Last month, the United Kingdom lifted its long-standing ban on accepting blood donations from gay men. Instead, health officials there implemented a new policy that allows men to become blood donors as long as they haven’t had sex with another man in the previous year.
With this decision, the U.K. joined France, Italy, Japan and eight other developed countries in allowing gay and bisexual men to contribute to the nation’s blood supply. Many of those countries require sexually active gay men to wait a year before giving blood, while others have deferral periods of six months or five years. Some countries have regulations that focus on potential donors’ risky sexual behavior rather than their sexual orientation.
In the United States, however, men who have sex with men are still subject to a lifetime ban on donating blood. The U.S. Food and Drug Administration implemented the ban in 1983 after an estimated 10,000 people with the bleeding disorder hemophilia became infected with HIV through transfusions of HIV-tainted blood.
That policy has become increasingly controversial in recent years. Some experts in the field of blood safety — as well as gay rights activists — say that it’s discriminatory and that scientific advances in testing for HIV render it obsolete. Many would like to see the policy changed to resemble the U.K.'s one-year deferral policy or have the ban lifted altogether.
On the other side of the debate are those who say that men who have sex with men still face a heightened risk of contracting HIV and that even a small increased threat to the blood supply isn’t justifiable.
The issue has divided major U.S. health organizations. Last year, the FDA denied a request to overturn the ban, but the American Red Cross and others support moving to a one-year deferral.
Read on for two views.
Allowing gay men to donate blood would increase the risk to recipients, and that’s unfair.
Dr. Jay P. Brooks is the director of blood banking and transfusion medicine at University Hospital in San Antonio and a professor of pathology at the University of Texas Health Science Center.
The science in the U.S. shows that changing the lifetime deferral on men who have sex with men will increase the risk of HIV-infected blood entering the blood supply.
The FDA estimates that HIV prevalence is 60 times higher among men who have sex with men than it is in the general public, and 800 times higher than it is in first-time blood donors, who are typically healthier than the general public. By introducing a population with such a heightened risk for HIV into the donor pool, it becomes more likely that someone will donate who is HIV-positive and doesn’t realize it.
In that case, under a one-year deferral, blood banks would detect the HIV infection during their testing process. That blood should then be quarantined and incinerated. But an administrative error can occur, causing blood to be accidentally released into the blood supply instead of going to the incinerator. The more likely donations are to be infected, the higher the chances of that kind of mistake become.
If the ban is lifted altogether, we run into the problem that our current lab test can detect an HIV infection only if it’s been at least 10 days since exposure. That means that someone who just became infected with HIV could come in to donate blood and test negative. Again, that’s more of a possibility with a higher-risk population.
Some hemophilia associations and other groups that represent people who get regular blood transfusions have been opposed to changing the current policy. With that in mind, I believe that the right of transfusion recipients to receive blood that is as safe as reasonably possible supersedes any asserted right of other groups to donate blood.
Also, with a one-year deferral, the number of new blood donations from gay men would likely be very minimal — very few people are going to abstain from sex for a year to donate blood.
If the current policy is changed or eliminated, we just don’t know what the increased risk to the blood supply will be. We could have one additional HIV-positive unit released every 10 years, every 20 years — or one per year. That’s kind of the worst possible scenario, but from my perspective, where blood safety is the primary concern, that’s the model I’m going to look at.
I understand the argument for reconsidering the policy regarding men who have sex with men because gay men feel stigmatized by it. But if the policy is changed to relieve the stigma, you have a risk that has been transferred to a completely different group — the recipients — and I think that is an unfair situation.
Advances in science and technology make a lifetime ban on blood donations from men who have sex with men unnecessary.
Dr. James P. AuBuchon is the president of the AABB (formerly known as the American Assn. of Blood Banks), chief executive of the Puget Sound Blood Center and a professor of laboratory medicine at the University of Washington in Seattle.
Maintaining a safe and available blood supply continues to be our highest priority, but a lifetime ban on donating blood for men who have had sex with men doesn’t decrease the risk of HIV entering the blood supply. We could safely use a much shorter period of deferral today.
The current ban applies to any man who has had sex with another man since 1977. There was a time when that made sense: The first test that was available for HIV wasn’t as accurate as the tests we have today. It also focused on detecting antibodies in the bloodstream, which don’t develop for three to six months.
Now our HIV test can detect infection earlier and is much more sensitive and accurate. We test for the presence of the viral genetic material and can detect HIV infection within two weeks of a person being exposed to the virus. We also have highly refined questions that we ask donors about their medical history in order to identify those who may have placed themselves in harm’s way.
Given the sensitivity of the tests we now have available, there is no detectable increased risk of HIV entering the blood supply by allowing gay and bisexual men to donate. Therefore, our proposal is to implement a one-year deferral for men who have had sex with men. This essentially brings the regulation in line with deferrals of other high-risk donors, including men who have had sex with a prostitute.
One concern that’s been raised about relaxing the current policy is that it would lead to more units of blood being found positive when we test them for HIV — units that would then need to be disposed of so that they aren’t distributed for transfusion. The worry is that some units wouldn’t be destroyed and would be entered into the blood supply in error.
But units of blood are typically destroyed quickly if they’re identified as unsuitable, and blood collectors have a robust protocols — including computer systems approved by the FDA — to prevent erroneous releases. In fact, so many things would have to go wrong for infected blood to be released in error that most blood bankers are not concerned about it.
This effort to lift the lifetime ban is not a matter of increasing the number of blood donors. Rather, it’s a matter of trying to apply known and accepted evidence in order to change a policy that made sense 28 years ago but doesn’t make sense today.