In the aftermath of the massacre of 49 people in a gay nightclub in Orlando Sunday, city officials urged residents to donate blood. There was just one problem: Queer men can't give blood. While they're no longer totally blocked from blood donation, the Food and Drug Administration requires that a blood donor who fits into this category wait a year from last sexual contact to donate. Effectively, this blocks many of the men who desperately want to help their own community during a time of need.
A complex mix of history, institutional caution and, according to some activists, discrimination has contributed to a system that affects queer people. And it prevents life-saving donations in the aftermath of a violent tragedy, when blood banks need to refill their supply, as we saw in Orlando.
Queer blood donation and the AIDS epidemic
In 1983, the federal government banned men who have sex with men from donating over fears that HIV-tainted donations would get into the blood supply.
The FDA partially lifted that ban in December 2015, but it kept a 12-month waiting period for donations in place. This prohibits sexually active gay men from donating.
"The FDA’s mission is to help ensure the safety of the blood supply," the agency said in a statement to The Huffington Post. "Although the current generation of HIV testing that is used to screen the blood supply is highly accurate, it is not perfect."
With current testing technology there's a wait period, when a person who has contracted HIV doesn't show up as returning a positive result on a diagnostic test. (The window period for modern diagnostic technology in the United States is around nine days.)
The agency uses sexual deferral periods because of this wait, rather than exclusively relying on testing blood for HIV, in case a person who tests positive to the virus has donated in the period when it's undetectable.
"During this time, when individuals may have no symptoms, the virus could be passed on to another individual through a blood transfusion," according to the agency. "The FDA has examined the possibility of eliminating all deferrals for HIV and simply relying on testing of donated blood; however, scientific evidence has shown this would lead to decreased safety of the blood supply."
The agency noted that it based its one-year deferral timeline on studies conducted in Australia, which found that a 12-month wait period had not compromised the safety of the country's blood supply. There's no comparable data available for shorter deferral periods.
“We have to have the data,” Dr. Louis Katz, an infectious disease expert and chief medical officer at America's Blood Centers, told HuffPost. "The FDA is going to demand a fair amount of rigor if we’re expected to move forward."
Other health advisers think the FDA is being excessively cautious, including Dan Bruner, senior director of health at Whitman-Walker, a community health center that focuses on HIV/AIDS and the LGBT community.
“The deferral period should be no longer than 30 days, given that with current testing technology an HIV infection can be detected in donated blood within several weeks of exposure,” Bruner told HuffPost in December. “And even then, those that would be subject to the deferral period should be able to donate blood if they agree to return for an HIV test 30 days after donating.”
HIV rates from blood transfusions close to zero
Gay men are disproportionally at risk of HIV infection. Having a history of male-to-male sex is associated with a 62-fold increased risk for HIV infection, compared to a 2.3 fold rise for heterosexual people who've had multiple sexual partners, according to the Retrovirus Epidemiology Donor Study. For black men who have sex with men, the numbers are particularly stark.
Current trends show 1 in 2 black men who have sex with men will be diagnosed with HIV in his lifetime, according to data from the U.S. Centers for Disease Control and Prevention released in February. (For comparison, 1 in 4 Latino men who have sex with men and 1 in 10 white men who have sex with men will contract the virus.)
The current risk of contracting HIV from a blood transfusion is less than 1 in 1.5 million blood units, according to the National Institutes of Health.
The new front-line defense against HIV
A relatively new drug could make blood donation even safer. Preexposure prophylaxis, or PrEP, a daily pill which was approved by the FDA in 2012 to prevent HIV infection, yielded exciting results in a study published in the journal Clinical Infectious Diseases. In the real-world study, conducted over 2.5 years in San Francisco, not a single one of the study's 657 participants contracted HIV.
But while half a million Americans are considered good candidates for PrEP, only 3,253 were taking the pill as of 2014. That's likely the result of a combination of factors, including the drug's high cost, its side effects and criticism from members of the gay community about the possibility that taking PrEP will encourage people to have sex without condoms, which could spread other sexually transmitted infections.
