Last week, the Food and Drug Administration released highly anticipated draft recommendations that would allow gay men to donate blood after one year of celibacy. While an improvement from the current, highly criticized lifetime ban, the new policy, which was announced in December, still caters to fear and stigma rather than science. It should be reconsidered.
In 1983, early in the AIDS crisis, the F.D.A. categorically prohibited any man who had had sex with a man since 1977 — even once — from ever donating blood. (The ban was one year for men who had had heterosexual sex with someone known to be H.I.V.-positive.) As we argued in The Journal of the American Medical Association last year, this policy was deeply misguided. It lacked solid public health evidence to support it, and was at variance with the policies of other countries — including Britain, Canada and South Africa — that had rescinded such lifetime bans without seeing an increase in infected blood in their supply. The ban meant that the F.D.A. was forgoing an estimated615,000 pints of blood annually that would be donated to save lives. And it deeply stigmatized gay men.
In December, the F.D.A. acknowledged that the policy was outdated and announced the change to a one-year ban. The decision is based primarily on data from Australia, which phased in such a change between 1996 and 2000.
But the F.D.A. has failed to explain how a blanket one-year ban is justified by the existing public health data. To appreciate the injustice of its proposed approach, consider an analogy. There are ZIP codes in America that have much higher H.I.V. rates than others for reasons such as poverty, poor access to health care or intravenous drug use rates. Imagine if the F.D.A. were to announce that anyone who had lived in that ZIP code would have to remain celibate for a year in order to donate blood. We would view such a blanket ban as unreasonable and discriminatory.
The sensible policy solution would be to rely on individualized risk assessments and the ultrarapid and extremely accurate antibody and nucleic testing already done to all blood that enters the blood supply to deal with donors who pose higher risks.
Such testing is already applied to every pint of blood donated in the United States. As a result, the F.D.A. estimates that the H.I.V. risk from a unit of blood has been reduced to about one per two million — almost exclusively from donations made during the “window period,” very early after infection, when even the most up-to-date testing methods cannot detect all infections.
For most gay men, the proposed one-year ban remains a de facto lifetime ban. To ask, for example, a married, monogamous gay man who has been tested and shown to be H.I.V.-negative to remain celibate for a year to be eligible to donate blood to his own children is an unrealistic burden we would never impose on heterosexual individuals. The policy also continues to deprive the country of much needed safe blood: A one-year ban would still exclude an estimated 2 million eligible donors and the approximately 300,000 pints of blood they would most likely donate each year.