The American Red Cross issued an urgent appeal for blood donations in January, warning that the U.S. blood supply is dangerously low because of a sharp drop in donations during the COVID-19 pandemic.
Even so, gay and bisexual men, clinically referred to as “men who have sex with men” or MSM, are still being told that their blood is too “dangerous” to donate. MSM must be celibate for three months to give blood because of a Food and Drug Administration (FDA) policy dating back 40 years to the onset of the AIDS crisis.
The ban does harm by perpetuating the stigma that HIV/AIDS is a “gay disease,” said Jason Cianciotto, GMHC’s vice president of communications and policy. “It suggests there is something inherently wrong and ‘dirty’ about gay and bisexual men that makes them diseased and dangerous to others.”
Gay and bisexual men are the only group singled out for the three-month deferral because of who they are. Otherwise, the FDA defers people based on behaviors—doing commercial sex work or injecting drugs—that increase the risk of HIV infection. People living with HIV also can’t donate.
The FDA’s blanket deferral includes many HIV-negative people with a low-to-zero risk of HIV infection, and it inaccurately suggests all gay and bisexual men are living with HIV.
For instance, although Cianciotto and his husband are not in an open relationship, the three-month celibacy period still applies. “I am at very low risk for exposure to HIV, based on my behavior. Yet, I am screened out simply because of who I am,” he said.
Gay and bisexual men who take PrEP, an HIV-prevention medication, are also very low risk, yet they too are deferred from donating blood.
Despite enormous advances in scientific knowledge about HIV transmission and the advent of highly accurate blood screening tests, the FDA has not changed its policy targeting gay and bisexual men.
When HIV and AIDS was incorrectly labeled a “gay disease” in the early 1980s, the FDA imposed a lifetime blood donation ban on any man who’d had sex with another man since 1977, along with sex workers, intravenous drug users and people living with HIV. The FDA relaxed the ban to a one-year deferral period in 2015, and then in April 2020, shortened that to three months of celibacy in response to blood shortages caused by the COVID-19 pandemic.
However, all blood is screened by both an antigen test for HIV antibodies and a highly sensitive nucleic acid test that can detect the actual virus within seven to 10 days of exposure. With these tests, the FDA places the per-unit risk of HIV infection from a blood transfusion at about 1 in 1.47 million.
Its rationale for continuing to use a donor history questionnaire for screening is to address the seven-to-10-day post-exposure period, where the tests might not detect HIV in a donor’s blood. This window is significantly less than the three months of celibacy required by the FDA.
For decades, GMHC has been fighting the discriminatory ban because it falsely stigmatizes gay and bisexual men as carriers of a “gay disease.” Along with the American Red Cross and other U.S. blood centers, the American Medical Association, and other HIV/AIDS and LGBTQ organizations, GMHC has advocated for screening blood based on behavioral HIV risk factors instead of screening out any man who has sex with another man.
GMHC first proposed this policy solution in 2010, releasing a report, “A Drive for Change: Reforming U.S. Blood Donation Policies,” with the law firm Davis, Polk & Wardwell, which laid out ways to effectively assess prospective blood donors for risky behaviors, instead of based on identity.
Asking about high-risk behaviors, like anal sex without a condom or sex with partners of unknown HIV status, Cianciotto said, would better screen donors for potentially HIV-infected blood. In an added benefit, it would educate all prospective blood donors about behaviors that increase HIV risks—GMHC’s mission for 40 years.
Other countries, like Italy and Spain, already use individual risk assessments for prospective blood donors. Prompted by the COVID-19 epidemic, the FDA in December 2020 signed off on a pilot study for three major blood centers, the American Red Cross, Vitalant and OneBlood, to do just that.
The ADVANCE Study is recruiting 2,000 gay and bisexual men in eight cities to supply a blood sample and answer behavioral questions about HIV risk factors. The aim is to see whether revising the FDA-mandated donor history questionnaire to identify individual risk factors would screen out any HIV-infected blood as effectively as the three-month deferral.
The results are slated to be submitted to the FDA by the end of 2022 for it to determine next steps—but in January the blood centers issued a renewed call for volunteers. They have not yet been able to recruit the requisite 2000 gay and bisexual men, perhaps because the study itself, by focusing solely on this population, perpetuates the stigma of “gay blood.”
Cianciotto still remembers the first time he tried to give blood in the early 1990s at a high school blood drive. Growing up in a conservative evangelical Christian family, he was not yet out at age 17. “I didn’t know what the process would be,” he recalled. “Then they asked the question about sex with another man since 1977—like that was something bad or dangerous.”
“At a time when I was still figuring out my identity, the government was affirming harmful things I had been raised to believe about myself: If you are gay, you will die alone from AIDS,” he said.
GMHC hasn’t been advocating all these years to ending the discriminatory deferral period just so gay and bisexual men can give blood, Cianciotto said. “It’s about that next kid who goes to participate in a blood drive at their high school or college. What is their experience going to be? How will that frame who they are?”
Thirty years after Cianciotto’s troubling experience, a gay male teen trying to do their civic duty and give blood will still be asked if they’ve had sex with a man—and turned away if the answer is yes.
“People give blood because they want to help,” he said. “Will they leave crestfallen, feeling there is something inherently wrong and diseased about themselves—or will they be able to carry through and help others?”
Photo: Blood Mirror is a sculpture and collaborative project by Jordan Eagles, created with 59 blood donations from gay, bisexual, and transgender men. Installation view: Trinity Wall Street, New York, NY (2015)