Advocate

The FDA implemented the ban in 1983, which originally prohibited MSM from donating blood for life, to help prevent inadvertent transmission of HIV through blood transfusions and blood products such as platelets. At that time, HIV was largely not understood by doctors, scientists, and the general public, and the technology and procedures used to test donated blood for HIV were extremely limited.

In the decades since the original MSM blood ban was implemented, vast improvements have been made in technology that can test donated blood for HIV. According to the CDC, Nucleic Acid Testing (NAT) can detect HIV in a unit of blood within 10 to 33 days of the donor’s exposure to the virus. When combined with best practices that screen prospective donors for high-risk behavior, regardless of sexual orientation, NAT renders the MSM blood ban scientifically obsolete and unnecessary.

In 2015, the FDA changed the lifetime MSM blood ban to a 12-month “deferral,” meaning that a prospective male donor who did not have sex with another man for a year could donate blood. Given that most MSM are not celibate, this change was a de facto lifetime ban. In 2020, the FDA reduced the deferral from 12 to three months in response to blood shortages caused by the COVID-19 pandemic. In 2023, the FDA released new guidelines that would allow MSM to donate blood if they have not had anal sex with new or multiple partners in the previous three months.

Individuals on PrEP are subject to donation deferrals despite the fact that PrEP is 99 percent effective in preventing HIV transmission through sex and 74 percent effective in preventing HIV transmission through intravenous drug usage. The FDA says this policy is based on a lack of HIV testing technology sensitive enough to reliably detect the virus in the blood of a donor on PrEP. The deferral period for those who use oral PrEP is three months after the last dose. For those using injectable PrEP, it’s two years after the last injection. The FDA and GMHC do not recommend discontinuing PrEP usage for the sole purpose of being able to donate blood. Additionally, the FDA does not differentiate whether a condom was used during anal sex despite the fact that condoms reduce risk of HIV transmission by 85 percent.

The FDA’s blood ban supports a false perception that HIV is a “gay disease,” while allowing heterosexual donors who participate in high-risk behavior to donate blood. For example, a prospective donor can have vaginal sex with multiple partners in a three-month period without taking PrEP or using condoms and is still allowed to donate blood, while a prospective MSM donor is deferred if they have had anal sex with just two partners in the same time period.

It also reduces the availability of blood across the country, especially during emergencies like the COVID-19 pandemic. A study by the UCLA School of Law’s Williams Institute found that fully repealing the ban could potentially unlock over a half million blood units per year from men who have sex with men.

It also reinforces negative stereotypes about gay and bisexual people, which is especially problematic because most blood donations occur at blood drives in workplaces or schools, where gay and bisexual donors may worry about employment or the social ramifications of not donating.

Amidst the good progress made on the FDA’s blood donation policy, GMHC has the following recommendations:

• The FDA needs to better educate the public, and MSM in particular, about its revised policy. For example, it is highly likely that prospective MSM donors have read news headlines that the ban is completely lifted, only to be rejected when they try to donate because they are taking PrEP.
• The FDA should reduce the existing three-month deferral period to 33 days, which is aligned with the maximum amount of time that modern testing can detect the virus post exposure.
• The FDA should advocate for government investment in research that will lead to next generation HIV testing that can more reliably detect the virus in the blood of PrEP users.