The blood supply in the United States is vital. During the COVID-19 pandemic, donations plummeted so severely that the American Red Cross proclaimed a national blood crisis. Because donated red blood cells only endure about six weeks, supplies cannot be re-stocked. A major shortage could necessitate difficult decisions about who should or should not receive a transfusion, decisions that could be life or death.
So, removing unnecessary limits on who can donate blood makes logical, right? Yet, according to FDA (Food and Drug Administration) criteria, men who have sex with men (MSM) are unable to donate blood if they have been sexually active in the previous three months.
Is it possible for homosexual guys to donate blood?
According to the FDA’s amended guidelines, MSM is eligible to donate blood if they have not engaged in sexual activity for three months or more. The same rules apply to men in monogamous same-sex relationships as well as anyone who has had sex with an MSM.
Males who have sex with females or females who have sex with other females do not have a deferral period.
Organizations like the Red Cross recognize that not everyone identifies as male or female and that there are many other gender identities. They also accept that sexual orientation should not be used to determine eligibility for blood donations. But the FDA’s new criteria require donors to identify as either male or female. Individuals can self-identify or self-report their gender, enabling donors to register with the gender with which they identify the most closely. There are no deferral criteria for being transgender, and eligibility is determined by criteria related to the reported gender.
Those who register as male, for example, will be disqualified to donate blood if they have had sex with another male within the last three months. People who identify as female and have sexual relations with a male may be eligible to donate blood if they meet all other blood donation requirements.
Those who are intersex must self-report a binary gender but do not need to indicate that they are intersex, according to FDA guidelines. Gender-expansive, genderqueer, gender fluid, agender, or nonbinary people are also included.
Asexual people can donate blood if they meet all other blood donation requirements.
Why pick out males who have sex with men?
Similar limits were originally imposed in the 1980s. Although HIV (Human Immunodeficiency Virus), the virus that causes AIDS, had not yet been discovered, it was evident that males who had intercourse with men were at an especially high risk of contracting the disease. Furthermore, researchers discovered that HIV may be spread through blood, even through blood transfusions. The lifetime limit on blood donations given by gay and bisexual males, which swiftly became policy, was meant to help stem the spread of AIDS.
What is the justification now?
More than 40 years later, the viral etiology of AIDS is well recognized, and detection tools have evolved.
HIV can be detected using highly sensitive blood testing. Prospective blood donors are questioned about their risk factors for HIV and other illnesses that could be transmitted through blood donation.
Donated blood is checked on a regular basis to ensure that contaminated blood is not transfused.
However, it was not until 2015 that the FDA changed the lifelong rule on blood donation to enable donation by MSM who reported being abstinent for a full year. When blood donations fell during the pandemic, restrictions were tightened once more. Men who have sex with men can currently donate blood if they can swear to not have intercourse with men for three months.
What is the point of waiting three months? The danger is that a recently acquired infection could be undetected even with very accurate tests.
Important actions to ensure the safety of the blood supply:
Of course, it is critical to safeguard the blood supply. There is no perfect system, but the safety record of transfused blood in the United States is surprisingly good: transfusion-related diseases such as HIV and hepatitis are quite rare. In this country, the estimated risk of HIV transmission through transfusion is significantly below one in a million.
Blood banks reach this high level of safety by:
Self-reporting: Questionnaires designed to exclude donors whose donations may induce disease in the recipient. Potential blood donors, for example, are asked comprehensive questions about infection risk factors and the medications they use. Of course, this is contingent on accurate and truthful self-reporting. Donated blood is regularly tested for several transmissible illnesses, including hepatitis B and C, HIV, syphilis, and West Nile virus, regardless of the responses to the screening questions.
Blood testing: Blood testing, unsurprisingly, is far more reliable than self-reporting. The astonishingly accurate testing that is now accessible is significantly more effective than an honor system in which potential donors are asked about risk factors for having an infectious disease.
It is one of the major reasons for the increased calls for revisions in the blood donation policies that apply to MSM. Current research may aid in policy decisions. The ADVANCE study (Assessing Donor Variability And New Concepts in Eligibility) is looking at the impact of altering the screening questionnaire to ask gay and bisexual men about particular activities that increase infection risk, rather than demanding three months of sexual abstinence. Unprotected sex with several partners, for example, or being paid for sex are both high-risk activities, regardless of gender or sexual orientation.
Past blood donation rule revisions:
The discovery of AIDS in the early 1980s and the realization that it may be transmitted through blood altered the American blood system.
Because of a lack of appropriate screening technologies, a lack of understanding of potential risk factors, and heterosexist beliefs, the United States imposed a lifetime ban on MSM, banning them from donating blood between 1985 and 2015.
The FDA altered the indefinite delay to a 12-month deferral from the most recent sexual interaction with another guy in 2015. The company chose this time frame to enable enough time to detect probable illnesses in the blood. According to research, this adjustment did not lead to an increase in HIV incidence among first-time donors.
In April 2020, in response to COVID-19-related blood shortages, the FDA decreased the delay to three months to address the urgent need for safe blood supplies.
Finally, who may safely donate blood?
There is now no convincing evidence that blood donation by males who have sex with men jeopardizes the safety of our blood supply. Regulations requiring a time of abstinence for MSM may exclude many persons who are at minimal risk of contracting an illness through blood donation while permitting others who are at higher risk to donate.
Many countries concentrate on individual risk factors for viruses transmitted through blood transfusions rather than a person’s gender or sexual orientation. Such regulations are used by the United Kingdom, France, Israel, and other countries to safeguard their blood supplies. The American Medical Association, the American Red Cross, and several US senators support similar policies for the US, as do many specialists in the field. A change in blood donation policy is long overdue: all donor eligibility should be based on medically justifiable risk factors, and all potential donors should be assessed in the same way. And the sooner these constraints are removed, the better. A just, egalitarian, and medically sound blood donation policy is not only a moral decision; it may also allow you to donate blood that saves your life.
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