Less than 10 percent of people in the United States donate blood on an annual basis, which explains in part the findings of American hematologists who recently conducted extensive research on the growing gap between blood supply and demand. The story of blood shortage is hardly new, however. One occurred in July, a Type O shortage happened in May—and that's just in the U.S. In the face of an obvious need for more ample stores, experts point to the unnecessary restrictions barring men who have sex with men from donating blood—a policy based on stigma rather than science.
"I am a gay male. I give blood because there's a need for it in our current situation, but I have to lie in order to donate. Just by having sex with another male, I'm automatically eliminated from donating blood," says Jason Kindt, MD, medical director at the Samuel J. Friedman Health Center for the Performing Arts.
The Food and Drug Administration (FDA) stipulates that "a man who has had sex with another man during the past 12 months" is not eligible to donate blood—a rule that doctors say is both outdated and detrimental to the nation's current blood supply levels. Charles Nicholas Cuneo, MD, a clinical fellow at Brigham and Women's Hospital, tells Well+Good that the FDA's recommendation is based on a population-level analysis of risk rather than an individual risk assessment. In other words, they treat all gay men as a homogenous group rather than looking at the unique sexual histories of each individual.
"Other countries have shown us that individual risk assessment can be carried out effectively and safely. Indeed, if done rigorously, individual risk assessment may be able to more accurately predict risk and protect the public than the current system," says Dr. Cuneo. For example, the American Red Cross might accept blood donations from a straight man with an active chlamydia infection who had unprotected sex with a woman an hour ago, but turns away gay men in a decade-long monogamous relationship who does not have an STI, explains Dr. Cuneo. "This system is obviously flawed based on our current knowledge of the modes of transmission of HIV," he says.
In 2019, it's easier than ever to test blood for HIV, making Dr. Cuneo question why the rule (which was last revised by the FDA in 2015) remains in place. "The technology for screening blood has changed dramatically in recent years; current direct HIV/RNA testing can pick up on a new infection with over 99.9 percent sensitivity in only 9 to 14 days," he says. "This makes the 12-month deferral as currently written into the FDA rules appear completely arbitrary and punitive, as it has no logical basis in scientific fact."
Dr. Kindt has seen the repercussions of the FDA's rules in his own practice. "A lot of my gay male patients are angry that that rule exists. They follow the law and they don't donate even though it could be helping a lot of people," he says. If blood shortages are to be ended, or, at the very least abated in the near future, Dr. Cuneo says blood screenings need to acknowledge the individual, not the boxes they check on their intake form.
"This rule could change by adopting an individual risk assessment strategy, where individuals—regardless of their sexual orientation—would be asked about recent high-risk sexual behaviors," he says. These behaviors include sexual activity with a new partner, sex with multiple concurrent partners, sex without the use of barrier protection, and sex while under the influence of drugs or alcohol. Alternatively, the FDA could change the deferral period from 12 months to 14 days, he says. By any measure, an update to the FDA's rules is long overdue.
We need to talk about biphobia in medical spaces, and who we leave out when we call periods a "woman thing."
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