This week, the return of the International AIDS Conference to the United States is bringing a renewed focus on the HIV epidemic and the rights of populations that have been most impacted by HIV and AIDS. Policies upholding unfair prejudice against these populations, such as the continued lifetime ban on blood donation by men who have sex with men (MSM), encourage discriminatory attitudes without adding any benefit to public health. HIV advocates should continue to be concerned about U.S. blood donation standards, precisely because they shift attention from effective interventions against HIV, and reinforce outdated and inaccurate stereotypes that are harmful to public policy.
There is a stark contrast between the lifetime deferral for potential MSM donors and policies addressing the many non-MSM donors who are also considered to be high risk. The deferral periods for potential donors who have engaged in high-risk heterosexual sexual conduct are limited to one year. For example, a person who has heterosexual sexual contact with an injection drug user may not donate blood for 12 months.
Since its inception, the lifetime deferral policy for MSM blood donors has been called into question for its roots in anti-gay bias and its lack of scientific basis. Significant criticisms of the donation ban include:
- Developments in blood screening and record keeping technologies since the donation ban was put in place may make the policy unnecessary. Current blood screening tests are so effective that the probability of HIV transmission through blood transfusion is one in 1.5 million. This is a significant decrease from the risk levels in the mid 1990s: one in 450,000–600,000 donations.
- The blood donor questionnaire used to exclude MSM focuses inappropriately on the identity and type of partners a potential donor has, rather than on the actual sources of risk from sexual contact. It uses imprecise questions about sexual practices, and does not ask about use of barrier contraceptives or the particular sexual contact they participated in. This is despite the fact that risk of transmitting HIV varies widely based on the type of sex people are having, and use of condoms clearly reduces these risk figures significantly.
- The ban excludes a large donor base while exacerbating the nation’s blood shortage. Illustrating how significant the exclusion of MSM donors is for the blood supply, the Williams Institute estimates that lifting the donation ban could increase the blood supply by more than enough to keep the blood supply out of critical shortage. That increase in donations would amount to 219,000 pints of blood, which could save over 650,000 lives annually.
While the U.S. Department of Health and Human Services (HHS) recently proposed a pilot study designed to explore alternative donation deferment policies for MSM, which is a step in the direction of evidence-based donor screening practices, it is not enough to reduce the harmful, homophobic message that the current donation policy sends. For the study, HHS proposes alternative donor acceptance criteria: MSM who have had a one or five year period of abstinence from sex with other men. While this may help in assessing HIV prevalence among these subsets of the MSM population, retaining the lifetime ban holding gay, bisexual, and other potential MSM donors to a different standard than other potentially high-risk individuals is both outdated and unfairly discriminatory. Additionally, the alternatives proposed by the study do not encourage development of more precise behavioral screening questions that get at the true sources of donor risk.
It is unquestionable that the task of balancing the safety and adequacy of the nation’s blood supply is an important one. The discriminatory policy of excluding potential MSM donors does not serve either of these goals. Instead, the MSM blood donation ban promotes homophobic attitudes and inaccurate assumptions about gay and bisexual men that drive the HIV epidemic and prevent rational evidence-based health policy. Under any framing of what is at issue in the lifetime blood donation deferral for MSM, the policy fails to fulfill its role. Maintaining a safe supply of donated blood will require refocusing on developing donor deferral standards that accurately measure risk equally among all potential donors, and dropping a donation ban that is decades behind scientific evidence.