Why are sexually active gay men not allowed to donate blood?
Originally written and published by Sarah Teague for The Standard on Feb. 19, 2018. Click here to be directed to the original posting. Featured photo by Bradley Balsters: A Missouri State student donates blood at the CBCO blood drive, located in the Plaster Student Union, Jan. 25, 2018.
When Danny Clover tells you about himself, he won’t share every detail. He won’t put his identities on a pedestal or brag about his attributes.
But he will be honest. Danny will tell you he’s a college student, if you ask. And if the conversation goes deeper, he might share he identifies as cisgender — identifying as the gender assigned to him at birth — and his pronouns are “he, him and his.”
But these are just a few of the hundreds of characteristics that glue together Danny’s individuality. And the identities mentioned above were not what kept Danny from donating blood at a school blood drive two years ago.
Danny holds another identity — he is gay, and sexually active.
Danny, a Missouri State senior studying human resources management, was confident as he spoke about his experience. He sat across the table, natural light splayed across his face, his eyes darting from the stained, fraying carpet of the newsroom to the window and back in focus.
PHOTO: Danny Clover, senior human resources management major, was deferred from donating blood in spring 2015 because of his sexual contact with other men. He has not tried to donate since.
As he spoke, he described his experience walking into a blood donation center’s truck on Missouri State University’s campus. It was early in the spring 2015 semester.
“I have no qualms about donating blood; it does nothing but help people,” Danny said. “I went in and (the blood donation center) had this questionnaire session where they were asking all sorts of things. The question I knew was coming — because I had heard about it — (was about sexual orientation). I said, ‘Yeah, I’m a homosexual man, and yes, I do have sex with other men.’ And that was pretty much like, ‘case closed.’”
Danny said the blood donation center worker was “sweet,” as she explained to him that he could not donate blood per FDA regulations, due to his sexual contact with men within the past year.
The U.S. Food and Drug Administration’s guidance the blood drive worker referenced to Danny started in the early ‘80s, though the guidance has changed over time. The reason Danny — or any man who has had sexual contact with men — cannot donate blood is due to FDA recommendations starting in 1983. This is referred to as “MSM deferral.” These recommendations have been updated along the way, most recently in December 2015.
“The blood ban”
From the early ‘80s to late 2015, men who have had sexual contact with men were deferred from donating blood for life. In 2015, this FDA recommendation was updated; now, a man who has been abstinent from sexual contact with another man for 12 months may donate.
In 1983, blood centers were not able to specifically identify the HIV virus, resulting in “thousands of recipients” infected with HIV before the virus was identified, and the first screening test was not approved until 1985. This is according to background in the FDA’s 2015 “Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products” for blood centers.
This 2015 guidance gives insight to the history of deferral for men who have had sexual contact with men and want to donate. The original deferral guidance was “due to the strong clustering of AIDS illness and the subsequent discovery of high rates of HIV infection in that (MSM) population.”
The above statement from the FDA’s 2015 guidance referenced an article printed in 1985 by the Centers for Disease Control and Prevention, which states: “Interviews with the small number of blood donors found infected with HTLV-III, (a former name for HIV) … have shown that most have a risk factor for HTLV-III infection; homosexual contact was the most common risk factor identified.”
Since 1985, the FDA has leaned on research from the CDC (among other independent researchers) to update blood donation centers on protocol for blood donor eligibility, and it still does today. The 2015 one-year deferral revised recommendations from the FDA to blood establishments includes the section: “Current Risk of HIV Infection Associated with Specific Behaviors.”
This section explains which individuals may be at “high risk” for HIV infection based on certain behaviors researched by the CDC included in its 2012 “HIV Surveillance Report.” The report cautions its readers to be aware not all individuals living with HIV may be represented in the data, as some have not been tested, or were tested at a time when the infection could not be detected.
Chris Pilgrim is the media relations representative for Community Blood Center of the Ozarks. He said CBCO does defer those not eligible for donation per FDA guidelines.
“While testing has greatly improved, it is not 100 percent effective at detecting infectious diseases in donors with very early infection,” Pilgrim said. “The FDA selected the 12-month deferral to provide adequate time for the detection of infected individuals.”
