We're experiencing the worst blood shortage in a decade, so why are some members of the LGBTQ+ community still blocked by policy?
Earlier this year, the American Red Cross declared its first national blood crisis as the US blood supply hit a decade-long low. And while the organization responsible for supplying 40% of the nation’s blood supply continues to send text alerts for local blood drives, the crisis has many medical experts, lawmakers, and LGBTQ+ advocates renewing their call for the removal of a ban preventing many gay and bisexual men from being donors.
As it currently exists under the Food and Drug Administration’s regulations, gay and bisexual men are required to abstain from sex for a minimum of three months before they’re eligible to donate blood. In April 2020, when COVID-19 began to take a toll on the national blood supply, the FDA shortened its previous requirement of a year of abstinence down to the current 90 day window.
But prior to the 2015 revision that changed it to a year, the FDA upheld its original lifetime ban placed on men who have sex with men for more than three decades. The origin of the lifetime ban harkens back to the 1980’s HIV/AIDS epidemic, when little was known about the virus or the way in which HIV can be transmitted.
For some background on the history of the policy, where it stands today, and the trajectory of what it may look like in a few years, we spoke with Carl Streed Jr MD MPH — an Assistant Professor of Medicine in the Boston University School of Medicine, who has chaired the American Medical Association Advisory Committee on LGBTQ Issues and served on the board of GLMA: Health Professionals Advancing LGBTQ Equality. In regards to why it’s taken so long for the policy to be called into question, despite the advances of both HIV testing and blood screening technology, Dr. Streed says much of it has to do with stigma and the “healthcare system’s significant issues around sexuality.”
But there may be a light at the end of the tunnel for those calling for reform, thanks to a groundbreaking study currently being conducted by the American Red Cross in partnership with One Blood, Vitalant, and local LGBTQ+ community health centers. The Assessing Donor Variability And New Concepts in Eligibility Study (or ADVANCE Study) aims to provide data for the FDA to determine if a donor history questionnaire based on individual risk would be just as effective as a time-based deferral in reducing the risk of HIV in the blood supply.
While results of the study should be available at the end of the year, many experts — including Dr. Streed — are hopeful that an evidence-based change will lead to an even more informed donor pool in regards to their status and general risk of exposure.
“In terms of the current ban, it's so identity-focused that it doesn’t really take into account the ways in which people are exposed to HIV and have potential risk for a new infection,” said Dr. Dr. Streed. “The behavior survey that they’re developing now will be broadly applicable to everyone. That way it’s not just people checking off boxes for themselves, but really thinking ‘Okay, what have I been up to in the last few months?’ And, honestly, this may help some people realize ‘Oh I’m looking at all these boxes. I probably shouldn’t donate right now, but if things are different in a few months I can donate then.’ And that applies to everyone, regardless of their sexual identity or relationships. It will take into account what’s actually happening in their lives and more than likely, lead to a safer blood pool.”
Because of the way policy reform of any kind requires time for reviews and approvals, Dr. Streed says results of the study won’t necessarily mean an immediate downstream change. Instead, he raises the importance of the role allies can play in everyday advocacy for change.
“I would love if every time that email [asking for a blood donation] came through, for people — and not just those of us who are affected by the ban, myself being in a gay relationship and not able to donate included — but others to donate on behalf of other individuals to make sure our blood supply is sufficient and also voice concern that this is cutting out such a significant portion of folks,” Dr. Streed said.
Dr. Streed also spoke to previously conducted studies, where gay and bisexual men surveyed during Pride and other LGBTQ-focused events were asked whether they were subject to the ban, and if they could donate if they would be able to. The overwhelming majority said yes. “There is this community aspect to broadly LGBTQ communities where like, ‘Yes, we’re going to help. We’re going to donate and do what we can.’ And that’s just one of our survival mechanisms as being part of a marginalized population.”
While the blood shortage remains at a critical status and efforts for policy reform continue to push forward as studies develop, there are still things you can do to make a difference. Whether that means donating blood or not, Dr. Streed stresses the importance of testing and being informed of your own sexual health status.
“Take the step regardless of the blood ban or not,” Dr. Streed said. “Know your status — get tested. Testing is so much more advanced and faster than it was back when I first started getting engaged in care. It’s so easy and accessible now and that’s just a reminder of how the technology is so much better.”
HIV can infect anyone, regardless of age, race, or sexual orientation, so it's important to get tested at least once in your lifetime (the CDC recommends more frequent screening for people at a greater risk of getting an HIV infection). If you suspect that you may have been infected with HIV, Everlywell’s HIV Test is a convenient way to check.
Your test results will tell you whether or not IgG (Immunoglobulin G) antibodies and p24 antigen combination was detected in your sample. Although testing includes a differentiation between HIV-1 and HIV-2, a single qualitative result is reported for clinical evaluation. In the event that your test results are abnormal, you’ll have the opportunity to connect with our physician network at no additional cost to discuss your particular case.
In light of the nation’s blood crisis, Everlywell has made a $2,500 donation in support of the American Red Cross and its efforts to rebuild the nation’s blood supply so those in need of vital medical treatments can continue to receive care without delay. If you’re interested in donating blood, you can visit redcrossblood.org to find a local blood drive near you.
References:
1. Red Cross Declares First-ever Blood Crisis amid Omicron Surgel. American Red Cross. URL. Accessed March 15, 2022.
2. The FDA must lift its discriminatory blood-donor policy. AMA. URL. Accessed March 15, 2022.
3. FDA's Revised Blood Donation Guidance for Gay Men Still Courts Controversy. AJMC. URL. Accessed March 15, 2022.
4. ADVANCE Study: About. ADVANCE Study. URL. Accessed March 15, 2022.
5. The beliefs and willingness of men who have sex with men to comply with a one-year blood donation deferral policy: a cross-sectional study. National Library of Medicine. URL. Accessed March 15, 2022.