By: Aimee Harvey
The Red Cross released a statement on September 29, 2021, urgently requesting Americans to donate blood. Blood centers across the country have reported dangerously low blood inventories due to canceled blood drives, an often overlooked yet alarming side effect of the ongoing COVID-19 pandemic. In an effort to increase donations, the U.S. Food and Drug Administration (“FDA”) made several changes to their donor eligibility requirements, including those that affect men who have sex with men (often referred to by the FDA and blood services organizations as “MSM”).
For nearly 30 years, the FDA has restricted MSMs’ ability to donate blood. The FDA first introduced these restrictions in 1983 in the form of a lifetime ban, barring any MSM from ever donating blood if they had sex with another man since 1977. This ban was introduced during the early stages of the AIDS crisis, at a time when little was understood about how the disease spread and testing was unavailable. This misinformation, especially in a time period where same-sex relations were still largely frowned upon, contributed to the often homophobic stigma surrounding individuals diagnosed with HIV/AIDs.
A BRIEF HISTORY OF THE HIV/AIDS CRISIS
The disease we now refer to as AIDS was first detected in 1981 when five young gay men in Los Angeles, California visited doctors due to ongoing health issues. All five were diagnosed with pneumocystis pneumonia, an illness almost exclusively seen in individuals with severe immunodeficiency. This illness was very rarely seen in young people, prompting doctors to investigate further as to why it was affecting these five otherwise healthy young men. In an article published in the Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, an editorial note speculated that, “[t]he fact that these patients were all homosexuals suggests an association between some aspect of a homosexual lifestyle or disease acquired through sexual contact….”
The following year, the New York Times published an article about the mysterious immune disorder, which had by then affected 335 people and killed 136. In the earlier years, the disease was referred to the disorder as “gay-related immunodeficiency” or “the gay plague” as a result of homophobic sensationalism surrounding the prevalence of the disease in gay men. The disease would not get its official name in September 1982: acquired immunodeficiency syndrome.
By 1983, researchers began to realize that AIDS was caused by a retrovirus (later discovered to be human immunodeficiency viruses or HIV) and could be transmitted through bodily fluids, such as blood. Because adequate testing did not exist at this time, the nation’s blood supply quickly became unsafe. Thousands of blood product recipients became infected with HIV due to unknowingly receiving contaminated blood, with some ultimately dying due to AIDS-related complications. Blood banks would not implement screening tests for donations until 1985.
Within 10 years of the disease’s discovery, 179,136 cases of AIDS would be diagnosed in the United States. Though there is still no cure, countless innovations have been made in the detection, prevention, and treatment of HIV/AIDS in the past 30 years. These advancements, particularly regarding detection, call into question why so few changes have been made to MSMs’ blood donation restrictions.
BLOOD DONATION RESTRICTIONS IN MODERN TIMES
The first revision to the FDA’s blood donation restrictions for MSM occurred in 2015, restricting the ban on donation only to men who have had sex with a man in the past year. This decision followed similar policy changes in other Western countries, as well as the publication of research examining the risks associated with loosening such restrictions. These new policies drew significant public attention just one year later, following a shooting at Pulse, a gay nightclub in Orlando, Florida in 2016. The shooting was considered the largest mass shooting in U.S. history, and ultimately left 49 dead and 53 wounded. Despite the dire need for blood, gay men were turned away from donating if they had not been celibate for at least one year, in accordance with the FDA’s 2015 policy. In response, more than 100 members of the House and 24 senators sent letters to the FDA expressing concern over the one-year celibacy policy.
However, the most recent change to the policy was not motivated by political support, public outcry, or mobilization efforts. Instead, it came about in response to a rapidly dwindling blood supply during the COVID-19 pandemic. After determining that it would not endanger the safety of the blood supply, the FDA reduced the deferral period to three months on April 2, 2020, in the hopes of increasing blood donor turnout. In response to the new 3-month celibacy policy, over 500 medical professionals signed an open letter requesting the FDA eliminate the restrictions on MSM altogether. The American Medical Association also released a statement requesting the FDA take steps to remove categorical restrictions on MSM donors in favor of restrictions based on individual risk. Despite these efforts, the 3-month policy remains in place today.
The issue with these restrictions is that they further perpetuate the stigma that HIV/AIDS only affects MSM. Gay men are not the only group that is at risk for the disease, yet they are the only group singled out on the basis of sexual orientation. Contrary to public perception, in 2019, almost a quarter of all new HIV diagnoses in the United States and dependent areas consisted of heterosexual individuals. To categorically restrict MSM directly contradicts the fact that anyone who is sexually active can carry the disease.
Alongside this, these restrictions undermine and ignore innovations in testing that help prevent the transmission of HIV through blood products. When the lifetime ban was first implemented, there were no testing procedures in place to ensure the safety of the blood supply. However, modern testing can detect the presence of HIV in blood sample as little as 10 days after exposure. Furthermore, the FDA mandates such testing for on all blood donations regardless of the sexuality of the donor, which calls into question why restrictions on MSM still exist.
However, there is still hope. In 2020, Vitalant, OneBlood, and the American Red Cross joined together to start a pilot study called the Assessing Donor Variability and New Concepts in Eligibility (ADVANCE) study. The study, which is funded by the FDA, seeks to determine whether making changes to the MSM blood donation policy will affect the safety of the blood supply. This study is being conducted in major cities across the U.S. and will ultimately gather research from 2,000 gay and bisexual men between the ages of 18 and 39. After the study is concluded, the data will be used by the FDA in further revisions of the MSM blood donation policy. Only time will tell if this data will actually result in a policy supported by science instead of stigma.
Aimee Harvey graduated from the University of Arizona with a B.S. in Public Health and a minor in Spanish. She is currently a 3L with plans to work in indigent defense, family law, or estate planning. Within the topic of social justice, her interests include LGBTQ+ issues and reforming criminal justice, immigration, and tax systems.