CDC) reported in May, but they represent 63 percent of the nation’s new HIV infections.
Approximately 50,000 people become infected with HIV every year in the U.S., the agency reports, and roughly 15,000 people die from AIDS annually.
Nonetheless, the FDA reports that only one in every 2 million blood transfusions results in the spread of HIV.
“The current lifetime deferral is medically and scientifically unwarranted,” Campbell said.
She agreed with Hayford, saying that the FDA’s policy to reject blood from gay men is without scientific merit and isolates the LGBTQ community.
“The FDA is telling this community they can’t donate simply for being who they are,” Campbell said. “I’m African American and I’ve had people say to me ‘black women should be banned because of high rates of HIV transmission in the black community.’ But that’s not appropriate reasoning.”
She added that the FDA needs to review whether there is any existing scientific evidence to support the lifetime disqualification of gay men who wish to donate blood.
There is a nine- or 10-day “window period” during which someone who is infected with HIV would test negative upon screening, Campbell explained. This time period, she said, accounts for what the FDA regards as increased risk for HIV-infection during blood transfusions.
She called for a one-year blood donation deferral following male-to-male sexual contact, adding that the window period falls well within 12 months and would allow for detection of HIV and other infections.
“Everybody that is eligible should be encouraged and able to come out and donate,” Campbell said, adding that the American Association of Blood Banks (AABB), for which she is a member, supports a deferment period of 12 months.
According to a 2010 estimate from the Williams Institute at the University of California, Los Angeles (UCLA), if the FDA completely revoked its deferral policy, an additional 130,150 men would likely contribute an extra 219,200 pints of blood to the nation’s blood supply every year.
In 1985, the initial test used for HIV screening, enzyme immunoassays (EIA), identified the infection by detecting the immune system’s response to it, which takes time to develop. But updated screening, such as the Nucleic Acid Test (NAT), tests for the virus itself. Implemented in 1999, this test can detect the presence of HIV quicker and with more accuracy than previous screening methods.
Meanwhile, John Peller, vice president of policy for the AIDS Foundation of Chicago, said the U.S. is “far behind on this issue."
Canada reformed its policy in May, switching from a lifetime ban to a five-year blood donation deferral for men who have had sex with other men. Also, Australia, Japan, Sweden and the U.K. have all reformed their indefinite deferrals to implement one-year policies.
“It’s important for the U.S. to look abroad and learn from those experiences,” said Peller. “We need to move quickly to implement a policy that is more in line with the science.”
He added that, as a gay man, he’s frustrated with the nation’s “unnecessary” policy that permanently excludes him from donating blood.
“As somebody who is HIV-negative, I feel I should be able to donate blood,” Peller said. “If I would like to help my fellow human beings by donating blood, I think I should be able to do that.”
The Department of Health and Human Services (HHS), the cabinet-level agency under which the FDA functions, last examined blood donation deferral criteria in 2010. Following recommendations from the agency’s Advisory Committee on Blood Safety and Availability (ACBSA), HHS determined further study is needed to justify a change in policy.
According to the FDA, the deferral’s sole purpose is to maintain the safety of the nation’s blood supply, and it “is not based on any judgment concerning the donor's sexual orientation.”
“FDA and HHS continue to reevaluate the scientific basis for its blood donor deferral policies,” said Curtis Allen, FDA spokesperson, in a statement.
In March 2012, HHS submitted a request for information (RFI) to the Federal Register to research the need for a pilot study on donor deferral criteria and investigate whether the agency could allow blood donations from gay men without increased risk.
Allen said HHS is still reviewing the comments submitted in response to the RFI and no decision has been made to proceed with the pilot.
In June, the American Medical Association (AMA) voted to recommend the FDA lift its ban on blood donations from gay and bisexual men and instead should implement “rational, scientifically-based deferral periods that are fairly and consistently applied to blood donors.”
That same month, would-be donors from across the country expressed their outrage over the indefinite deferral and ramped up pressure on the FDA to accept blood donations from gay and bisexual men by participating in the first-ever National Gay Blood Drive.
“This is a policy based out of fear,” said Ryan Yezak, organizer of the National Gay Blood Drive. “It represents one of the many ways in which we’re still legally discriminated against.”
After testing negative for HIV, more than 200 gay and bisexual men from 52 cities, including Chicago, were rejected from donating blood.
Yezak said he plans to deliver the test results and rejection forms to the FDA this month, in an attempt to demonstrate how much blood the nation’s bank is foregoing by excluding all gay and bisexual men from eligible donor lists.
“It’s important to raise awareness of this and get it on people’s radar,” he said.
Dozens of members of Congress have expressed support for reforming the nation’s “indefensible” blood donation deferral policy for men who have had sex with other men.
“Healthy gay and bisexual men continue to be banned for life while the FDA allows men who have had sex with an HIV-positive woman to give blood after waiting only one year,” U.S. Rep. Mike Quigley (D, IL-5) said in an interview with Progress Illinois.
For years Quigley has advocated for the FDA to allow gay and bisexual men to donate blood, and in 2012 sent a letter, signed by 62 lawmakers, to HHS calling for a revision to the “outdated and discriminatory” deferral policy.
He said, in light of the agency’s inaction, he is currently circulating another letter around Congress. For the first time, he added, his effort has garnered bipartisan support and was signed by U.S. Sen. Mike Enzi (R-WY).
“We’re hoping the policy will catch up with the science and move toward a non-discriminatory position,” he said.