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For the first time since 1985 and the height of the AIDS epidemic, the FDA has made a major adjustment to its policy banning blood donations from men who have sex with men, but the real impact is limited.
Instead of a lifetime ban (called a permanent deferral), the FDA now recommends that blood donation centers and other entities require men to wait 12 months after their last sexual encounter with another man before donating. This rules out gay and bi men in sexually active, monogomous relationships with other men, those who only have protected sex, and those who for other reasons are at low risk of transmission of HIV.
The guidelines also include women who have sex with men that have had sex with men in the last 12 months. BiLaw, an organization of bisexual law professionals, noted in a July letter that this line of policy is particularly stigmatizing to bisexual people and urged for its removal to no avail.
Meghan Maury of the LGBTQ Task Force put it bluntly: the updated recommendations remain “phenomenally far away from what any of the science tells us about transmission risk, about testing, and about the available pharmaceutical and condom options.”
The Task Force released comments in June urging the FDA to lift the blanket ban on MSM and other groups entirely.
In the new FDA documents, there is no change to recommendations for lifetime bans on individuals who have ever engaged in sex work or non-prescription injection drug use. This policy increases stigma for current and former sex workers and those who use injected drugs, who are more likely to be LGBT, with trans folks at particularly high risk.
For example, trans individuals who have used hormone treatments without their own prescription fall under the ban, Maury explained.
“Those provisions say things to me as a person who was an injection drug user 20 years ago, it feels as if the FDA is saying ‘once a junkie always a junkie,’” they said. “It says that people who have engaged in sex work are marked for life. It’s stigma. It’s not related to science in any way. The MSM provision is the same, it’s just the stigma that we don’t trust men who have sex with men to not have sex with multiple partners without condoms.”
The FDA’s guidelines regarding blood donation by trans individuals have never been clear, and the new version doesn’t help much. Trans people are likely to still experience discrimination at blood centers, regardless of their sexual history. Buzzfeed reported earlier this year that some places have a blanket policy of rejecting any transgender donor. And trans women who have had sex with cis men, for example, will fall into the same restrictions as cis men. There is a positive change in the new regulations: the guidelines state 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.” It will be important to watch to what extent that recommendation is honored in practice.
Given the one-year deferral requirement for MSM and women who have sex with MSM, it seems unlikely that the adjustment in policy will majorly impact the supply of available blood, though it may at least help reduce stigma against men who have sex with men.
There are many categories of people who can’t give blood, and some estimates say that less than half the population is actually eligible. I myself can’t give for at least three years because I lived in Nicaragua, which has the presence of malaria, even though I never contracted malaria. However, these other limits are irrelevant to the fact that the FDA continues to uphold discriminatory and hypocritical standards when it comes to which sexually active people can give blood. After all, straight people do not have to identify their number of partners before donating even though a high number of partners increases the risk of HIV transmission.
So groups like The Task Force and the National Center for Transgender Equality will keep fighting for FDA guidelines that better account for medical science and modern technology, Maura said. And, they added, good work is happening to help reduce stigma against and increase resources for the same intravenous drug users, sex workers, and LGBT people who are affected by this policy.
