Since 1983, blood donations from men who have sex with men (MSM) have been strictly regulated by the FDA. Federal regulations against MSM donation began amid the AIDS pandemic as the government tried to prevent contamination of the blood supply. As MSM were identified as a major demographic suffering from HIV/AIDS, they were given a “lifetime ban”, permanently prohibiting any man who had ever had sex with another man from donating. After decades of protest, the policy was decreased to a twelve-month deferral period in 2014, and a three-month deferral period in 2020. [1,2] This policy has faced continuous criticism for its lack of addressing individual risk levels and restricting blood donation based on sexual orientation. While there is reasoning behind these decrees, there are much more effective alternatives for regulation and protection of the United States blood supply that are less discriminatory and do not group all MSM into one risk category.
Blood donation is, in principle, not an individual right. It is within the government’s power to limit or allow blood donation under any criteria they choose. The current FDA policy states that all MSM are ineligible to donate within three months of having sex with another man. The object of this policy is to prevent contamination of the blood supply, as testing for HIV in blood samples is never 100 percent accurate. As HIV transmission still tends to be higher among MSM, accounting for 68% of cases, they are the most strictly regulated demographic—although heterosexual sexual contact still accounts for 22% of cases, according to the CDC. [3]
Restrictions on MSM blood donation and testing of donated blood samples have not eliminated HIV in the blood supply in the past. According to the Human Rights Campaign, “Despite current restrictions and testing of approximately 12 million units donated each year, 10 HIV-infected units have slipped through.” [2] While this means that the current restrictions do not fully eliminate HIV, it also shows that error is possible with blood testing and that keeping the blood supply uncontaminated is still of great importance.
Placing all MSM into one risk group doesn’t account for different factors that affect their chance of having HIV. “Some have argued that those in monogamous relationships, MSM who always wear condoms, and those on pre-exposure prophylaxis (PrEP) have a much lower transmission rate of HIV than the general MSM population – or other groups that are currently allowed to donate – and thus should be allowed to donate.” [1] Perhaps all individuals should be individually assessed for their HIV risk, regardless of whether they are MSM or not. “A man who has had protected oral sex with another man once in the 3 months [is] currently barred from donating blood. Yet a woman who has had unprotected sex with multiple partners over the same time frame with no knowledge of their personal histories remains in the donor pool.” [2]
There are other options to protect the US blood supply while doing so in an ethical and non-discriminatory manner. Individual risk assessment prior to donation, as mentioned before, is an option. This could include identifying whether one has knowledge of previous partner(s)’ HIV status, how many partners they have had in the recent past, the type of sexual encounter it was (oral, anal, vaginal, etc.), and whether they are in a long-term closed relationship with a partner(s). Additionally, nucleic acid tests (NATs) can detect HIV in an individual within a 10 to 33 day window. [4] By testing the donors a second time after this window has passed, HIV-positive samples could be more consistently caught.
The Red Cross and the Human Rights Campaign (HRC) both agree that the policy regarding blood donation should be changed by the FDA. Both organizations support an individual risk assessment questionnaire as the best course of action. [2,5] Due to pressure from these organizations, the public, and other advocacy groups, the FDA has recently proposed an initial draft of new blood supply regulations that would remove the time deferral for MSM. It would, as suggested, use individual risk assessment to decide whether to allow or deny a donor. The survey will ask about recent sexual history, and those who report having anal sex with new or multiple partners within the past three months will be deferred from donation. This proposed referendum was released on January 27, 2023. It became open to public comment on January 30th and will remain open until March 31st. [6,7]
Balancing public health concerns and individual rights is a major ethical challenge. However, outrage during the aftermath of events such as the Pulse Nightclub shooting—where members of the LGBTQ+ community were prohibited from donating blood to the victims—reminds us that blood donation is an important, life-saving act that members of our greater community depend on. The ability to aid one’s neighbors in times of crisis should be made as accessible as is safely possible to promote a healthier, cooperative society.
References:
1: Arora, K. S. (2017). Righting anachronistic exclusions: The ethics of blood donation by men who have sex with men. Journal of Gay and Lesbian Social Services, 29(1), 87–90. https://doi.org/10.1080/10538720.2016.1261385
2: Blood Donations and the LGBTQ Community. (n.d.). Human Rights Campaign. https://www.hrc.org/resources/blood-donations
3: Basic Statistics | HIV Basics | HIV/AIDS | CDC. (n.d.). https://www.cdc.gov/hiv/basics/statistics.html
4: Understanding the HIV Window Period | Testing | HIV Basics | HIV/AIDS | CDC. (n.d.). https://www.cdc.gov/hiv/basics/hiv-testing/hiv-window-period.html#:~:text=An%20antigen%2Fantibody%20lab%20test,to%2033%20days%20after%20exposure
5: LGBTQ Donors. (n.d.). https://www.redcrossblood.org/donate-blood/how-to-donate/eligibility-requirements/lgbtq-donors.html
6: U.S. Food and Drug Administration. (2023, January 27). FDA Proposes Individual Risk Assessment for Blood Donations, While Continuing to Safeguard U.S. Blood Supply. U.S. Food And Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-proposes-individual-risk-assessment-blood-donations-while-continuing-safeguard-us-blood-supply
7: Regulations.gov. (n.d.). https://www.regulations.gov/document/FDA-2015-D-1211-0152