New rules on blood donation: Step in the right direction for LGBTQ+ rights?

Restrictions on blood donation by men who have sex with men (MSM) and their women partners has been a sore point among critics, who claim the practice is rooted in non-scientific and discriminatory perspectives.

In January 2023, the FDA issued a press release describing a proposed a change from the use of time-based deferrals to the use of gender-inclusive, risk-based questions in the assessment of blood donor eligibility.^[] The agency believes that this approach will still decrease the risk of transfusion-transmitted HIV. This model follows the approach taken in countries like the UK and Canada.

Up until this point, MSM had to abstain from sex for 12 months before donating blood, which was a highly controversial policy. Opponents of this policy have long been calling for it to be lifted.^[] 

Proposed changes

The new draft recommendations by the FDA are based on data from other countries with similar HIV epidemiology that have adopted this strategy, and on data from continued monitoring of the US blood supply.^[]

Here are the recommendations in a nutshell, as summarized in the FDA press release:

• Time-based deferrals for MSM or women who have sex with MSM will be eliminated.

• The donor-history questionnaire would be revised to inquire about new or multiple sexual partners during the past 3 months.

• Respondents who have had a new sexual partner or multiple partners within the past 3 months would be asked about a history of anal sex in the past 3 months. 

• Individuals with (a) a new sexual partner or multiple sexual partners and (b) a history of anal sex within the last 3 months would be deferred from donation.

• There will be no change in the donor deferral time for other HIV risk factors, including cases of sex being exchanged for money or drugs, or a history of non-prescription injection drug use. 

• Anyone with a history of HIV infection or taking medication for HIV infection will be permanently excluded from blood donation.

• Individuals taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) for HIV infection need to defer from donation for 3 months after the most recent dose.

• Persons administered injectable PrEp are deferred for 2 years following the most recent injection.

Blood donation in context

To better appreciate the discriminatory nature of blood donations concerning MSM, it’s important to take a look back. The authors of an analytic essay published in the American Journal of Public Health explained that the FDA officially placed a lifelong ban on blood product donations from MSM in 1985 during the dawn of the AIDS epidemic.^[] At the time, this restriction was accepted by the medical community because HIV had not been fully elucidated, no treatments existed, and diagnostics were plagued by high false-negative rates (low sensitivity).

“The 3-decade span between the 1985 MSM ban and the 2015 MSM 1-year deferral policy,” the authors wrote, “was partly the result of the morbidity and mortality related to transfusion-associated HIV; importantly, however, it also arose from homophobic public perceptions of lesbian, gay, bisexual, transgender, and queer people that led to an incoherent approach to blood donor qualification policies.”

Over time, the authors say, the perspective has changed: 

“In developing equitable screening practices,” they wrote, “we must remember to continually assess standing policies and be willing to change them in light of new information.”

Damaging homophobia

In a piece published in The Atlantic, a Johns Hopkins University pathologist expressed the point of view that homophobia surrounding the donation of blood products by MSM is personally damaging to donors.^[]

“Donors' feelings matter, too, and the FDA’s policies toward gay and bisexual men who wish to give blood have been unfair for many years,” he said. “While officials speak in the supposedly objective language of risk and safety, their selective deployment of concern suggests a deeper homophobia.”

US Health and Human Services recently announced its support of changes to blood-donation policies.

“I commend [the] FDA for proposing a shift to a gender-inclusive, individual risk based assessment for blood donations,” tweeted Admiral Rachel L. Levine, MD, Assistant Secretary for Health.^[] “This positive change treats everyone the same regardless of gender and sexual orientation. Once finalized, this policy will help ensure a steady & safe supply of blood to save lives by asking everyone the same risk-based questions. HHS is committed to advancing equity & using evidence in making decisions to protect the health of our nation,” she added.