The Food and Drug Administration (FDA) policy which disqualifies men who have had sex with men (MSM) from donating blood is once again receiving national attention.
The ban, implemented in 1977, came as a response to the HIV/AIDS epidemic. At the time, HIV was getting into the nation’s blood supply and gay men were found to be disproportionately affected by the disease. Since there was no way to detect HIV, scientists believed that banning gay males from donating blood was the best policy.
Advancements in science and technology have made HIV more easily detectable. Scientist can detect the presence of HIV in as little as 9-11 days via a RNA test. There are even HIV home test kits that can detect HIV antibodies in 20-40 minutes with 92-99% accuracy. These improved methods of detection have lead many to believe the MSM ban is not only outdated and unnecessary, but also discriminatory against gay and bisexual individuals.
The only other groups permanently banned from donating blood are individuals who have exchanged sex for money, tested positive for HIV or other infections, and intravenous drug users. A non-MSM person who has sexual contact with a sex worker or HIV partner can still donate blood after a one year deferral period. Opponents of the MSM ban argue these polices show the MSM ban unfairly targets sexual orientation while personal behavior is considered for other groups.
“I think it’s unfair,” Hayes Thorton, a graphic designer in Berkeley, California, told 429Magazine. “I imagine the blood has to be tested for diseases, and to assume a certain disease is present in every sexually active member of one community is bigotry and preventative to those who need blood.”
Thorton, a gay man, learned about the ban in high school when The American Red Cross came for donations. He was interested in contributing until a friend informed him that the relationship he had with his boyfriend rendered him ineligible.
“I felt uncomfortable. For an outside group to come into my liberal haven and accept donations from a specific demographic based on sexuality that I did not belong to felt intrusive,” he said.
Although Thorton views the MSM ban as discriminatory, he believes much more is stake. For him and others who support modifying the MSM ban, the policy compromises lives which make the issue beyond sexuality-specific. USA Today reported last June that The American Red Cross’s blood supply had hit a 15-year low and dipped below emergency levels.
Stephanie Millian, a spokesperson for the Red Cross, said her organization supports “rational and scientific-based deferral periods,” and “the current lifetime deferral of men who have had sex with men is unwarranted.”
Since 2000 the FDA has organized panels to discuss whether to modify the MSM ban in light of modern understanding and testing of HIV. However, the same conclusion—to keep the full ban in place—was always decided.
The panels say they need more information to better understand the MSM circumstance before the FDA can make a policy change. In March 2012 the Department of Health and Human Services made a “request for more information” for a study that could lead to alternative policies regarding the ban.
Dr. Brian Custer, an Associate Investigator at Blood Systems Institute, the second biggest collector of blood in the United States, is working on submitting that information. Dr. Custer has two ongoing studies that could provide more information about what impact modifying the MSM policy would have on the safety of the nation’s blood supply. “These studies help contribute some information, but not all,” he told 429Magazine.
The first study (risk-factor study) will analyze existing data to determine what proportion of blood donors “pass” the initial screening process, but test positive for transfusion-transmittable infections anyways. This will provide a baseline estimate of the current risk of transfusion-transmittable viruses in the US blood supply.
The second study will use focus groups and survey MSM to learn if easing the MSM ban would lead to more or less compliance (honesty during the initial donor screening). Additionally, it will seek to identify the behavior of men who are eligible to donate and men who are not, and if a modified policy would lead to a net increase in donors.
The results of these studies should be available in 2014 and could provide a comprehensive look at the current risks in donating, who is donating, and if a modified policy helps or hurts blood safety goals.
Dr. Custer hypothesizes if the MSM ban were lifted and led to more compliance, then higher risk donors could be removed, resulting in a safer blood supply. The net effect might be safer blood transfusions.
“This is important to determine,” he said, “because the risk-factor study indicates that some people are not compliant.”
Dr. Custer said he cannot speak to the FDA’s rationale for continuing the MSM ban, but does believe “the purpose of the policy was not meant to exclude people, but to maximize the supply of healthy blood.”
According to a 2010 study at the Williams Institute at the University of California, Los Angeles, if a one year deferral policy were used for MSM, then more than 53,000 additional men would likely make more than 89,000 blood donations in the United States. This is the policy currently implemented in places such as Australia and the United Kingdom.
Last year Mexico became the first country in North America to lift the MSM ban and disregard sexual orientation completely. Instead, blood donation rules will focus on risk factors associated with certain practices and conditions when determining eligibility.