The U.S. Food and Drug Administration announced recently it is re-evaluating its ban against accepting blood donations from gay men.
The FDA is now seeking ways to assess a potential donor's individual HIV risk as opposed to a general ban on a population. The agency is currently seeking public comment on the policy.
Following June's mass shooting in Orlando at the gay nightclub Pulse, calls rose from activists, support agencies and politicians to change the ban. While Florida hospitals called for blood drives in the wake of the shooting, many of the victims own friends and partners might be turned away from donating.
The FDA has for decades placed restrictions against men who have sex with men, starting with a lifetime ban implemented in 1983. The FDA recently reduced its restrictions for gay and bisexual men in 2015 to one year since their last sexual contact.
St. Louis Public Radio reported in June that local agencies have struggled to carry out the reduced restriction, and relatively few gay men have become new donors under the revised policy.
Critics say the policy still discriminates.
Representative of St. Louis Effort for AIDS, Dale Wrigley, says the organization plans to submit comments to the FDA. He says the revised policy makes little difference for most potential donors.
"Basically, what that did was for many people put another lifetime ban on gay men donating blood," Wrigley said.
Risks FDA Considers
Men who have sex with men are at the highest risk for HIV, which is why the FDA maintained a broad rule. FDA representative Lyndsay Meyer says two out of every three new HIV infections in the U.S. occur in this group.
Wrigley says several safeguards exist that could be used to test blood from donors from demographics at a higher risk for HIV.
Wrigley administers HIV tests on a regular basis. He says blood drives could do the same.
"I could test you in 10 minutes, a 15-minute test result. So while you're there, while you're waiting. A rapid test is a finger stick," Wrigley said.
However, widespread pre-testing could be costly. An advisory committee of the Department of Health and Human Services stated in a 2014 presentation that the pre-testing option was rejected because it would "place a logistical financial burden on blood centers."
Wrigley also suggests potential donors could be tested before giving blood and bring their recent HIV test results when they come to donate.
That suggestion also has a caveat. FDA representative Meyer says that the deferral policy for gay men and others at high risk for HIV also takes into account that testing cannot accurately detect the infection when a person has contracted it in the past 10 days.
Every donation of blood is sent to processing centers and screened for HIV among other blood-borne illnesses such as Hepatitis C.
Given the multiple opportunities for levels of screening, some feel the blanket policy against gay men is an unnecessarily discriminatory rule.
LGBT Advocates Object
Jay Franzone of the National Gay Blood Drive says the FDA's policy is inconsistent because other populations at a high risk for HIV are not automatically deferred from giving blood.
"Banning an entire group of people based on the gender of their sexual partner is no less outlandish than banning people based on where they live in the U.S.," Franzone said.
Franzone points to Washington D.C. as an example. The HIV rate in Washington D.C. is almost nine times the national average, and exceeds the World Health Organization's definition of a 'severe pandemic.'
"Based on that, should the FDA ban blood donations by people residing there too?" Franzone asked.
Aaron Laxton is a community advocate who works on HIV-related issues, running a needle exchange program for intravenous drug users. He is studying for his master's in social work at St. Louis University. He is also a gay man living with HIV.
Laxton says that with advancements in HIV testing and a better understanding of the illness's risk factors, the blanket policy is outdated.
"It hearkens to a time when our society was much less gay friendly and was much more anchored in fear and rhetoric," Laxton said. "It instantly makes a group of citizens second class."
Complaints like these put pressure on the FDA to refine the policy again, to assess the risk of every donor. For example, two gay man in a long term monogamous relationship who have been tested for HIV run a lower risk than others.
FDA Seeks Solutions
Kirby Winn is the Mississippi Valley Blood Center’s spokesman. He says the FDA is most concerned with statistics and is looking for evidence-based suggestions to possibly replace the rule.
"I don't believe they are asking, 'Is this discriminatory?' What will be relevant to FDA is what is medically and scientifically warranted for a safe blood supply," Winn said. "And those frankly are the questions we would want FDA to answer in a way that is neutral."
The FDA confirmed it’s mainly seeking practical solutions to assess risk. It’s accepting public comments on the issue through November.
Comments can be submitted electronically to the FDA here.