The discrimination factor
Of course, those statistics aren't an excuse to discriminate against an entire population of people, advocates say.
"Everyone wants to make sure that the blood supply is safe, that's not an argument," Jordan Eagles, a New York-based artist and advocate for open blood donation policies, told HuffPost. "But how we choose to include those individuals who could be helping to safe lives and contributing to the community and their citizenship is an issue."
When Eagles decided to donate blood at his former high school in his early 20s, he didn't anticipate being turned away because he's gay.
"I answered the forms honestly and then they told me I couldn't donate," Eagles said. When the person evaluating Eagles' paperwork refused to return it to him, Eagles got mad.
It was something that always stuck with me as a very demeaning experience. I never tried to give blood again.
"You're turning me away, but now you're going to file me somewhere as some delinquent?" he asked. "No frickin' way."
Eagles reached across the table and grabbed back his forms.
"It was something that always stuck with me as a very demeaning experience," he said. "I never tried to give blood again."
Eagles' artwork today reflects that early experience. His project Blood Mirror -- an art piece in which viewers can see themselves reflected in the blood of donors -- is a critique of the FDA's blood donation policy (see video below). He's also involved in a movement called #BloodEquality, a partnership with the advocacy group Gay Men's Health Crisis to stop discrimination against blood donors.
"We saw it [in Orlando], where blood can be a representation of death and carnage," he explained. "You also can see it as a way for healing and lifesaving and connection to one’s community."
Why not lift all restrictions and just test all blood for HIV?
The priorities for blood donation are three-fold, according to Katz, who is straight: Safety of blood supply and adequacy of that supply are paramount, while the fairness issue is "a little less strong."
"There is no right to donate blood," he said.
In addition to safety concerns, Katz suggested that sterilizing donated blood isn't practical because it slows up the supply and could even lead to expired blood that needs to be discarded.
Certain parts of blood have a short shelf life. Platelets, for instance, are only good for five days, according to the Mayo Clinic. And for decades, the gold standard for refrigerated blood cells was 42 days, but recent research suggests that blood may age more quickly than we had previously thought.
Blood cell membranes have already stiffened after 21 days, according to a study published in the journal Anesthesia and Analgesia in 2013. The cells did not regain flexibility after being transfused into a transfusion recipient and researchers are unsure of how these changed cells might affect patients, if at all.
Sterilizing blood donations is expensive, Katz explained. "Adoption has been slow so far, mainly because of concerns about cost. And some clinicians are concerned about quality of product."
AIDS panic from the 1980s still exists in 2016
"It is really about the political will to remove the homophobic block," said Jennifer Brier, an associate history and gender studies professor at the University of Illinois at Chicago and author of a book about the AIDS crisis.
"As a historian I don’t understand it. As a person who works on the history of HIV, I don’t understand it," she added. "It’s a historic pattern of homophobia that connects identity to HIV and not behaviors."
A few Democrats spoke out on Monday, calling on the FDA to end the blood donation restrictions in favor of a move toward behavior-based criteria for donation.
“The fact that loved ones, and friends, and spouses of victims were unable to donate blood showed the moral bankruptcy of the ban,” Rep. Jared Polis (D-Colo.), co-chair of the LGBT Equality Caucus, previously told HuffPost.
“It’s ridiculous that a straight person can have unprotected sex with multiple partners and donate, but a monogamous gay or bisexual man cannot,” Polis said.
As of Monday, the FDA had no plans to loosen its donation requirements, even temporarily.
"We empathize with those who might wish to donate, but reiterate that at this time no one who needs blood is doing without it," the agency told HuffPost. "That being said, the FDA is committed to continuing to reevaluate its blood donor deferral policies as new scientific information becomes available."
Mixed messages from public health officials aren't lost on Cecilia Chung, a senior strategist at the Transgender Law Center, an organization that advocates for LGBT rights.
"The CDC and HIV providers say that HIV is no longer a death sentence," Chung said. "Then on the other hand, we are treating those who might be HIV positive like their blood is some kind of deadly weapon."
Read more on the Orlando Shooting: