For the first time ever, the American Red Cross this week declared a national blood shortage crisis and hospitals are putting out calls for donors — yet the Food and Drug Administration continues to ban men who have sex with men from donating blood.
It is long past time for the FDA to eliminate this ban. No other group is similarly banned from donating blood. Prohibiting only men who have sex with men from donating blood is the definition of homophobic, because it presumes that this sexual orientation is unsafe. That is provably false: Studies report no risk to the blood supply in other countries that do not ban donations from this group of men.
The assumption that blood from sexually active gay and bisexual men is deadly is deadly. UCLA researchers say lifting the ban would mean as many as 350,000 new donors and could treat more than a million people.
The FDA’s current policy is this: A man who has had sex with another man in the last three months may not donate blood. It is an outdated artifact of the early years of the HIV/AIDS epidemic.
In March 1983, the Centers for Disease Control and Prevention published a report that HIV can be transmitted by blood. Shortly after, gay and bisexual men began to be turned away from donating blood at Irwin Memorial Blood Bank in San Francisco if they had been sexually active in the last five years. This unofficial policy became official in September 1985, when the FDA banned gay and bisexual men for life from donating blood.
That policy was partially lifted 30 years later when the FDA swapped the lifetime ban for a year of abstinence. That policy was shortened to the current three-month ban in April 2020, when the coronavirus pandemic forced the cancellation of blood drives across the country, causing blood supply shortages in New York and Seattle and the loss of enough blood to treat 3,000 people in Southern California.
The argument for a three-month ban is to account for early infection that an individual may not be aware of. In the summer of 2021, the United Kingdom revised its 12-month abstinence requirement to allow blood donations by men who have sex with men as long as they have been monogamous for three months. Yet even a three-month ban is scientifically unwarranted.
The FDA acknowledges that current blood-screening methods can detect infectious diseases such as HIV and hepatitis C within this three-month window. That the U.S. has sophisticated screening methods in place is why no one was surprised when researchers found found no difference in HIV infection when the lifetime ban was shortened to one year in 2015. This is good news: With more than 17 million blood transfusions every year in the U.S., the country does not rely on the honor system. The bad news is that people are punished for telling the truth about who they are and blood donors are turned away even though their blood is needed and would be carefully screened.
Yet here we are today. To turn away blood donors because of their sexual orientation while there is a critical blood shortage during the worst pandemic in a century is medically baseless and morally reprehensible.
A more sensible approach would be to assess potential blood donors’ risk for infectious disease on a case-by-case basis, regardless of sexual orientation. Other countries are doing just that. Three weeks ago, the Canadian Blood Services announced it would entirely lift its ban on men who have sex with men donating blood. Israel did the same thing back in August. Both are shifting toward a practice similar to Italy’s, which eliminated its ban in 2001. That country went straight from an outright ban to an individual risk assessment, a practice that does not consider sexual orientation but at-risk behavior. A study led by Italy’s National Institute of Health compared HIV infection among blood donors before and after the ban was lifted. There was no difference in the rate between men who have sex with men and heterosexuals.
The ban on blood donations by men who have sex with men should have been ended in the wake of the Pulse Nightclub shooting in Orlando in 2016, when men who tried to give their blood to save their friends’ lives could not do so. Now, as countries around the world report dangerously low numbers of blood donors and the American Red Cross says hospitals in the U.S. have “less than a day’s supply of certain blood types,” the FDA ought to do what is medically and morally right and end the ban on blood donation by sexually active men who have sex with men.
Jason Silverstein is co-director of the Media, Medicine, and Health program and lecturer and writer-in-residence at the Department of Global Health and Social Medicine, both at Harvard Medical School.
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