As gay dads, we could not give blood for son
When our son was fighting for his life, my husband and I were ready to give him anything he needed to get healthy.
But what he needed was a blood transfusion, and we couldn’t be the ones to give it to him. It wasn’t because we didn’t have the right blood type, but because of the type of people we are: gay men. Men who have sex with men (MSM) have been excluded from donating blood in the United States since 1983.
We pulled out every stop to try to donate our blood to our son, knowing we were in good health and Hiv-negative, and thus could do so safely. We worked our way up the blood bank hierarchy, but officials were unwavering. They said the blood bank could lose its Food and Drug Administration license if they allowed us to donate for him.
Hopeful signs from the FDA
Our son got his transfusion thanks to an anonymous donor and today is thriving. And there are now encouraging signs that families like ours won’t be turned down in the future.
The FDA is considering smart, science-based reforms that would allow more people to safely donate blood.
As a physician, I welcome this change. What better time to invite it than on World Blood Donor Day on Tuesday, during LGBTQ Pride Month? The timing is especially key as our nation has been facing severe blood supply shortages – dipping to less than a oneday supply for certain blood types around the country.
The restrictions on men like me donating blood date to the early AIDS epidemic, when they were first enacted. The rule was rigid: A man who had ever had sex with another man any time after 1977 was banned for life from donating blood.
It was, in some ways, an understandable response to an unknown and terrifying new disease. There was no approved test to screen blood for HIV, and thousands were infected through blood and blood components.
But the advent of testing, combined with education for prospective donors, dramatically reduced the incidence of infections.
The risk of HIV transmission fell from 1 in 2,500 blood transfusions to 1 in 1.47 million. Now, donated blood is rigorously tested for HIV, and the tests have become more sophisticated in their ability to detect the virus sooner after infection.
The FDA took far too long to acknowledge this new reality, but in recent years, it has started to listen to the science.
A lifetime to a year to 90-day ban
In 2015, after decades of datainformed advocacy, the FDA finally shortened the lifetime ban to a one-year deferral period – so that MSM could donate blood if they had not had sex with a man in the prior 12 months.
This move was supported by compelling data on other countries’ experiences.
When Australia implemented a oneyear deferral, they saw no significantly greater risk of HIV transmission.
Then in April 2020, in response to a blood shortage related to the COVID-19 pandemic, the FDA reduced the U.S. deferral period to 90 days.
We can go further than that.
Enact these two simple changes
Science supports two changes that would allow more people to donate blood while making our blood supply safer.
First, we can implement an even shorter deferral period, reflecting the reality that the HIV nucleic acid testing already used can identify a positive case within 33 days post-infection – sometimes as soon as nine days after infection.
Second, we can more widely adopt well-researched, risk-based questionnaire screeners, which could be more effective than current strategies in preventing transfusions with Hiv-infected blood. Painting MSM as a dangerous group with a high risk of transmitting HIV isn’t just discriminatory; it’s incorrect. Many use pre-exposure prophylaxis to prevent becoming infected with HIV, and this has dramatically reduced transmission. Many also test themselves regularly, and undiagnosed HIV infections have been declining.
It makes no sense: A gay man who engages in sexual activity, even activity that puts him at extremely low risk for HIV transmission, with his male partner in the context of a monogamous relationship in three months is banned from donating blood, while people who engage in riskier activities with multiple partners are free to donate.
My husband and I weren’t the first – or last – gay men to be prevented from giving blood to save a life. Men lined up to donate in 2016 after the Pulse nightclub shooting, a horrific attack at a gay venue in Orlando, Florida, but were turned away because of who they partnered with.
Given our nation’s ongoing blood shortage – on top of equity in blood donation – the urge to help by donating is one we should celebrate, not hold back.
I commend the FDA for considering these changes and setting us on a course to safe, inclusive blood donations for everyone.
And I look forward to rolling up my sleeves as soon as I’m allowed.
Mark A. Schuster, MD, PH.D., is the founding dean and CEO of the Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, California.