In a much trumpeted announcement, the U.S. Food and Drug Administration released revised guidelines for blood banks last week on how to screen eligible donors. This comes among pleas for more people to donate blood during the ongoing COVID-19 pandemic.
On page eight of the wonderfully titled “Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products” comes the recommendation that seems to have everyone abuzz: Blood banks can now let men who have sex with men (MSM) donate blood as long as said donors have remained celibate for three months.
This, frankly, is absurd.
Three months, as opposed to the previous 12, is still discriminatory. Three months still effectively bans anyone in a long-term relationship or anyone engaging in regular casual sex. Three months still says, “You’re second-class, and we don’t want your blood if we can help it.”
I am keenly aware that this change comes because of a crisis and the shortage of blood products — which has been exacerbated in recent weeks — not because the FDA has truly changed its mind on anything.
The fact that the FDA issued these recommendations now, after years of insisting the deferment period had to be a year (and before that, indefinitely), is also striking. There are two theories here.
Theory one: The FDA knew all along that a deferment period as short as three months (if not shorter) would be effective at keeping the blood supply safe from HIV but kept insisting on a year or longer. Theory two: Three months really isn’t long enough to keep the blood supply safe, but the FDA is willing to risk it.
Both options are horrifying for different reasons. But the issues don’t end there.
The people that the newest FDA guidance defers from blood donation for at least three months are people who have sex for money or drugs, people who use non-prescription drugs and men who have sex with men.
(The guidance also defers people who have had sex with anyone in the above categories in the last three months, along with anyone who has had a blood transfusion or exposure to another person’s blood through injury in the past three months, people who have recently gotten tattoos or piercings and people who have tested positive for and/or been treated for syphilis or gonorrhea within the last three months.)
Who’s missing from that? Quite a lot of people, including plenty of people who could be engaging in HIV high-risk behavior but who aren’t considered “risky” by the government. The guidance contains no pronouncements on how long men must abstain from sex with women before donating, provided none of those men and women are sex workers or inject drugs.
It stands to reason, in my cynically queer mind, that Joe Heterosexual could have sex with a different woman he meets every night for a month and still donate blood, free and clear. Yet I am completely barred from sexual activity for upwards of ninety days if I want to donate.
There is also the issue of how trans and non-binary people are classed when taking donor histories. The FDA says that “[in] the context of the donor history questionnaire, FDA recommends that male or female gender be taken to be self-identified and self-reported,” but such guidance is close to meaningless.
Trans people may have wildly different risk factors than a cisgender person of similar status. Furthermore, the FDA’s guidance only takes into account binary genders — a non-binary person who has sex with men may be allowed to donate or may be deferred on the basis of sexual history or simply for being non-binary.
I am also concerned that, given the conditions under which the recommendations were released, the FDA will simply snap its guidance back to a 12-month deferral period once the coronavirus national emergency ends.
This, to be fair, would probably not affect a significant number of people. But it would signal that MSM, sex workers, people who use drugs, people with a history of sexually transmitted infections and people with tattoos and piercings are undesireables whose blood is only to be used in times of desperation.
The FDA, to its credit, “remains committed to further investigating individual risk assessment as an alternative to time-based deferrals.” That is, they may be open to implementing a system where people are not deferred wholly for months based on behaviors.
The FDA should follow this path. Data that the agency itself presented in its newest recommendations show that, although male-to-male sexual contact does statistically increase one’s risk of contracting HIV, MSM blood donors had a much lower incidence of HIV than men who have sex with men overall. Additionally, countries that relaxed their deferment policies for men who have sex with men showed no increase in the presence of HIV in the blood supply.
If the FDA wanted to be truly fair about how it implements blood donation policy, it would ban anyone who has had sex in the last month from donating. The agency mandates all blood be screened for HIV using a nucleic acid test, which can take up to a month to detect the virus in someone’s blood. This is an issue of fairness but, in the end, it’s also an issue of protecting the blood supply.
Or, if the agency really wanted to be fair, it could rework its guidelines away from “time-based deferrals,” just like it says it would consider.
I know that HIV — the reason the FDA has these restrictions in the first place — is a serious virus. But I also know that pre-exposure prophylaxis, barrier methods and clean needle exchanges can greatly reduce one’s risk of contracting HIV and that people living with HIV who have an undetectable viral load on tests cannot transmit the virus. In light of these advances, we must reconsider how we continue to defer HIV-negative “high risk” individuals.
This is not the world of the 1980s anymore. There is a new pandemic haunting us, now, and we cannot let fearmongering or political posturing from decades ago prevent us from allowing everyone who can potentially help in solving it from doing so.
Three months’ deferment is not a step forward and it won’t make a lick of difference for many who were ineligible under the 12-month rule. Time-based deferments, given all the evidence in this crisis, are deadly.
Donnie TC Denome PZ ’20 is an award-winning journalist who has received accolades from the California Newspaper Publishers Association and California College Media Association. They are a public health major currently at home in Sunnyvale, California. Donated blood saved their life and allowed them to become the obstinate queer they are today.