Last week, Argentina's Health Ministry lifted its ban on gay blood donors in favor of an individualized risk assessment policy. The news comes at a time when the United States Food and Drug Administration (FDA) is reviewing public comments on their own proposed policy change - to swap a lifetime deferral of men who have sex with men (MSM) for a 12-month deferral. If approved, the new American policy would then allow MSM to donate blood if they have abstained from same-sex sexual contact for the last year. Thus, the potential new American policy does not go nearly as far as Argentina's complete overhaul of the blood donor deferral process.
However, the forthcoming potential shift in blood donation policy in the USA is a note worthy of excitement. The Williams Institute estimates that the 12-month deferral will add about 185,800 new likely blood donors and 317,000 pints of blood. With each pint of blood potentially saving up to three lives, the new deferral is certainly a great step towards removing bias from the donation process while also benefitting the people whom are affected most - recipients of blood transfusions.
That being said, the FDA has much to learn from our counterparts down south, as even though our new American policy will contribute to our blood supply, it remains grounded in stereotypes about HIV and sexual orientation. These stereotypes are damaging to both MSM and blood recipients, especially during blood shortages, which last occurred in 2014.
The FDA's current policy of a lifetime deferral was adopted in 1983, during the HIV epidemic, out of fear of transmitting HIV to transfusion recipients. Much as our understanding of the virus has evolved, though, so have our methods for its detection. For that exact reason, the FDA screens all donated blood for HIV.
The current and potentially new FDA policies thus beg the question - what is unique about MSM that subjects them to additional scrutiny in the blood donation process?
Is it that the CDC estimates that gay and bisexual men comprise 57% of the HIV positive population and 63% of new HIV infections? This reasoning would make sense, but MSM are not the only group that is disproportionately susceptible. For example, African American individuals are eight times more likely than white people to be HIV positive and account for 44% of new adult and adolescent HIV infections. Does that mean that the FDA should defer African Americans for 12 months until they have remained abstinent? No - because that is racism and we know better.
But the FDA fails to apply that same logic to MSM, who also make up a very large group with such vast variations in sexual behavior and other HIV risk factors. It makes no sense to apply such a policy uniformly to such a diverse demographic.
Perhaps it is that MSM are unique in their prevalence of anal intercourse, the type of sex that presents the highest risk of HIV infection. Well, straight people have anal sex too - a lot of them. 44% of straight men and 36% of straight women report having anal intercourse at least once in their lifetimes.
A heterosexual person who has unprotected anal sex with multiple partners jumps to the front of the blood donation line, while a monogamous married gay man must remain abstinent for 12 months to be seen as equal in the eyes of the FDA. The skewed rationale behind the FDA's deferral of MSM is a reminder of the double standards inflicted upon LGBTQ individuals in American society. In addition to failing to meet the blood needs of potential transfusion recipients, a policy like this can also take a negative toll on the deferred population. These discriminatory social policies adversely impact the wellbeing of the groups they target.
What's the solution? The great news is that it has already been laid out and implemented around the world. Chile, Mexico, Spain, Italy, and now Argentina have shifted from damaging stereotypes to a more practical individualized risk assessment protocol. Now is a critical time for the FDA to learn from our peers around the world - American lives could depend on it.