We ended 2014 with an announcement from the Food and Drug Administration that it would end its decades-old lifetime ban on blood donations by gay and bisexual men. But the caveat that the FDA included – that a prohibition continue on blood donations by gay and bi men who have had sex with a man in the last year – is as outdated as the ban itself. It's also stigmatizing and not based on scientific research, as many advocates have pointed out. In short, we don't see a significant shift in the federal government's blood donor policy, and the LGBT and HIV/AIDS communities must continue to press for the FDA to remove the ban entirely.
Gay and bi men would have to be celibate in order for them to donate, which is at odds with reality. Married men in monogamous sexual relationships wouldn't be able to donate, not to mention single guys. And while FDA rules do prohibit some heterosexuals from donating blood, including a 12-month ban for those who have sex with prostitutes or people who inject drugs, the blanket ban on gay and bi men unless they haven't had sex for a year is offensive, harmful, and discriminatory.
The blood ban, of course, had its origins at the height of the AIDS epidemic in the 1980s. Back then, tests couldn't quickly determine whether someone was infected with HIV and blood centers couldn't adequately screen donations. As a result, there were incidents of people becoming infected through blood transfusions. Thankfully, medical and scientific advances over the past 30-plus years have changed the nature of both HIV and blood donations dramatically. Now, tests can determine antibodies to HIV within a couple weeks. People can get into treatment quickly, and decrease their viral load to undetectable. Blood centers also have developed better screening tools.
Unfortunately, the FDA's recent announcement also relies on unfounded fears, generalizations, and stereotypes, as Lambda Legal Defense and Education Fund attorney Scott Schoettes said in a statement. "Merely changing the parameters of this outdated policy does not alter its underlying discriminatory nature, eliminate its negative and stigmatizing effects, nor transform it into a policy based on current scientific and medical knowledge," he added.
Schoettes, who is director of Lambda Legal's HIV Project, said that within 45 days of exposure, currently required blood donation testing detects "all known serious blood-borne pathogens, including HIV." Since that is the case, a deferral of more than two months – for anyone – is not necessary and does not noticeably enhance the safety of the blood supply, he explained.
A better approach, as Lambda Legal suggests, is that donor deferrals be based entirely on the conduct of the potential donor and not on sexual orientation, gender identity, or the perceived health status or risk factors of the donor's sexual partners.
"The reason is straightforward, and is a foundational principle of our prevention efforts: an adult person becomes HIV-positive – or acquires another blood-borne pathogen – only after engaging in activities that present a risk of transmission," Schoettes said. "To base deferrals primarily on prevalence within certain communities rather than behavior could serve to disqualify other segments of the population based on race, sex, and where they reside – a very slippery slope toward more easily recognizable forms of illegal discrimination."
We know that when it comes to gays, the federal government can be squeamish. We may have the right to legally marry in 35 states (soon to be 36) and be able to receive federal benefits, but discrimination exists in the medical arena not only around blood donations, but also around organ transplants for HIV-positive people.
There needs to be a more comprehensive system for monitoring blood donations, including donations that test positive for blood-borne pathogens like HIV and hepatitis C. Lambda Legal pointed to the hemovigilance system, which is the international standard. It "could inform further development of the donor questionnaire used to assess an individual's conduct-based risk, as well as to track any new, emerging infections before they have the chance to infiltrate the blood supply," said Schoettes.
The FDA keeps saying that more research is needed. Actually, medical experts already know the routes and relative risks of transmission for blood-borne pathogens that recipients are legitimately concerned about. The blood donor system should instead focus on individual donors, and not one that still prohibits a whole group of people from donating simply based on who they are.