A year ago today, a gay man in a monogamous relationship with another man would have been banned from donating blood unless he attested that he had been abstinent from sex for three months. Meanwhile, a heterosexual man engaging in unprotected sex with multiple partners would face no such ban. The message from the medical community: all gay people are inherently diseased, high risk, promiscuous, and their relationships are untrustworthy compared to their heterosexual counterparts.
The ban on men who have sex with men (MSM) donating blood was first created during the HIV/AIDS epidemic in the 1980s. In 2015, it was revised to allow men who have sex with men to donate blood if they had been abstinent from sex for 12 months. In 2020, this was shortened to three months of abstinence. Over a decade of evidence has shown that screening based on sexual orientation and gender identity instead of individual-based risk assessments has not increased protection of the blood supply — and has instead deterred people from donating blood.
The United States now faces a critical blood supply shortage that has lasted since the onset of the COVID-19 pandemic. Apparently, now that times are tough for the national blood supply, gay blood isn’t bad blood anymore. On August 7, the American Red Cross (ARC) eliminated the discriminatory practice of risk assessment based on sexual orientation and gender identity, following a change in FDA guidelines in May 2023. The elimination of this blanket ban was a long overdue step in the right direction toward ending medical discrimination against gay and bisexual men and others within the LGBTQ community. Many LGBTQ Americans are torn between anger that this change took so long to come and joy that medicine is becoming more inclusive. The ARC has now adopted individual-based risk assessments for all people, regardless of sexual orientation or gender identity. In doing so, they are acknowledging that MSM are not all the same in their sexual practices and that in fact, many heterosexual men engage in risky sexual practices that warrant screening. In a time when the blood supply is dwindling, hopefully the lifting of this ban will encourage more donations.
Since blood donations are down, the goal of blood donation programs should be in maximizing the number of people who can donate, while keeping the blood supply safe. Many people are still excluded, including people who use PrEP for HIV prevention. The future of blood donation programs should lie in funding advancements in biochemical screening tools for blood products to maximize the protection of the blood supply, while decreasing the need for subjective criteria for people who want to donate blood. After all, the use of subjective criteria often opens the door for discriminatory practices while also being vulnerable to dishonesty or forgetting pertinent historical health information on the part of the donor. Funding advancements in biochemical screening tools will have many benefits for blood donation programs.
Lessons learned from the elimination of blood donation bans based on sexual orientation, and the embrace of individual risk assessments can be expanded to health care at large. Medicine should be based on the multitude of individual factors that can affect one’s health. Medical guidelines that incorporate different diagnoses or treatment strategies based on groupings that are broad, diverse, and often ill-defined, such as race, gender, or sexual orientation, are not patient-centered and are not accurate for the individual. We should strive to create health policies, medical screening tools, and treatment guidelines that acknowledge individual diversity. Overly broad categories such as race and sexual orientation should not be incorporated. Health policy should be based on data, science, and constant review of best practices, not fear and stigma of individual groups. Creating inclusive health policies can benefit us all.
Where do you see the future of blood donation heading? Share in the comments!
Dr. Rory Harte is an Internal Medicine and Pediatrics resident at The MetroHealth System Campus of Case Western Reserve University School of Medicine.
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