The COVID-19 pandemic has caused a concerning shortage of blood donations, with nearly a third of community blood centers operating with less than a day’s supply of blood. Physicians are urging Americans to consider donating, remarking that places like New York are seeing supplies at only about 65 percent of pre-COVID levels. As a healthy 20-year-old, I want nothing more than to offer my own blood to a patient in need of a transfusion, but the government has barred me from doing so. Why? Because I’m gay.
The federal ban on MSM — men who have sex with men — blood donation originated during the early years of the HIV/AIDS epidemic. With the virus disproportionately affecting gay and bisexual men, the Food and Drug Administration imposed a deferral of MSM from donating blood in order to keep HIV from slipping into blood supplies.
From the adoption of the policy in 1983 until 2015, gay and bisexual men in America were subject to a lifetime ban on donating blood if they had ever engaged in sexual activity — protected or unprotected — with another man. Following HIV testing advancements in the 21st century, the ban was decreased from a lifetime restriction to a one-year deferral in 2015. More recently, on account of COVID-19 and associated blood shortages, the deferral period was reduced from one year to three months.
Even today, the rate of HIV among MSM is disproportionately high. However, considering HIV screening advancements, is a blanket deferral of MSM from donating blood an effective strategy for preventing transmission? Is there any scientific evidence to justify the deferral, or is the policy nothing more than residual homophobia from the 1980s?
According to a 2018 study by Massachusetts General Hospital researchers — including Rochelle Walensky, President Biden’s choice to lead the Centers for Disease Control and Prevention — a one-year deferral for MSM paired with current testing standards resulted in 5.39 HIV-positive accepted blood donations per million. This is compared to 7.10 HIV-positive accepted donations with testing but no deferral. In other words, a complete elimination of the time-based deferral on MSM blood donation would result in only 1.71 more HIV-positive accepted units per million.
However, an increase of HIV in the blood supply, no matter how small, is objectively bad. Fortunately, the 2018 study offers a third option — a risk-based deferral — which both eliminates discrimination and reduces the quantity of HIV-positive donations.
In the risk-based deferral, the study turned away all men, both gay and straight, who had engaged in unprotected anal intercourse in the past six weeks. This strategy, coupled with the same testing, resulted in only 2.54 HIV-positive accepted blood units per million, a twofold improvement of the FDA’s MSM blanket deferral.
This study presents conclusive evidence that a risk-based approach is far more effective — and more ethical — than a time-based deferral of MSM. Many nations are opting for such a change in policy. The U.K. recently ended its ban on MSM blood donation in favor of a risk-based deferral, one which does not consider the sexual orientation of donors.
With blood donations stagnant during the COVID-19 pandemic, now is the time for the FDA to reconsider its deferral policy. The evidence is clear: A blanket ban on MSM blood donation is less effective than a risk-based deferral. The current deferral is not only homophobic, but also reduces the pool of eligible donors.
During a pandemic, the government should do everything in its power to provide for those in need. An unsubstantiated ban on gay blood is both discriminatory and detrimental to those in need of a transfusion. My blood, and the blood of 12 million gay and bisexual men across the country, is currently rejected solely on the basis of our sexuality. Now, more than ever, the FDA must rethink its ban on gay blood donation.
JEFF CIESLIKOWSKI is a junior in Franklin College studying physics and philosophy. Contact him at firstname.lastname@example.org.