Two of the Bay Area's main blood centers are asking eligible gay and bisexual men to donate during the holiday season when they usually see a dip in donations. Their appeals come after they implemented new rules covering when men who have sex with men can donate blood that took effect earlier this year.
"We welcome all those now eligible to donate to donate," said Kevin Adler, a spokesperson for Vitalant, which has two blood donation centers in San Francisco.
Added Dr. Suchi Pandey, the chief medical officer for Stanford Blood Center, which has locations in the South and East bays, "Definitely, there is a critical need for blood right now. We encourage people in the LGBTQ-plus community to consider donating."
Under the changes approved by the U.S. Food and Drug Administration, gay and bi men are no longer automatically selected for a separate screening process to see if they can donate blood. Now everyone who goes in to give blood is asked the same set of questions about their recent sexual activity.
The questioning no longer asks if people are monogamous or in a monogamous relationship. Instead, they are asked about their recent sexual activity.
"It is a more equitable approach, where everybody is being assessed the same way," noted Pandey, a straight ally who lives in San Francisco. "What that means is with this new policy there are people, specifically gay and bisexual men, who have been deferred and will now be eligible as long as they meet those sexual risk behavior questions that everyone else has to comply with."
Thus, everyone is now asked if they have had a new sexual partner or more than one sexual partner in the last three months. If the answer is yes to either, they are then asked if they have engaged in anal sex in the last three months, regardless of their sexual orientation or gender identity.
If they have not, and meet all other eligibility criteria, they are able to donate. Otherwise, they must wait three months from the date they most recently had anal sex to donate blood, as the Association for the Advancement of Blood & Biotherapies explains on its website.
"The reason is because the epidemiology shows if you have anal sex you are at a higher risk for transmission of sexually transmitted diseases. So if the answer is yes, the individual will be deferred," said Pandey during a recent video interview with the Bay Area Reporter.
Also, anyone taking the HIV medications PrEP, for pre-exposure prophylaxis, or PEP, for post-exposure prophylaxis, needs to wait three months after their last oral dose of the medicines before giving blood. For injectable PrEP, people are advised to wait two years following their most recent injection.
"We just want to say people should not stop taking PrEP," said Pandey. "But if it is no longer important for them to stay on PrEP, then they can donate three months after their last dose."
Vitalant and Stanford Blood Center both took part in the ADVANCE Study, which stands for Assessing Donor Variability And New Concepts in Eligibility, and provided data to the FDA as it examined changing the eligibility requirements for gay and bi blood donors. As the B.A.R. has previously reported, the federal agency banned all men who have sex with men from donating blood in 1983 during the early days of the AIDS epidemic. The lifetime ban applied to any man who had sex with another man after 1977.
As the science on AIDS evolved, so did the FDA's blood donor rules. In 2016, it allowed men who had sex with men to donate blood if they had been sexually abstinent during the prior 12 months. Amid ongoing backlash that its policy was homophobic and outdated, the FDA shortened the timeline in 2020 to a three-month deferral for gay and bi men who were sexually active.
Systems now updated
Vitalant had updated its systems by August 21 to reflect the latest change to the screening process for blood donors. Stanford Blood Center had fully implemented the change as of October 19, as it needed extra time to not only update its computer systems but also train its staff on the new questioning protocol.
"There was some sensitivity for team members in asking personal questions about anal sex and how to explain to donors the changes. We spent a lot of time training staff with those soft skills as well," said Pandey. "It really is stating it is OK to talk about anal sex and it's a behavior we are trying to assess. It is something different but the best way to do an individual, risk-based approach."
Stanford Blood Center currently does not have any locations in San Francisco. Interested blood donors can make an appointment for one of its four centers in Alameda or Santa Clara counties; it just opened the one at Fallon Plaza (3738 Fallon Road) in Dublin in late October.
Vitalant has locations throughout the Bay Area, including its downtown San Francisco donation center at 250 Bush Street. After selling its property off Masonic Avenue to the University of San Francisco, Vitalant is now located across from the Stonestown Galleria shopping mall at 555 Buckingham Way. (It is a short Muni ride away from the city's LGBTQ Castro district via the M-Ocean View subway line.)
Neither of the blood centers could provide the B.A.R. with any statistical data showing that they are seeing more gay and bi men coming in to donate blood due to the new eligibility criteria. They did say the change went into effect smoothly.
"It has been well received," said Pandey. "Overall, it is going well."
As it does not track if blood donors are part of the LGBTQ community, Stanford Blood Center only knows anecdotally due to reports from its staff that several gay and bi men had self disclosed it was their first time donating blood, Pandey told the B.A.R. Under the first two weeks of using the new eligibility criteria, she did know that only two people who had come in to give blood were deferred because of it.
She didn't know, however, if the people were male or female. Nor could she say if they were heterosexual or not.
"In my just anecdotal experience knowing some donors who have been deferred and were excited to be able to start donating, and seeing that response and seeing very few deferrals of two in two weeks, this tells me this is a positive impact," said Pandey. "We have to continue to look. Ultimately, I do think we will see an increase in our donor visits and collections."
