By Leo Rennie (Senior Legislative and Federal Affairs Officer, APA Public Interest Government Relations Office)
Understanding the Controversy
After the horrific shooting on June 12, 2016 at Pulse, a popular gay bar in Orlando, Florida, many of the victims were in extreme need of blood transfusions. Driven by empathy and solidarity with the victims, gay and bisexual men rushed to area hospitals and blood donation centers to help, along with scores of their Orlando neighbors. Sadly, hundreds identifying as men who have sex with men (MSM) were turned away because current FDA regulations prohibit gay and bisexual men from donating blood unless they abstain from sex with other men for a full year before donating blood.
HIV risk depends on several factors including condom use, number of sex partners and type of sexual activity, with unprotected anal sex being the most risky. While gay men and bisexual men make up more than half of the number of persons living with HIV/AIDS in Orlando, it is individual behavior, not sexual orientation, that puts someone at risk of acquiring or transmitting HIV.
The FDA 12-month MSM deferral policy prevents healthy gay and bisexual men from donating blood solely based on their sexual orientation rather than actual risk to the blood supply. The tragic Orlando shootings have brought attention to an outdated, discriminatory and stigmatizing policy and sparked renewed calls for the FDA to end it once and for all.
What is the FDA MSM deferral policy?
According to the FDA Blood Products Advisory Committee recommendations, blood centers must follow guidelines that inherently discriminate against and stigmatize gay and bisexual men. While the guidelines prior to 2015 included a lifetime ban on all donations from MSM, the 2015 guidelines are not much better. They require that blood donors must not be a man who has had sex with a man for the past 12 months, or a woman who has had sex with an MSM in the past 12 months.
What’s Wrong with Current FDA Regulations on Blood Donations?
Beyond being discriminatory and stigmatizing towards gay and bisexual men, they perpetuate stereotypes that HIV is a “gay disease” and that gay and bisexual men are the primary carriers of communicable diseases. This type of stigma and discrimination has no scientific basis and is particularly damaging to the psyche of gay and bisexual men.
The policy is also obsolete. The FDA implemented the MSM deferral policy in the early days of the HIV epidemic before blood donations could be screened for HIV. HIV tests weren’t developed before 1985, putting those receiving blood transfusions at risk of HIV infection. However, modern HIV and other sexually transmitted infection testing methods are incredibly rapid.
Compared with older testing methods, recent testing methods can detect positive results within days of exposure, or at most, a few weeks. Today, the nation’s blood supply is incredibly safe. The risk of HIV infection via blood transfusion is low. As of December 2015, the rate of HIV infection via blood transmission was miniscule at one out of 1.47 million donation cases.
What Can Policymakers Do?
We know that the current FDA deferral policy singles out gay and bisexual men based on criteria unlikely to put those receiving blood transfusions at risk of HIV infection. The FDA should change its 2015 blood donation guidelines to end the 12-month deferral policy for gay and bisexual men once and for all, replacing it with one based on assessment of individual risk behaviors.
One day after the shooting, Rep. Mike Quigley (D-IL), Vice President of the Congressional LGBT Equality Caucus, led a bipartisan group of more than 100 members of the House of Representatives in calling on the FDA to end its discriminatory blood ban. Senators Tammy Baldwin (D-MN) and Elizabeth Warren (D-MA) led a similar charge in their chamber. Lawmakers stopped short of taking legislative action, but they strongly urged the FDA commissioner to revise the 12-month MSM deferral policy to more closely align with current science and blood screening technologies.
FDA should promptly report back to congressional oversight committees and, in coordination with the Department of Health and Human Services Secretary’s Office, engage public health and LGBT stakeholders in devising a policy that may defer high-risk gay and bisexual men, while permitting low-risk gay and bisexual men to donate blood.
We urge federal agency heads and Members of Congress to consider the impact of stigmatizing and discriminatory laws and health policies on the LGBT community, and to take steps to correct them. For example, lawmakers can support the Equality Act of 2016, a bill to prohibit discrimination based on sex, sexual orientation and gender identity. APA supports policies that decrease stigmatization and marginalization of LGBT individuals. To learn more about APA’s advocacy efforts on this topic and others, please visit the Public Interest Government Relations Office website.