Why can't men who have sex with men donate blood?

Originally Published: December 15, 2000 - Last Updated / Reviewed On: September 14, 2012
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Dear Alice,

This week Columbia hosted a blood drive. Gay men were not allowed to donate. I was so repulsed by this that I, a female friend, refused to donate just on principle. Is there some reason why gay men are still excluded from blood drives? Are they still so much more likely to be HIV positive than heterosexuals? Is this a policy from a time before blood screening was required? Someone said it was some sort of economic benefit. It seems to me that the amount of blood they would get from including such a huge percentage of the population would make up for the maybe one percent (this is what I'm unsure of) that they had to take, screen, and eliminate. There's such a shortage of blood donated in the U.S. Why are we refusing so much healthy blood?

Thanks,

—Frustrated First-Year

Dear Frustrated First-Year,

The policy that you discovered at the campus blood drive — that men who have had sex with another man since 1977 are banned from donating blood — has existed nationally since 1983. Back in the early eighties, when gay men were among populations affected in high numbers by HIV/AIDS, and a way to screen blood for HIV was not yet available, the decision to bar men who have sex with men (MSM) from donating made sense to many scientists. But times have changed — sort of. In 2000, 2007, 2010, and 2012, panels organized by the U.S. Food and Drug Administration (FDA) met to decide whether to ease the ban on blood donations in light of new information and technology. So far, however, they’ve decided to keep the full ban in place, despite objections from the American Red Cross.

They cited a lack of new evidence assuring that changing the requirements for MSMs would not jeopardize the blood supply. One reason for this concern is the potential for human error in the screening and incineration of infected blood. When blood is screened and infected blood is identified, it is sent to be destroyed. On very rare occasions, errors occur and infected blood is not destroyed, but instead released into the blood supply. This is extremely rare (about one sample in a million), but it can happen.

The Centers for Disease Control and Prevention (CDC) estimates that HIV prevalence among MSM is about  44 times higher among MSM than it is in the general public. Statistically speaking, if more infected blood is introduced into the to-be-screened supply, the likelihood of an error occurring goes up. In other words, the more HIV positive blood in the donor pool, the greater the chance the infected blood won’t be identified, or will be identified, but not destroyed. Proponents of the ban argue that even one case of HIV infection from donated blood is not worth the risk. The FDA panel also stated that this risk is elevated because of the “window period,” when HIV is undetectable in a newly infected person three to six months from exposure.

Since tests are now available that can detect HIV just 20 days after infection (as opposed to previous three to six months), and all blood is screened for HIV, some officials support an easing of the ban and regard the continued use of the 1983 policy as an issue of discrimination. In 2006 the American Red Cross, the AABB (an international blood association), and America's Blood Centers proposed a one-year deferral period following male-to-male sexual contact (which is the same standard used for people who have high-risk sexual behaviors or have used injection drugs) rather than the current “lifetime ban.” This one year deferral policy for MSM is now in place in the U.K. Health organizations point to the numbers of potentially healthy donors who are barred from giving blood as reason to change the current policy and LGBT activists point to the discriminatory nature of the policy. In 2012, the Health and Human Services Department began research to determine other deferral criteria for MSM, such as the one-year deferral program. While such a program would not eliminate ban on MSM blood donation, it would be the first step in deregulating the current lifetime ban.

Your frustration with your blood donation experience is understandable. While protecting the nation's blood supply is critically important, advancing science and a more nuanced understanding of sexual behavior may play a role in changing blood donation eligibility requirements in the future. Advocates recommend contacting the FDA to voice your disagreement with the ban rather than protesting by not donating, as this strategy may be harmful for people in need of blood donations. You can check out the American Red Cross eligibility requirements page for more information about all of the medical issues impacting blood donor eligibility. You may also be interested in the following organizations that are working on the issue:

Gay Men's Health Crisis (GMHC)

American Foundation for AIDS Research (amfAR)

You may decide that working to address this issue by advocating for new eligibility policies with the federal government, would help you feel better about being a donor, if you are still interested next time a blood drive comes to campus.

Alice