Adler, a straight ally who noted many of Vitalant's employees are from the LGBTQ community, also told the B.A.R. he has no way of knowing how the new criteria for blood donors is changing their demographics.
"When it comes to the impact we really have no way of knowing how many donors who identify as a gay man or bisexual man have come in to donate," he said. "All we can look at are first time donors in general, and there we have seen a slight uptick. It's about a 2% increase over the last three months."
Adler spoke to the B.A.R. in late November. He specified that he didn't have any more identifying information about first time donors, such as if they are gay men or not.
"It is really unfortunate because something like this is such a landmark change that there isn't a better way to judge the impact that it is having or could potentially have on donors, and figure out who is donating for the first time because of it," said Adler. "We are definitely seeing a drop in overall donors and in the overall donor base of donors giving regularly."
Some of that has to do with the ongoing impact of the COVID pandemic, which reduced blood donations over the last three years. Pre-pandemic in 2019 Vitalant held 483 business-sponsored blood drives, whereas it has only had 207 so far this year. Four years ago it held 125 high school blood drives but only 66 this year.
There is usually a drop off at this time of year in its blood drives at businesses and schools because of the holidays, noted Adler. The flu season also sees a decrease in people donating blood, as anyone sick with the flu or who has a cold is barred from doing so.
"Typically, this time between Thanksgiving and New Year's historically is the most difficult time for us to collect. We see fewer donors this time of year than any other time during the entire year," said Adler.
Stanford Blood Center has also yet to return to the number of blood drives it had been doing at high schools and colleges prior to 2020. But the need for donated blood remains high, noted Pandey.
"There is a constant need for blood donations," she said. "So anything that can be done like this policy change that helps decrease deferrals, or allows new individuals who couldn't donate before can now donate, is good because we need to keep our blood donations high."
Vitalant and Stanford Blood Center are looking to do mobile blood drives in the LGBTQ community in 2024 because of the new eligibility rules for donors. Their implementation of them this year came too late to do so at most of the Bay Area's Pride celebrations and LGBTQ-focused street fairs.
"We have reached out to various groups around the Bay Area, not just in San Francisco, about doing those things," said Adler. "It takes a little while to get them to warm up to the idea of donating blood because for them it has not been available to them at all for the most part. Getting them to welcome the idea of a blood drive is not challenging but not as easy as we would like it to be."
Stanford Blood Center did team with an LGBTQ group on the Stanford campus this fall to promote donating blood. It has had a booth in the past at Silicon Valley Pride and would like to now bring its blood drive bus to the event.
"That will be coming someday undoubtedly," said Jenn Bennett, its director of marketing and communications.
Gay Assemblymember Evan Low (D-Cupertino) for years has been calling on federal health officials to lift the restrictions on gay and bi blood donors. He told the B.A.R. that he has not reviewed the new eligibility requirements to see if he qualifies to be a blood donor, though when asked about the PrEP restrictions he said they do not apply to him.
Until those are also lifted, Low told the B.A.R. he isn't planning to give blood. Having launched a bid Tuesday for an open South Bay House seat, Low could become a leading voice in Congress on the issue should he win the 2024 contest.
"We won't stop until we get absolutely equal and full and fair treatment," said Low, who over the years has hosted blood drives where those who could donate were asked to do so on behalf of a gay and bi men restricted from doing so.
With LGBTQ advocates and others continuing to call on the FDA to further open up blood donations to people on PrEP, Adler told the B.A.R. that Vitalant continues to share its data with the federal agency and supports seeing more people become eligible to give blood if they can do so without impacting the blood supply.
"Vitalant continues to support and provide data to expand the donor base even more and give them information to support a safe blood supply and to collect blood from individuals eligible in different areas," he said. "Vitalant continues to be an advocate of new policies to allow as many people as possible to give blood."
Its Vitalant Research Institute continues to analyze data from the ADVANCE Study, so Adler noted there will be more reporting from that project. Vitalant is also one of four blood centers that participate in the Transfusion Transmissible Infections Monitoring System (TTIMS), which is continually evaluating blood safety in the U.S., added Adler.
"Part of that study is evaluating PrEP use in blood donors," Adler noted to the B.A.R. "Both the ADVANCE Study and TTIMS were instrumental in shaping the current eligibility requirements and the recent individual donor assessment changes."
Pandey didn't rule out seeing PrEP users be able to donate blood in the future. She understands why the FDA is taking "a conservative approach" on the issue for now.
"The potential rule with PrEP may be changed in the future. It is a matter of getting more data and understanding how PrEP impacts donor testing," she said.
For those who currently can donate blood, Adler stressed it is vital to do so and only takes an hour.
"The big thing is donating blood makes an immediate impact in our community," he said. "It can save someone's life and is really easy to do."
For more information, go to vitalant.org or stanfordbloodcenter.org.
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