A Donor Deferred: The Lifetime Ban on Blood Donations from Gay Men

A heterosexual person who has sex with an HIV-positive partner is eligible to donate blood after only 12 months. Yet all gay and bisexual men, even those who are HIV-negative, practice safe sex, or in monogamous relationships, are permanently banned.
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"Save a life, give blood," read the sticker on a colleague's lapel. It sounds wonderful -- where do I sign up? Unfortunately, I can't donate blood because I'm gay. Many people are surprised to hear that gay men are prohibited from donating blood in most countries around the world, including the U.S. I've sat at several dinner parties, perched atop my advocacy soapbox, informing straights and gays alike of the U.S. Food and Drug Administration's (FDA) policy that permanently defers any man who has had sex with another man, even once, since 1977, from donating blood.

It wasn't long ago that I was unaware of the policy. Like many college students across the nation, I happily signed up to donate blood at the campus blood drive. In fact, I rallied a group of friends to join me in participating in one of our country's most noble civic duties. One by one, we were called to donate. However, when my name was called, I was escorted to speak with a phlebotomist rather than fitted with an arm tie and stress ball. I was informed that my blood would not be accepted. Not today, not ever again. It had nothing to do with having consumed questionable British meat products or having a deficiency in iron. Rather, I had answered yes to the question -- the one that asked if I had had sex with a man since the 1970s. Given that I was born in the 1980s, the question seemed oddly phrased to me, not to mention unclear as to the definition of sex. Regardless, I checked the box, unaware of its repercussions. Suddenly, I was blacklisted.

Perhaps there was a misunderstanding, I thought. In a state of disbelief, I tried to reason with the phlebotomist by providing details. "I've only had one partner," I said. "And we always used a condom," I decried. My testimony was met with a furrowed brow and an empathic shake of the head. Without so much as a complimentary cookie as consolation, I was escorted back to the lobby to face my friends, all nursing their cotton-swabbed elbow pits and staring at me with puzzled amazement.

I felt like a walking contagion. Shamed and confused, I couldn't figure out where I had erred. I followed the rules of a progressive sexual mantra: I waited until I was "ready" to have sex, and I always used a condom. Was I now being judged by some archaic moral code? This couldn't possibly be an egregious act of discrimination, could it? I asked for an explanation, but the only one provided was something you might hear if you try to return a pair of used khakis at a clothing store: "Sorry, that's the policy."

So where did this policy come from? And why is it still enforced despite advances in technology that can identify HIV in a unit of blood within days of infection?

The policy dates back to the early days of the HIV epidemic, when knowledge of transmission was nonexistent. Recognizing the disproportionate incidence rates among gay and bisexual men, the FDA responded by enacting a policy that prohibited all men who had sex with other men from donating blood. The year was 1985. Twenty-six years later, the policy remains unchanged.

Current blood donor eligibility criteria are largely inconsistent, imposing significantly less restrictive deferrals to heterosexual men and women who engage in high-risk sexual behavior. For example, a heterosexual person who has sex with a partner who is HIV-positive is eligible to donate blood after only 12 months. Yet the policy permanently bans all gay and bisexual men, even those who are HIV-negative, consistently practice safe sex, or in monogamous relationships.

This information leaves many people confused, shocked and even enraged. I'm consistently asked, "Don't they test for HIV?" The answer is, of course, yes. Then how does the FDA justify the policy? This question fueled Gay Men's Health Crisis (GMHC) and other advocacy organizations to mobilize and push the FDA to revisit its policies.

After significant pressure, the Advisory Committee on Blood Safety and Availability (ACBSA) convened in June 2010 to consider moving to an alternative policy that would allow gay and bisexual male donors. The ACBSA is an advisory body to the U.S. Department of Health and Human Services that oversees the FDA and other federal agencies on a range of policy issues. These issues include public health parameters around safety of the blood supply and blood products, and ethical and legal issues related to transfusion safety, among others.

With little data available to support moving to an alternative policy, the ACBSA voted in favor of maintaining the ban on gay male donors. However, the inconsistencies of current blood donation guidelines were also acknowledged by the ACBSA, who declared them suboptimal and provided a number of recommendations for improving safety protocols, as well as expanding the blood pool. This includes recommendations for implementing research that can identify a subset of low-risk gay and bisexual donors. GMHC remains in conversation with researchers and federal employees to assist with implementation of these recommendations.

Thankfully, momentum to reform current blood donation guidelines continues to grow. The nation's leading blood centers, national hemophilia organizations, and several U.S. representatives have joined GMHC in championing the cause. Abroad, the tide is also turning, with the U.K. moving away from a permanent deferral to a one-year deferral of gay and bisexual male donors. Opportunities for continued advocacy around blood donation reform, including a community forum hosted by GMHC, are essential to ensuring its implementation.

Blood safety is a public health issue that should be carefully examined and improved based on scientific review. It is imperative, especially in light of the recent spate of natural disasters, that blood reserves be robust and at the highest standard of safety. This should not exclude the generous donations of the majority of HIV-negative gay and bisexual men. Now is the time for healthy gay and bisexual men to join the ranks of other altruistic Americans who save lives and proudly bear a simple yet noble sticker that reads: "Just Donated."

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