43,200 people need life-saving blood transfusions every day in America. There is a significant shortage of blood, tissue and organ donations that results in deaths each day. Unfortunately, antiquated policies that stigmatize the LGBTQ community in the United States are partially responsible for this shortage.
The Original “Gay Blood Ban”
For 33 years, starting with the dawn of the AIDS epidemic, there was a lifetime ban on blood donations by gay and bisexual men. Men who had ever had sex with another man were banned from donating blood not just for a period of time, but their entire lives. Tissue donation was less restrictive. There was no lifetime ban. Men who had had sex with another man in the five years prior to the time of offering to donate were ineligible.
These restrictions were written around the same time that transmission of HIV began to be criminalized. Numerous states continue to maintain these criminal laws, which are intended to punish HIV-positive individuals for allegedly exposing others to the virus even if precautions are taken to avoid it. In many of these jurisdictions, someone who donates HIV-infected blood, tissue or organs can still be criminally prosecuted.
During the early days of the AIDS epidemic, HIV testing was slower and less accurate, and officials were concerned that someone could be infected without showing up as HIV positive on a blood test. However, at this point, tests can detect the presence of HIV in as few as 9 days after infection.
The Revised Guidelines and Continued Stigma
In 2015, the Food and Drug Administration (FDA) issued a recommendation that the guidelines be revised to require blood collection centers to accept blood donations from all donors, with some exceptions. The guidelines were subsequently revised. However, under the new policy, gay and bisexual men are required to affirm that they have not had sex with other men for a year, and sexually active gay and bisexual men cannot donate. This means that sexually active gay or bisexual men who are married or in a monogamous relationship are not able to donate.
LGBTQ advocates, including the Human Rights Campaign, believe the revision doesn’t go far enough to correct the earlier policy and continues to stigmatize and unfairly discriminate against gay and bisexual men. The American Association of Blood Banks, America’s Blood Centers, and the American Red Cross have also denounced the ban. The Williams Institute at UCLA has calculated that ending the ban would have the effect of generating twice as many pints of donated blood per year as the current policy.
In response, the FDA has argued that the 12-month waiting period is supported by evidence that is relevant to the American population and is similar to Australia’s model. It argues that the 12 months are based on “behavior” rather than sexual orientation.
Blood and Tissue Donations by Transgender Individuals
How does the policy affect the transgender community? Historically, the FDA had an incoherent policy in which the sex of a donor was determined at birth for purposes of establishing eligibility to donate. However, in a section of the new policy guidelines issued at the end of 2015 entitled “Nonbinding Recommendations,” the FDA recommended to donation facilities that male and female gender be self-identified and self-reported. This is a recommendation, but because it is “nonbinding,” it is not clear that all donation facilities will appropriately implement the recommendation. Facilities can choose to adopt more “stringent” donation guidelines if they wish. Further, those who were previously identified according to their assigned birth gender will continue to be deferred if they meet other current criteria for donor deferral.