Following the 2016 Pulse nightclub shooting in Orlando, Florida, many gay and bisexual men were turned away from donating blood — blood that was desperately needed — to replace all that was lost by close friends, family, partners and strangers.
Prior to this, the Food and Drug Administration had revised its blood donation policy for men who have sex with men (MSM) from a lifetime deferral to 12 months after sexual contact with another man. Still barring otherwise eligible men from contributing to the blood bank that would help keep their loved ones alive, the new policy only continued to compound the grief, stigma and helplessness felt by those wanting to help.
Nearly four years later, in the face of the COVID-19 pandemic, our country and communities again face blood shortages, with an estimated loss of 86,000 blood donations so far reported by the American Red Cross.
Again, like others, gay and bisexual men want to help.
And yet, the FDA turns away an estimated 130,000 men each year, according to a recent report by the Williams Institute.
In recent weeks, the FDA lessened the deferral policy to three months in light of COVID-19 shortages. But this policy is still every bit as prohibitive as the 12-month policy, and does not address the immediate shortages caused by this pandemic. It must be changed — and quickly — lest we lose countless more lives despite having ample resources to save them.
The U.S. surgeon general recently referenced the glaring need for continued donation: “You can still go out and give blood … social distancing does not mean social disengagement.” He surely isn’t talking to those forced into this “social disengagement,” those unable to contribute to the public’s health despite being ready and willing to do so.
The FDA’s blanket prohibition — a relic of the 1980s AIDS epidemic and rooted in fear, stereotype and stigma — unjustly targets an entire group, rather than specific behaviors associated with higher levels of HIV transmission risk (unprotected anal or oral sex with partners of unknown HIV status). It operates under a stereotype of sexual promiscuity and other higher-risk behaviors for all MSM. Given the inability to capably screen for pathogens in blood and the lack of HIV-preventive and treatment drugs at the height of the epidemic, the deferral made more sense 30 years ago.
But not today. Donated blood is reliably and rigorously tested for HIV and other communicable diseases. A growing body of scientific evidence clearly refutes the FDA’s uniform policy. While it’s true that MSM are still disproportionately burdened with HIV, using the disparity as justification for this wholesale denial is dated. It perpetuates harmful stereotypes while categorically ignoring men in monogamous relationships, men who practice safer sex and even men who have HIV but take medication that makes it verifiably nontransmissible.
Especially in light of the shortages of blood already incurred and predicted due to COVID-19, the FDA needs to lift the three-month ban on MSM immediately. This can be done alongside overall efforts to screen and clean donated blood, effectively increasing the quality and quantity of the diminishing U.S. supply. Like everyone else, gay and bisexual men simply want to help, especially to support their own community (which, given persisting disparities in this population, is already at higher risk of poorer health outcomes due to COVID-19).
A policy of banning donated blood from those reporting high-risk sexual contact without regard for the partner’s sex should replace the three-month deferral. MSM are the only group named and wholly deferred following sexual contact, insinuating that all male-male sex is inherently higher risk. The three-month policy is not progressive or forward thinking; many countries had adopted this interval before the pandemic and are now moving towards a lift on this ban (given their respective testing capabilities).
This policy change would not challenge the existing infrastructure of blood donation. Behavioral risk questionnaires are already in place, asking all donors about sexual practices, other high-risk behaviors and pre-determined HIV status. Sixteen countries, including Spain, Italy and South Africa, operate their blood donation in this way, discriminating not against an entire demographic, but rather against behaviors associated with higher risk, irrespective of sex.
Amid the pandemic, recent activism from a handful of Democratic senators and the LGBTQ+ activist group GLAAD is pushing for the FDA to revisit the policy, with a letter and petition garnering over 20,000 signatures so far. Nationally, the daily increase in the number of letters and calls to representatives regarding this policy is compelling. Please consider adding your voice.
We are all practicing social distancing right now as a devotion to the collective good, working to protect strangers, friends and loved ones from disease and death. But all of those who are eligible could also be donating blood — another selfless and vital way to contribute, pandemic or not. It is unethical, illogical and amoral for those who are willing and able, including gay and bisexual men, to be banned from uplifting the health of others during this pandemic.
We have already seen and will continue to see sweeping changes in health policy and daily life because of COVID-19. Let’s make one of these changes a lasting, positive and meaningful one; we must allow healthy gay and bisexual men to help save the lives of their friends, families and partners through donating blood, and do away with a stigma-perfused FDA policy that actively hampers the public’s health.
CONLIN BASS is an MPH candidate at the Yale School of Public Health. Contact him at firstname.lastname@example.org .