GMHC Calls for End to FDA's Ban on Blood Donations By MSM

As advocates fight for a change to the current lifetime ban on blood donations by men who have sex with men, many are disappointed that once again, the Food and Drug Administration has chosen not to replace its outdated and unscientific ban with a behavioral-based rubric. Among those groups is the Gay Men's Health Crisis, which traveled to Washington, DC, on December 3 to ask that the FDA move forward with a policy that screens all donors based on risk, regardless of sexual orientation or gender identity.

"It was surreal, particularly because only a few weeks earlier on November 13, the Health and Human Services Advisory Committee on Blood and Tissue Safety and Availability (ACBTSA) had a robust discussion and voted overwhelmingly in support of this 12-month deferral policy," said GMHC's Public Policy Director Jason Cianciotto. "To go to this meeting and see that debate stifled and the intentional direction from the FDA to prevent a vote from happening makes it as unclear as possible as what the future might hold."

Cianciotto said that while advocates expected that the findings would be presented, and then the FDA would hold a vote and recommend changing the ban to Secretary Sylvia Mathews Burwell, instead, the committee said they did not have enough science to make a recommendation.

"We also heard from a lot of anti-gay 'family' groups, who said that all gay and bisexual men were diseased, and this ban was the only way to prevent the spread of HIV was to prevent them from donating blood forever," said Cianciotto.

What was really needed, he said, was for this 12-month ban to be a precursor to a policy that looked at all donors, regardless of sexual orientation or gender identity, and defer them from donating blood based only on behavior.

"This 12-month deferral still precludes a majority of gay and bisexual men from donating blood. Now, regardless if they have an HIV-negative boyfriend, if they use condoms, PrEP or safe sex, they are still banned for life," said Cianciotto. "Yet a similarly situated heterosexual man with the same behavior is not only allowed but encouraged to donate."

The proposed recommendation, which would require gay and bisexual men to be celibate for 12 months in order to be eligible to donate blood, is based on the findings of four years of research commissioned by the Department of Health and Human Services (HHS), as well as evaluation of similar and successful donor policy already implemented in Australia for 14 years.

"The advisory panel recommended for the first time that the 31-year ban preventing gay and bisexual men from donating blood should be partially ended, placing the nation's policy in line with other countries," wrote 19-year-old advocate Caleb Laieski, who spoke before the panel about the lawsuit he had filed against the U.S. Food and Drug Administration regarding this blood ban. "The suggested action was to place a one-year deferral on gay men from donating blood, opposed to their lifetime ban."

The current U.S. ban prohibited blood donations from any man who had sex with another man (MSM), since 1977, the beginning of the AIDS epidemic in the U.S. But critics, among them top health care officials, said that the ban was outdated, discriminatory and unnecessary, as screening for HIV in blood rendered risks nearly infinitesimal.

As Laieski noted in his speech before the panel, "A recent study by the American Red Cross estimates that lifting the blood ban donation ban could be used to help save the lives of more than 1.8 million people."
In addition, the U.S. policy is way behind the blood donation policy in many other countries, from the UK and Canada to Australia, which allows MSM to donate blood after either a year or five years of abstinence from same-sex encounters.

Although GMHC was amenable to the 12-month deferral for celibate MSM, this policy is not ideal in their eyes. They are asking one similar to the behavior-based policy used in Italy since 2001, which as of 2013 had revealed no relative increase in risk of contamination of the blood supply by gay and bisexual men.

"This isn't something new and cutting edge we're asking for," said Cianciotto. "Anyone who sees common sense is angered by the notion that in order to donate blood, MSM have to be celibate for a year. We will make sure this recommendation that is four years in making moves forward, with a hemovigiliant system, ensuring all people assessed on whether donate is based on risk, not identity."

Countering this argument, the FDA insists that the blood monitoring system in the U.S. is not as technologically forward as people mike think. Blood donations are pooled and then tested for HIV and hepatitis, because the FDA said that testing individual samples is too costly. They fear that with combined testing, blood from those in the 9-10 day window of initial HIV infection might be diluted to the point of not registering as tainted, and might make its way into the blood supply.

GMHC argues that individual testing of blood products is just one more thing to add to the FDA's wish list, with Cianciotto saying, "The community needs to ask the FDA, 'What is the cost of discrimination? How long do we cite costs as a reason from preventing this community from donating, particularly when this stigma is helping to fuel HIV epidemic?"

Health advocates insist that we must stop reacting to HIV like it is the early 1980s, when our country assumed it was a "gay disease." The FDA's blood ban perpetuates a dangerous ignorance about behavior that places people at risk for HIV, regardless of their sexual orientation or gender identity. It also defies research that clearly connects stigma and discrimination to increased risk for HIV among gay and bisexual men.

"While a step in the right direction, even the one-year ban proposal still falls far short of a policy that treats all donors equally based on risk, rather than identity," said GMHC CEO Kelsey Louie. "Until the U.S. joins Italy and the other nations that have implemented a risk-based donation policy, the FDA will continue to poison our blood supply with stigma and discrimination. Is the FDA now going to also require heterosexuals to be abstinent for one year, regardless of assessing their risk for HIV?"