Earlier this week, the White House, for the first time, placed pressure on the Food and Drug Administration to lift its decades-long blood ban that prevents queer men from being eligible blood donors.
“The legacy of bans on blood donation continues to be painful, especially for LGBTQI-plus communities,” a White House official said to ABC News. “The president is committed to ensuring that this policy is based on science, not fiction or stigma.”
The statement came on the heels of the American Red Cross declaring that the United States is experiencing its first-ever national blood crisis.
“In recent weeks, the Red Cross had less than a one-day supply of critical blood types and has had to limit blood product distributions to hospitals,” the organization said of the emergency. “At times, as much as one-quarter of hospital-blood needs are not being met.”
As supplies at hospitals and blood banks become dangerously low, many are asking themselves what is the so-called “gay ban” and why does it exist in the first place? And perhaps more importantly, how will lifting the ban impact the current nationwide blood shortage?
The answers are both complicated and simple.
Remnants of the AIDS Crisis
Currently, the FDA’s policy states that queer men must abstain from sex with men for at least three months before they’re allowed to donate either blood or potentially life-saving convalescent plasma for COVID research — even if they’ve tested negative for HIV, practice safe sex and are in a monogamous relationship.
The FDA had originally placed a lifetime ban on blood donations for men who have sex with men — that was in 1983, two years after the first AIDS patient was diagnosed.
That ban was in place until 2015, when it was then reduced to a 12-month celibacy period. Later, in 2020, it was reduced again to a three-month period as an attempt to counter blood shortages early in the COVID-19 pandemic.
The FDA restriction is one example of a number of policies and laws that went into effect in the early 1980s, when very little was known about the virus that causes AIDS. At the time, there was no effective HIV treatment (those didn’t arrive until the advent of antiretroviral therapies in 1996) nor any reliable way of screening HIV in the blood.
One thing was clear though: Queer men were disproportionately affected by HIV and AIDS. In fact, AIDS was the leading cause of death among men ages 25 to 44 in 1992. This fueled even more fear and stigma among the public, leading legislators to enact draconian laws and policies criminalizing those living with HIV but, more specifically, queer men. Many of those laws still exist today.
Now, thanks to advanced treatment, HIV is considered a chronic, manageable condition no different than diabetes.
That's largely thanks to the global consensus that Undetectable Equals Untransmittable (U=U), a belief health agencies like the Centers for Disease Control and Prevention and the World Health Organization have endorsed: that when a person living with HIV is on treatment and their viral load (the volume of virus found in the body) is suppressed or undetectable, it is impossible for them to transmit the virus to others.
Still, despite this knowledge, the ban persists.
More lives would be saved
All blood centers in the U.S., including the major three — the American Red Cross, OneBlood and Vitalant — have strict guidelines from the FDA they must follow in order to operate effectively and ensure they’re providing safe blood to the public.
“We’re regulated by the FDA,” Susan Forbes, senior vice president of corporate communications at OneBlood, tells Yahoo Life, adding that there are often “planned and unplanned inspections by the FDA” to ensure their centers are operating efficiently and adhering to policies.
As Forbes explains, once blood is drawn it gets sent to their biologics facility where it is processed. At the same time, testing takes place to ensure the blood is safe.
The miraculous part is that each donation has the potential of being distributed to multiple recipients.
“One blood donation can save up to three lives because your red blood cells can go to one patient, your platelets to another, your plasma to another," she says, adding that blood is tested for HIV and other sexually transmitted diseases during this time. “Obviously, donations that don't pass testing for whatever reason are discarded.”
“Less than 10 percent of the population is donating blood,” notes Forbes, explaining that if the FDA makes a change to the policy, it could potentially allow more people the opportunity to donate and help save lives. "Anytime more people are able to be blood donors, it’s a good thing.”
Christian Morris, a researcher at the Whitman-Walker Institute in Washington, D.C., explains that increasing the number of blood donors is surely possible, but it can’t be done without the approval of the FDA, on which activists like himself, are sounding the alarm.
“The FDA is the policymaker when it comes to blood donations, so without a change from their recommendations it'd be impossible for the blood donation centers to adjust,” Morris explains to Yahoo Life. Still, he points out, “If the ban was to be lifted, and gay and bisexual men had the ability to donate blood [without restriction], there's no evidence to suggest that we would end the blood shortage crisis in the United States by any means,”
But Morris is quick to note that even though gay and bisexual men “are still a minority of the population,” the community is highly “invested in being able to do our part” to combat blood supply shortage.
As the Gay & Lesbian Alliance Against Defamation (GLAAD) points out, if the deferral period were lifted, "an additional 360,000 men would likely donate, which could save the lives of more than a million people."
What's being done now?
The FDA is currently funding a study uniting the American Red Cross, Vitalant and OneBlood with several LGBTQ organizations nationwide to provide clearer data, which may help the agency decide on how to update its policy.
The ADVANCE study (Assessing Donor Variability And New Concepts in Eligibility), is pulling together over 2,000 male participants across the country — all of whom have had sex with men in the last three months — to fill out an updated donor history questionnaire before donating blood. That questionnaire is based on individual risk assessment rather than focusing on their last sexual encounters.
From there, the organizations hope to provide better data to the FDA that shows blood centers can still provide safe blood without using the deferral system.
“What the study is trying to provide is evidence that a risk assessment survey is an accurate screening tool for HIV risk, one that can capture an individual's susceptibility to HIV rather than broad-based demographic assumptions,” explains Morris, whose organization is playing a major role in recruiting participants for the study.
Brian Custer, vice president of research and scientific program at Vitalant, has been involved in all points of data collection. He argues that given the advances science has made in blood testing, any policy change — even if it means simply shortening the deferral period — would be a step forward.
“The fact that we test both for direct presence of the HIV virus and other viruses — through RNA detection, or DNA detection — and separately, we also test for the human immune response and antibodies to infection, to me, really does mean there's no reason why we cannot have a policy that might be based on some shorter window,” he explains, adding that, of course, “it’s not the final destination.”
Ultimately, Custer says he’d like to see an “individual risk-based approach” to decide someone’s eligibility for blood donation. “I think the FDA, conceptually, is committed to that kind of process,” he adds.
Currently, the ADVANCE study is about halfway to its participant goal.
“It's groundbreaking because it’s the first time that we’ve had a study like this be done,” explains Forbes. “It's important that gay and bisexual men enroll in the study. Their participation is crucial in determining if additional changes can be made to this policy.”
“We're in eight different cities and easily accessible,” Forbes adds of the local organizations that are enrolled in the study (see more details here). “It doesn't take much of their time to participate in it. But they are playing a huge role in helping be able to provide additional data back to the FDA about this policy, to see if additional changes can be made. We need more people to participate and be part of this groundbreaking moment.”