Pilgrim’s quote is a line taken straight from a joint statement published on Dec. 12, 2016, by the American Association of Blood Banks, America’s Blood Centers and the American Red Cross.
Joe Zydlo, external communications manager with the American Red Cross for the Missouri-Illinois Blood Services Region, referred The Standard to the same joint statement that Pilgrim from CBCO quoted in regard to its view on 12-month deferral.
The 2012 HIV Surveillance Report provides data on the number of HIV diagnoses from 2011-2016 and includes data from “selected characteristics” or “transmission categories.” The rate of HIV diagnoses in each category are listed for male-to-male contact, injection drug use, male-to-male contact paired with injection drug use, heterosexual contact and “other,” which “includes hemophilia, blood transfusion, perinatal exposure and risk factor not reported or not identified,” according to the report.
The CDC released a 2016 HIV Surveillance Report, but the one-year deferral guidance was not based on this data, since it was released in December 2015.
Danny heard rumors about sexually active gay men not being able to donate, but he said he wanted to go through the questionnaire process and witness deferral for himself. And since then, he hasn’t attempted to donate blood again.
Alex Durbin, junior psychology major at MSU, donated blood as often as he could. Since the age of 16, he would find a blood center every eight weeks and do what he says is his “civic duty.”
Originally from Lee’s Summit, Alex remembers being deferred in the fall of 2014.
He said that for a while, even after he came out to his friends and family, he continued to give blood because he had no reason not to. But this changed when he turned 17 and became sexually active. Alex said in June 2014 he got a boyfriend.
Just like Danny, Alex knew he was ineligible. But he wanted to witness deferral for himself. So that’s what he did, in September 2014.
“If nothing else, (deferral) is a little bit invalidating,” Alex said. “You get all these questions about going overseas — did you go on vacation to (certain countries) lately. And being gay is not a vacation — like, it’s not a choice. …‘Did you do x,y and z, and by the way, do you like men?’”
The price for clean blood
Dr. Louis Katz is the chief medical officer of America’s Blood Centers. He said while it’s important to be sensitive to donors, there is a lot of blood to wade through every year.
“Before I went to work for ABC in Washington, I spent 30-plus years … as the medical director of a medium to large blood center in the upper Midwest,” Katz said. “And we had to get through 200,000 donors a year.
“So that means you have to be able to do your work with deliberate speed. … So the easy way out has been the way we took since, literally, 1983. …We have to be able to move people through blood centers at a pace that is acceptable to the donors, and that allows us to collect what we need.”
Katz said that at this point, knowing there are some MSM who are not at a high risk versus others who may be, it becomes a question of how blood donation centers can predict risk levels of contracting and spreading HIV for each individual in an efficient way.
“We know very, very well that there are MSM who are at higher risk than others, and there are heterosexuals that are at higher risk than some MSM,” Katz said.
Not only was an efficient “operational reality” needed, Katz said, but the FDA’s guidance must be fulfilled.
“They’re not recommendations,” Katz said. “I mean, they are, but they’re not. They are the law. They come out in ‘guidances,’ and guidances are different than rules and regulations. But it’s the law. Essentially, these are FDA requirements. Whether you’re an ABC center or an American Red Cross Center or a small hospital-based program, you have to follow them. The qualifications for an acceptable blood donor are very much determined by FDA rules and guidances.”
When The Standard reached out to the FDA, FDA press officer Megan McSeveney referred The Standard to a statement on its website detailing whether blood centers must follow this 2015 guidance.
The answer states: “Blood establishments typically revise their existing standard operating procedures regarding donor deferral following issuance of final FDA guidance on the matter. However, establishments may voluntarily elect more stringent donor deferral criteria than those required or recommended by the FDA.”
When pressed for further explanation, McSeveney referred The Standard back to the above statement.
“There is an enormous amount of regulation, and it’s designed — in FDA language — so that the blood component that gets distributed to the hospital is safe, potent and pure,” Katz said.
Katz is quoting directly from the FDA’s Code of Regulations, from Part 606 of Subchapter F.
Katz recounted his memories from the early days of the HIV epidemic of the ‘80s.
“We’re not bad guys — blood bankers and even the FDA,” Katz said. “This is hard, this is really hard. … I remember when HIV entered the blood supply … and that’s what the FDA remembers. And they’re not going to do things to make the blood supply less safe.
