Tainted blood: Rooting blood donation policies for queer men in science rather than stigma

Every so often, the American Red Cross truck rolls into the horseshoe. Every so often, student broadcast shoots out an email to let us know the truck is there. Every so often, the MUSC colleges compete for some incentive to see who can rack up the most donations. And, every so often, I am reminded that my blood is tainted.

The College of Graduate Studies recently published an article titled “Something we all can do to help” in reference to blood donation during the pandemic. Blood donation is a noble and worthy cause in which anyone who is willing and able ought to participate.

Blood donation, however, is not something we all can do to help. Today, under the Food and Drug Administration’s (FDA’s) ‘donor deferral’ policy, I, an openly queer man, cannot donate blood. Current FDA policy states that if I wish to make a lifesaving donation, I must not engage in sex with another man for at least three months.

"With a stark lack of scientific evidence supporting such a ban, queer men like myself are led to believe that, at worst, the FDA perceives our blood as tainted, and at best, an unacceptable risk to public health. "

-- Daniel McCalley

Most adults have sex more frequently than once every three months. Queer men, myself included, are no different. In reality, I am not ‘deferred’ from blood donation, I am outright banned. With a stark lack of scientific evidence supporting such a ban, queer men like myself are led to believe that, at worst, the FDA perceives our blood as tainted, and at best, an unacceptable risk to public health.

The aforementioned risk, and indeed, the spirit of banning queer men from blood donation, is rooted in the early panic of the HIV/AIDS crisis in the 1980s. In October 1980, the first cases of diagnosed HIV were identified exclusively in homosexual men in Los Angeles. By early 1981, cases emerged in gay men across the country, from New York to San Francisco. So many of these early cases were identified strictly in gay men that in the early 1980s, what we now know as HIV/AIDS was dubbed gay cancer by the masses and Gay-Related Immunodeficiency Disease (GRID) by the research community.

At the time, there was no rush or societal pressure to fully understand, treat, or even address a disease limited mostly to gay men (looking at you, Reagan et al.). That is, until 1983, when evidence began to emerge demonstrating that HIV may be transmitted via blood transfusion from an individual with HIV (at the time, called GRID) and hemophiliacs requiring blood transfusion. Heated debate surrounding how HIV was contracted raged amongst public health agencies, blood donation agencies, gay activists, hemophilia activists, and the research community. Final consensus was reached in 1985 when HIV was identified as a blood-borne pathogen most commonly affecting men who have sex with men. The solution then, was to implement a lifetime blood donation ban for any man who had ever had sex with another man.

Not long after, however, the 1^st generation of HIV testing was developed. Despite limited technological resources at the time, the test boasted an impressive 99% sensitivity (indicating only a 1% chance of a false negative result) and the ability to detect HIV within several weeks post-exposure.

Even in 1985, HIV testing was highly effective on a scale of weeks, yet in 2021, queer men are ‘deferred’ from blood donation on a scale of months.

Fast forward to today. Five iterations of HIV tests have incrementally improved our ability to rapidly detect HIV. Current testing is 100% sensitive after nine days of exposure to HIV. In large-scale clinical trials, every single HIV positive person who was tested was correctly identified, thereby rendering a false negative result a statistical impossibility. Despite these advances, FDA policy regarding donation deferral has changed only twice – once in 2015, from a lifetime ban to a one-year ban, and once in 2020, from a one-year ban to a three-month ban. This second change was largely intended to increase blood donations during the pandemic.

So, we have nearly perfect detection rates within nine days of exposure, yet the FDA maintains a required abstinence period of three months prior to blood donation.

By this point you may be asking yourself: “Well, don’t they test all of the donated blood samples before transfusing them into patients anyway?” The answer, of course, is yes. The American Red Cross for instance, performs a panel of nine blood-borne pathogen screenings for each unit of donated blood. With these safeguards in place, the risk of contracting HIV from a blood transfusion in the United States, conservatively, is less than one in two million (0.00005%). To further mitigate this risk, many blood donation centers or hospitals receiving blood donations will perform a second pathogen screening to confirm the previous results. Further still, within the United States, approximately 81% of those living with HIV know their status, indicating that substantial self-selection occurs before donating blood.

Despite this knowledge, the FDA insists on deferring blood donations from queer individuals. Often, the foundation of the ban originates from a simple argument – most of the world applies similar bans or ‘deferral periods’ (which, in reality, are also bans).

The scaffolding of this argument is quickly eroding. Two developed nations, Italy and Spain, have rigorously studied the impact of removing donation deferral policies for queer men. In 2001, both nations transitioned away from deferral-based policies to individual behavior-based policies. Under this system, every individual, regardless of sexual orientation, meets with a physician to determine the relative risk for HIV based on recent sexual behaviors, condom usage, usage of preventative HIV medication, etc. From 2001-2011, this change in policy did not yield any increase in HIV in the national blood supplies, providing scientific evidence that alternative strategies are both safe and effective. These studies changed the global landscape of blood donation policy for queer men influencing many nations to adopt similar deferral-free policies within the last decade. Today, Argentina, Bolivia, Hungary, Brazil, Chile, Mexico, Peru, South Africa and France have all removed deferral periods or bans for queer men. The United States, however, continues to lag behind.

"Even in 1985, HIV testing was highly effective on a scale of weeks, yet in 2021, queer men are ‘deferred’ from blood donation on a scale of months."

-- Daniel McCalley

Considering the above examples, it is increasingly difficult to see the scientific motivation behind the existing blood donation ban for queer men in the United States. The evidence is clear: the FDA’s blood donation policy is sustained by stigma rather than science.

Today, the United States operates on a severe blood deficit with 60% of blood donation centers only having enough blood on hand to last 0-2 days. Queer men, representing roughly 3-7% of the U.S. population, are an increasingly latent resource that can serve to close this gap.

Each day that there are continued shortages of blood and a subsequent loss of life, queer men are left waiting in the wings. Despite robust scientific evidence, despite remarkable advancements in HIV prevention, and despite perfection in available testing methods, our blood remains tainted.

In perhaps the most gut-punching implementation of this policy, the FDA refused to budge its blood donation policy after the Pulse Nightclub shooting in 2016. The shooting occurred within a popular gay, Orlando nightclub, leaving 49 dead and 53 injured – at the time, the largest act of domestic terrorism since 9/11 and the deadliest act of violence directed towards the LGBTQIA+ community. As Orlandoans rushed to donate blood for the victims of the shooting, the very community whose blood was spilled was unable to help save lives and was turned away at donation centers.

The FDA’s extraordinary hesitance in changing blood donation policy for queer men is unmerited, scientifically unsupported, and likely homophobic. The pandemic has thrust scientists’ role in policy making into the spotlight and we need to strike while the hammer is hot – it’s time we use our voices to advocate for a change. I’d like to donate blood someday.