The American Medical Association (AMA) has, for the first time, voted to recommend a repeal of America’s lifetime ban on men who have sex with men donating blood.
The vote calls for an end to the U.S. Food and Drug Administration (FDA) 1983-enacted lifetime donation ban on men who have sex with men (MSM).
AMA board member Dr. William Kobler said in a statement on the vote:
The lifetime ban on blood donation for men who have sex with men is discriminatory and not based on sound science. This new policy urges a federal policy change to ensure blood donation bans or deferrals are applied to donors according to their individual level of risk and are not based on sexual orientation alone.
The FDA enacted the lifetime ban on MSM as a reaction to the AIDS crisis.
While that decision may have seemed prudent at the time, health professionals and the LGBT community have protested that the lifetime ban is not just damaging to blood stocks, it is also discriminatory.
While certain sexual practices, such as anal sex, are incontrovertibly high risk, risk factors for contracting HIV can be vastly reduced by practicing safe — or safer – sex, monogamy and regular screenings. Teamed with vastly improved testing procedures that make it highly unlikely, though admittedly not impossible, that a contaminated blood donation would make it into wider blood stocks, and the risks are further reduced.
Therefore, treating all MSM as though they are high risk implies that HIV transmission is the inevitable or unavoidable outcome of men having sex with other men, which it of course is not.
The AMA, under its H-50.974 Revision of the Lifetime Deferral for Blood Donation of the Men Who Have Sex with Men (MSM) Population, has suggested shifting from a lifetime ban to a five year deferral period for MSM. This means that male donors who have not had sexual contact with another men for five years, and if they meet all other criteria, would be allowed to donate.
Alternatively, and the preferred approach among many ban repeal advocates, the AMA has floated a case by case test that would focus on individuals rather than categories, something that may sound initially cumbersome but, with carefully crafted questionnaires and highly sensitive screening measures, certainly could be viable.
Other countries have made shifts to either one year or five year deferrals, including Australia, the United Kingdom (with the exception of Northern Ireland), and most recently Canada. The potential benefit to the bloody supply would be modest but, with the blood supply always lacking, of some significance.
A 2010 study by the Williams Institute of UCLA suggested that under a five year deferral period, 42,286 additional men would make 71,218 blood donations.
Under a one year deferral, researchers estimated that 53,269 more men were likely to donate 89,716 pints each year. Get rid of the deferral period entirely and an additional 130,150 men would likely donate 219,200 additional pints of blood each year.
A 2011 estimate for the UK, used here only as an example and not necessarily reflective of U.S. figures, though interesting, suggested that a five year deferral increases the risk of HIV transmission via a contaminated blood supply by less than 5%.
This figure would need revising down now as screening methods have advanced considerably and reduced the window of time in which HIV can be hard to detect in a blood sample. The FDA maintains that its current policy is not discriminatory, as evidenced by the language used in its lengthy explanation of the MSM ban.
However, it fails to wholly account for why straight men who have multiple sexual partners and practice unsafe anal sex are not also subject to this kind of ban. As such, and as we have detailed before, any deferral period against MSM without also attaching the same deferral mandate to high-risk straight men and women continues the same prejudicial heterosexual privilege as the lifetime ban and should be no more acceptable than its predecessor.
The Health and Human Services Department said in a statement in late May that the current ban is “sub-optimal” and that it would look again at lifting the restrictions based on a wider scientific analysis.
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