“We really thought, ‘We’re the good guys, man. We’re getting these donors in and we’re getting blood and saving lives. And all of the sudden, we’re killing people. But there is a way forward now.”
The risk of contraction
Dr. Stephen Adams, medical director for AIDS Project of the Ozarks, said that while a deferral has been placed on gay, sexually active men for over three decades now, they are not the only population at risk for contracting HIV.
PHOTO: Alex Durbin, junior psychology major, stands outside Glass Hall on Missouri State’s campus. Alex was deferred from donating blood before he came to college for his sexual contact with other men.
“The most common new diagnoses in this clinic (are given) to gay men,” Adams said. “Nationally, the people that are most at-risk (for contracting HIV), are women of color and men of color who have sex with men. The incidence of HIV among gay white males is actually going down, and we think that’s related to treatment as prevention.”
Adams explained though a heterosexual individual may be as active, if not more active, than a gay man, they can still give blood.
“My personal feeling on this is that (the FDA) is singling out a group based on sexual behaviors, but they’re really not paying any attention to the sexual behaviors of non-MSMs,” Adams said. “So if you’re a woman who’s had sex with 14 guys in the last six months, your risk of having HIV is not insignificant, but you can still give blood.”
Both Adams and Katz spoke about a specific example of two monogamous gay men coming into a blood center wanting to donate, but being deferred solely because they are gay, sexually active men.With no individual assessments that provide exceptions to the one-year deferral, these men will not be allowed to donate, though they are HIV-free and monogamous.
“If I’m a gay man in a monogamous relationship and have been for the past 20 years, my risk of getting HIV and giving it to someone else in a blood transfusion is zero,” Adams said. “And to not allow me to give blood is a disservice to the community, as well as it is disrespectful of who I am as a person.”
Katz echoed this frustration.
“So I have a (gay, male) couple in front of me that are mutually monogamous and HIV uninfected,” Katz said. “And they’ve been together for 20 years. Why shouldn’t they be allowed to be a blood donor, right? … So it’s been a very difficult process.”
‘My blood isn’t good enough’
Alex said he never wanted to lie about his sexual behavior to donate blood, like some of his peers have. He said he was most upset by the one-year deferral after the Pulse Nightclub shooting in Orlando on June 12, 2016. Fifty people died, including the shooter.
“It was specifically queer people that were targeted (in the Orlando shooting) and … (sexually active men) in the LGBTQ community couldn’t help (through blood donation),” Alex said. “It was already such a powerless situation, and losing a pint of blood was going to make me feel a little bit better. But I couldn’t do that without lying.
“My mentality after that basically became, ‘If my blood isn’t good enough just because of who I am, it’s not worth breaking the rules and lying to donate.’”
Katz said the 2015 revised guidance has opened the door for a gay men to donate, but he doesn’t see someone sacrificing their sex life to donate one time.
“If you were an MSM, would you quit being sexually active to be a blood donor?” Katz asked.
He answered his own question with a laugh.
“So, is the one-year deferral realistic for a large proportion of MSM? It’s still a permanent deferral, right? And is that fair? A year is better than life, but it’s not an answer to more than a few guys who came through my clinic. They’re friends of mine; these guys are my pals. So you can imagine how many times I’ve had this discussion.”
For more information on blood guidance, MSM deferral, HIV/AIDS resources or LGBTQ resources, check below:
• For more information about the considerations made by the FDA in deciding to implement a one-year deferral, or all other questions regarding the 2015 guidance, see the recommendations at this link: https://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/UCM446580.pdf
• For questions directly for the FDA’s Center for Biologics Evaluation & Research (CBER), call 1-800-835-4709 or 1-240-402-8010 or email ocod@fda.hhs.gov.
• To view a list of FDA blood guidances, visit: https://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/default.htm
• Contact the Community Blood Center of the Ozarks by calling 417-227-5000 or 800-280-5337.
• Contact the American Red Cross Springfield Center at 417-823-4000.
• Contact the AIDS Project of the Ozarks at 417-881-1900 or visit its website at https://apo-ozarks.org/to view resources offered in the community.
• Contact the GLO Center, a local LGBTQ resource center, by calling 417-869-3978 or by walking in at 518 E. Commercial St. in Springfield.
