All I want for the New Year is a chance to give blood: How outdated rules restrict gay men from donating | Expert Opinion
Outdated rules restrict gay men from donating blood. This Penn doctor shares his experience trying to donate.
In the wake of landmark bipartisan approval of legislation to legalize same-sex marriage across the country, it is time to repair the policy that uniquely discriminates against a large group of men who want to give blood.
Some may be as surprised as I was to learn that the current rule discriminates against men who have sex with men. The Food and Drug Administration (FDA) is currently reviewing its policy, which began during the early days of the HIV epidemic, well before treatment for HIV was commonplace, and long before testing for the virus was as accurate as it is today. The agency is expected to update its guidance soon, with leading organizations such as the American Red Cross in support of needed changes.
As a physician, and a gay married man who has been monogamous for close to 17 years, I first confronted this antiquated legislation when my husband and I decided to do what we could at the beginning of the pandemic. At that time, there was a severe blood shortage, and we scheduled appointments to donate blood.
Only then did we discover that we needed to attest to being celibate for three months before being allowed to donate blood. We were shocked. I mean, our children may call us “old-school,” but they would never mistake us for monks. This policy had been in place since 2020, before which the FDA-sanctioned “deferral” time for men who had sex with men was 12 months of celibacy.
There was a time when this approach was justified. In 1985, AIDS was widespread and known to be transmitted through blood transfusions. Blood testing was just becoming available. This crisis led the FDA to recommend that blood-donation facilities screen and indefinitely defer male donors who had sex with another male since 1977.
Much has happened since the earliest days of HIV/AIDS. Not only is HIV testing commonplace among those who might be considered at risk; it is also now routinely used to test blood that has been donated. And, with the advent of HIV nucleic acid tests, the virus can be detected between 10 and 33 days after exposure. HIV infection rates are declining every year.
Furthermore, HIV and other blood-borne pathogens are in no way limited to men who have sex with men. HIV may be acquired by men or women who inject drugs, or through heterosexual contact, especially among non-monogamous couples. Data from HIV.gov notes that people who acquired HIV through heterosexual contact made up 22% of HIV diagnoses in 2020. So why should our current practice focus solely on men who have sex with men?
One might ask how our policies compare with those in peer countries. The World Health Organization recommends universal blood screening for HIV, hepatitis B, hepatitis C, syphilis, and other blood-borne diseases.
Mexico has accepted blood donations from gay and bisexual men, screening all donors based on sexual history rather than sexual preferences since 2013. The U.K. implemented a universal screening policy that allows men who have sex with men and who have had the same partner for three months to give blood. And, as of September 2022, Canada has a universal screening program like the U.K.’s. All are significantly less restrictive policies and nondiscriminating.
It is time to move quickly to a policy under which all donors are evaluated equally and fairly, and to encourage local blood collection facilities to comply with that policy. The American Red Cross, the American Medical Association, the WHO, and the Gay and Lesbian Alliance Against Defamation (GLAAD) have called for the end of discriminatory practices based on our available science.
The FDA is preparing to announce some changes in this policy that may create a more uniform screening policy, in response to these recommendations as well as scientific review by an ongoing trial known as the ADVANCE study.
Why wait until another critical blood shortage, such as the one experienced as recently as January and February 2022 — a shortage the Red Cross called “the worst in a decade”? Why wait for additional data analysis, for a panel of experts to respond to a doodle poll, and for more deliberation, to bring the U.S. on par with the U.K, Canada, and Mexico?
Blood donation is a gift I’d love to give in the new year — as would a substantial number of the 360,000 other men in this country who currently are subjected to unnecessary discriminatory practices.
Kevin B. Johnson is a senior fellow of the Leonard Davis Institute of Health Economics, senior fellow of the Annenberg Public Policy Center, and the David L. Cohen University Professor of Pediatrics, Informatics, Computer Science and Communication at Penn.