The first case of HIV transmission through the blood supply was reported in 1982. Fueled by emerging epidemiological data, negative stigmas surrounding homosexual populations were strengthened in fear of further contamination of the blood supply. In response to the public health threat, the FDA prohibited blood donations by men who had sex with men (MSM) dating back to 1977. Recently, the FDA changed their policy to allow MSM blood donation as long as the donor has not had sex with another man for a period of 12 months. Although this is a step in the right direction, those involved in the continuous fight against HIV/AIDS discrimination and stigma say the revision is less impactful than completely lifting the ban.
Limiting the Blood Donor Pool
Numerically speaking, the Williams Institute reveals the limiting effects of the MSM blood donor ban (BDB) to the overall blood donor pool:
|Estimates of MSM in the United States|
|Report Male Sex Partner||% of Men (U.S. Population)||# of Men|
|Since age 18||6.4||7,168,638|
|In the last 5 years||4.0||4,480,398|
|In the last 12 months||3.5||3,920,349|
MSM blood is an untapped resource. It is unwise to leave out that potential supply, especially taking into account the common shortages in the blood supply. Lifting the ban on MSM blood donations would add more than 200,000 pints to the blood supply. Models from the American Red Cross show that only 5 percent of the overall population actually donate blood. It should be noted that about 40 percent of the overall population are eligible to donate. Using these same percentages, the following chart shows potential MSM donors and pints of blood that would be added to the national blood bank.
|Estimates of Men Who May Donate Blood|
| ||# Eligible to Donate||# Likely to Donate||# of Pints Donated|
|Lifting Blood Donor Ban||2,603,004||130,150||219,200|
|12 Month Ban||845,714||42,286||71,218|
The current safety measures used to screen donors decrease the chance of HIV transmission from a blood transfusion to 1 in 1.47 million transfusions. Taking into account that approximately 2.6 percent of current blood donors are MSM who are not adhering to FDA recommendations, there have still not been any HIV, hepatitis B nor hepatitis C transmissions through U.S.-licensed plasma-derived products in the last two decades. It would be expected that the same screening measures would continue to be used and the blood bank would remain HIV-free.
From a public health perspective, unfairly restricting donors places an unnecessary burden on the nation's blood supply. The Centers of Disease and Control (CDC) estimates about 30 percent of the 1.2 million people living with HIV in the U.S. will require blood products or a transplant due to kidney malfunction. In May of 2015, the HHS lifted its previous ban to allow individuals living with HIV to donate organs to others living with the virus. This more inclusive policy revision could be adopted by blood donor policies.
There are both logistic and principle-based issues with the 12 month donor ban. Logistically, the ban prevents donors from contributing to the blood bank. Due to our current blood screening technology and continual improvements in HIV research, there is negligible risk to the blood supply, proving the ban unjustifiable. A mathematical model factoring in the HIV incidence rate in MSM estimates the remote possibility of 1 in 10,000 positive HIV blood samples donated. This number could easily be screened for and any breach could be completely eliminated. David Stacy, the Government Affairs Director at Human Rights Campaign, states the new revision continues to stigmatize gay and bisexual men. The ban implies all MSM blood is unclean or tainted, and discriminates against their sexual orientation rather than actual risk posed to the blood bank supply.
A similar 12 month ban has been implemented in Australia, which has reported zero cases of HIV contamination in their blood supply. In contrast to the U.S., their policy also imposes a signed legal document that fines or imprisons any donor providing false information that could lead to contaminating the blood supply. We do not support HIV criminalization, yet alternative preventative measures are essential to maintain the integrity of the blood bank. Restrictions need to be based on objective research and public health safety, as opposed to suppositions stemming from the 1980s.
We support continuous and rigorous screening of the blood supply, but emphasize that this procedure should be applied to all donors. Given that HIV testing takes significantly less time than 12 months, we recommend a universal testing and approval period of 9 days. This is the estimated time period to detect any viral load in newly infected people. During this time, any voluntary donor (of any gender or sexual orientation) would lose donor eligibility if they engaged in behaviors associated with increased risk of HIV transmission.
Most importantly, eliminating discriminatory policies should be on the forefront of discussions surrounding HIV. These policies exacerbate health disparities faced by ethnic and sexual minorities, and lead to higher incidence rates within MSM and LGBTQ communities of color. By increasing access and availability of health care services to key populations that face these disparities, the incidence rates of HIV and all STIs would decrease. Following this trend, stigmas surrounding people living with HIV/AIDS would also decrease, and policies such as the MSM Blood Donor Ban would not be in effect in the first place. If there is no difference of HIV incidence between populations, there would be no need to differentiate between donors. For every one us, there should be blood.
Ernesto Flores is a policy and advocacy fellow at HIV Prevention Justice Alliance.