Ban the Ban: An argument against the 12 month blood donation deferral for men who have sex with men

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Ban the Ban: An argument against the 12 month blood donation deferral for men who have sex with men

December 1, 2018
This article was written, in collaboration, by members of the Queer People and Allies for the Advancement of Medicine at Brown University: Jeremy Wang, Ingrid Mader, Jonathan Spiegel, Matthew Marciello, and Cole Exline.

As a young gay or bisexual man, the first time you tried to donate blood was probably an embarrassing and slightly confusing experience. As you go through the screening forms, everything seems normal until you stumble upon a question on whether you have had sex with another man in the past 12 months.

A few questions run through your head. Why do they need to know? Why does it matter? Isn’t this homophobic? This article will explore the history of the U.S. blood donation ban in the context of the HIV and AIDS epidemic and discrimination of the LGBTQ+ community. Additionally, we will attempt to answer some of these difficult questions and propose a method of action. With increased knowledge, it is our hope that we can empower people to speak up to policy makers and health leaders and create change. This World AIDS Day, we encourage students and activists to join us in resistance against all forms of stigma and discrimination faced by the LGBTQ+ community.

Origin and History of the Ban in the U.S.

The blood donation ban for men who have sex with men (MSM) was a restriction that prevented any man who had sex with another man, regardless of sexual orientation, from donating blood. Originating in 1983 during the height of the HIV and AIDS epidemic in the U.S., the policy was created as an emergency measure to prevent contamination of the U.S. blood supply by this deadly disease. The policy impacted MSM, women who have sex with MSM, and transgender people that could be considered MSM. Despite medical and diagnostic advances in the field of HIV, the FDA continued to enforce a lifetime ban on MSM from donating blood until 2015, when they reduced the lifetime deferral to 12 months from the most recent sexual contact. Though the change in policy is a step in the right direction, the current MSM blood donation deferral is based on questionable science and perpetuates a stigma against MSM while limiting the already scarce U.S. blood supply.

Scientific Basis of the Ban

The goal of blood drives is to collect the largest volume of healthy blood to be used in lifesaving medical treatments and surgical procedures. Unfortunately, not all blood donated is safe or usable. Various viruses including HIV can be present in donated blood, which contaminate the general blood supply and pose a threat to recipients of blood transfusions. To prevent this from happening, rigorous laboratory tests are performed on every unit of blood before it enters the blood pool. Even with these testing procedures in place, a small number of infected samples still make it through the screen. Since MSM have higher rates of HIV as compared to the general U.S. population, the FDA put the 12 month MSM blood deferral policy in place with the goal of minimizing HIV transmission risks through blood transfusions.

But does a ban of this length really decrease the likelihood of HIV ending up in the blood pool? The FDA screens every unit of blood donated for infectious diseases prior to entering the donation pool. Current tests for HIV are able to detect the presence of the virus with high precision within 11 days after infection. Based on this science, a 12-month deferral for MSM does not make any sense; furthermore, the test is able to detect HIV with such a high precision that only 1 in 3.1 million units of blood infected with HIV will make it past the screen. Therefore, opening up blood donations to MSM donors would not cause a significant difference in HIV transmission risk from blood transfusions. The American Public Health Association confirms this, stating that the 12-month deferral was modeled after policies of other countries rather than empirical scientific studies.

Still, the premise of the MSM blood donation deferral revolves around the assumption that MSM blood donors have a higher risk of contaminating blood supplies due to disproportionately high rates of HIV as compared to other groups in the U.S. Though this is true, the MSM population is not homogenous. MSM vary widely in the number of sexual partners they have as well as in their engagement with risky sexual behaviors that determine HIV infection risks. The FDA deferral policy ignores these differences and applies a blanket 12-month deferral without providing exceptions to those in monogamous relationships, those on HIV medications that lower transmission risks, and those that practice safer sex. At the same time, non MSM donors who have multiple sexual partners are permitted to donate blood. This policy is clearly based on stigma towards MSM rather than on science.

Ramifications of the Ban in the LGBTQ+ Community

Since the beginning of the epidemic, HIV has been falsely labeled as the “gay disease.” Hostility towards MSM during this time extended all the way up to the government and policy makers, delaying government response towards the epidemic. The blood deferral for MSM is a remnant of this past sentiment where the health system is more willing to push MSM aside rather than work with them to solve health problems.

Ironically, the same stigma used to justify blood donation deferrals contributes to the increased prevalence of HIV in MSM communities. Stigma experienced by MSM regarding HIV and sexual health translates into distrust of the healthcare system and less engagement with healthcare professionals regarding sexual health among gay and bisexual men. This is extremely concerning given that healthcare professionals can provide vital information regarding HIV prevention and testing to at-risk patients. Furthermore, research shows that perceived stigma may cause MSM to engage in more risky sexual behaviors that may increase the risk of contracting HIV. Considering population-wide HIV incidence, stigma-based policies may inadvertently increase risk for HIV contamination of the blood pool in the long run. Rather than instituting bans, policy makers and healthcare leaders should be working with MSM to improve access to HIV prevention resources and treatments.

So what can we do about this discriminatory policy?

While we certainly do not advocate for a boycott of blood drives, it is important that we speak up and resist the MSM blood donation deferral. To start, we can inform the public about the issue.

At Brown University, we conducted an awareness campaign to educate students about the discriminatory nature of the blood deferral. As a part of this initiative, we held a Stem Cell Registry Drive on campus (which does not discriminate against MSM) to give people who are not allowed to donate blood an alternative while simultaneously raising awareness on the topic.

Additional Resources

Quick Facts on Blood Deferral

Science on 12-Month Deferral

How to Hold a Stem Cell Registry Drive

Jeremy Wang is a GLAAD Campus Ambassador and senior at Brown University studying Public Health. He serves as the President of Queer People and Allies for the Advancement of Medicine, an organization that aims to improve health outcomes among LGBTQ+ communities. In the future, he hopes to combine his experiences in advocacy and Public Health scholarship as a physician and community organizer.

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