Opening up blood donations to sexually active gay men could save millions

Advertisements for the latest “Saw” movie — “Jigsaw,” set to hit theaters tomorrow — take aim at rules imposed by the Federal Drug Administration (FDA) that ban most gay and bisexual men from donating blood. The ad campaign, titled “All Types Welcome,” encourages individuals to donate blood leading up to the film release and features social media influencers with large LGBT fan bases dressed as eccentric nurses.

The advertisements are undeniably a promotional stunt, but they still have a point.

In the early 1980s, our country was facing an AIDS epidemic. Not much was known yet about the emergent virus other than it was associated with male-to-male sexual contact and could be transmitted by blood. The mysterious infectious agent was sometimes referred to as the “gay plague.” In an effort to protect the nation’s blood supply, the FDA issued its first blood donor deferral policy in 1983. The ban prohibited men who have sex with men (MSM) from donating blood at all if they had a single sexual encounter with another man any time since 1977.

In the years since 1983, we have learned much more about HIV and AIDS. Major technological advances have improved testing, prevention and treatment of the virus. Biochemical tests to detect the presence of HIV antibodies combined with nucleic acid testing have reduced the risk of HIV transmission by donor blood transfusion from about one in 2,500 to roughly one in every 1.5 million.

In 2012, the FDA approved pre-exposure prophylaxis (PrEP) for individuals at high risk of contracting HIV. The Centers for Disease Control and Prevention advises that when taken daily, PrEP alone can lower an individual’s risk of infection by up to 90 percent. When supplemented with condom usage during sex, the risk is even lower. While there is still no cure for HIV or AIDS, antiretroviral therapy treatment is effective in reducing the amount of virus in the body, helping to prevent the onset of illness and transmission to others through sex.

Following in the footsteps of other developed nations, in December 2015 the FDA revised its decades-old policy, placing MSM on a “deferral” period that prevents such donors from giving blood for a full 12 months after their last sexual encounter with another man. While the revised policy allows some gay and bisexual men to donate blood under the 12-month deferral, many more are not eligible simply because they are sexually active with other men. Many gay rights advocacy groups are dissatisfied with the piecemeal progression of amending an outdated policy. The 12-month deferral is undoubtedly a stride in the right direction, but it is not enough.

The FDA cites the high prevalence of HIV in the MSM population compared to the general population as support for the deferral policy — and it’s true: HIV is identified more commonly in MSM than in any other demographic. However, modern technology has effectively minimized the risk of transmission. By shelving donated blood for just nine days during the “window” of infection, nucleic acid testing can determine with outstanding accuracy whether blood is infected. Additionally, transfusion recipients can receive PrEP to further reduce the likelihood of virus transmission. The current policy is not only stigmatizing and discriminatory, but today it is an unnecessary measure to safeguard our nation’s blood supply.

Our country desperately needs more blood donations. In the U.S., someone requires a blood transfusion about every two seconds. According to the American Red Cross, we are facing a constant shortage of blood, but in the wake of an emergency like the Las Vegas massacre or a natural disaster such as Hurricane Harvey, blood donations are especially critical. Researchers at the University of California at Los Angeles estimated that lifting the 12-month ban on MSM blood donors could increase the total annual supply of donated blood in the U.S. by 2 to 4 percent, and could help save the lives of more than a million people.

Rather than uphold a poor policy based on residual prejudice from decades past, the FDA should reform its guidelines and eliminate the ban on MSM blood donors.

All types should be welcome.

Rachel Laufer (rlaufer@som.umaryland.edu) is a graduate student in public health at the University of Maryland School of Medicine.

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