There’s a major blood shortage in the U.S. right now, exacerbated by the pandemic, the holiday season, and recent winter storms that have cancelled blood drives while sometimes increasing demand.
Cally Edwards, the Communications Director for the Eastern North Carolina Red Cross, said the shortage is the worst in ten years. Tornadoes in Kentucky and Tennessee limited blood collection in those areas, and recent winter storms have likely caused similar problems.
“If more donors don’t come out to give, hospitals may be forced to delay care to patients relying on blood transfusion. It’s almost unimaginable,” she said.
But even as the Red Cross is struggling to meet demand, some prospective donors are still barred from giving blood.
Men who are sexually active with other men (MSMs) aren’t allowed to donate blood unless they’ve been celibate for three months. And while that’s a long time, it’s actually shorter than it used to be: the U.S. Food and Drug Administration used to require a year between the last date of sexual contact with another man and the date of blood donation. The same policy was in place for tattoos.
But in April of 2020, the FDA released new guidance that changed that time limit from 12 months to three months. The goal was to help more donations come in during an earlier blood shortage caused by the pandemic. Still, healthcare advocates and queer activists alike say the limit is still discriminatory, and not based in science.
Low-risk, but still excluded
Matt Bigham is a teacher at Winter Park Elementary, and has been in a committed partnership with another man for 23 years. He says the guidance still feels like bigotry.
“I think it's just part of the age-old discrimination against gay people, especially gay men,” he said. It’s been more than 20 years since he last gave blood, though he’d do it much more often if he were allowed.
“I believe its part of my civic duty to give blood,” Bigham said. “There's a good chance that, especially as I get older, I'm going to be in the hospital one day, and I'm going to need it. So I think we should all do our part. But unfortunately, the rules keep me from doing my part.”
Bigham’s risk of providing blood that’s unsafe is very low — his risk level is the same as any married person, or any other person in a committed relationship. And all blood used for transfusions is tested for HIV and other diseases, so any infected blood should be caught, regardless of the donor’s sexual orientation or activity.
The FDA could change guidelines, but does 'not have a specific timeline'
The FDA is in the process of exploring different safety regulations for MSMs through the ADVANCE study (Assessing Donor Variability And New Concepts in Eligibility). The program is only running in eight larger cities, including Atlanta, GA and Washington, D.C.
Rodney J. Wilson, the Senior Biomedical Communications Specialist for the Red Cross, said the study is funded by the FDA. It launched a year ago, and involved 2,000 participants across eight cities. “The Red Cross believes blood donation eligibility should not be based on sexual orientation and is committed to working toward that goal,” Wilson said, though it’s unclear whether the number of excluded donors would make a significant difference for the blood shortage.
ADVANCE participants donate blood for assessment, and also answer questionnaires aimed at determining their risk-level for transmitting HIV. They’re asked about the number of male sexual partners, type of male sex, condom use, sex with an HIV positive person, and lastly about the type and frequency of PrEP use — that's pre-exposure prophylaxis, medication used to preemptively block HIV infection from sexual contact or injection drug use.
“The study is designed to assess if the questions related to behaviors are effective in distinguishing between MSM who have recently become infected with HIV and those who do not have HIV infection,” Wilson said.
In a statement, the FDA said “We do not have a specific timeline for when these studies may be completed, but remain committed to gathering the scientific data that can support alternative donor deferral policies that maintain a high level of blood safety.”
Bigham thinks that kind of questionnaire would probably allow him to donate blood again. “I think my personal risk could be very low for infecting the blood supply. And I mean, I would assume they would test it.”
Other issues with FDA guidelines
The ban on MSMs who are sexually active impacts other queer people, too.
In order to assess whether someone is eligible to give blood based on the sexual orientation requirements, the FDA asks donors their gender. There are two options: male or female. That excludes donors who identify as non-binary, and they are then forced to choose one option or another.
The FDA said it “did not foresee the issues that blood establishments are encountering when prospective donors identify as non-binary.” It also does not provide any recommendations to donation centers for how to deal with the problem, so non-binary donors who wish to give blood are forced to mis-gender themselves and lie on a federal form in order to donate.
The FDA doesn't have any current plans to address that concern, and doesn't have a specific timeline for the ADVANCE study to change its three-month celibacy policy. But Bigham hopes the policy will change soon.
"It makes me feel inferior. I already live in a state where our lieutenant governor, Mark Robinson, refers to homosexuality as filth," Bigham said. "And so that doesn't help, when I can't even do things like go give blood?"
The Red Cross is still seeking donors to help with the ongoing national blood shortage. Those interested and able to donate can find out how at RedCrossBlood.org.
