Should low-risk gay men be allowed to donate blood?

Apr 18, 2012

Sexually active gay men are prohibited for life from donating blood in the United States due to the risk of HIV transmission. Some activists argue that advances in blood-screening techniques make the lifetime ban outdated and discriminatory. But scientists, even many who support the ban, think that the safety of the blood supply trumps any such concern. In a nation facing a continuing shortage of donated blood, should the federal policy be changed? Medical writer Laura Ungar will discuss the issue online Wed, April 18th at Noon EDT. read her story on this topic here.

Okay, I'm a healthy gay man who hasn't had sex with another person for, oh, close to 5 years (tried it a couple times - didn't like it). And we can immediately rule out intravenous drug use; I can't even fathom why someone would do that. Why should I be considered a threat to the blood supply?

Thanks for your question. Other gay men I spoke with expressed the same sentiment. Two of them said they've been in monogamous relationships for years, get tested for HIV regularly, etc. They said they are not a threat to the blood supply. They also said they had heterosexual friends who had multiple partners, and they didn't think it was fair that they were not considered a threat.

46% of all new HIV infections occur in blacks of both genders and all orientations. Black women are 15 times more likely to get infected than white women. Could you imagine the (justified) uproar if we started asking whether black people should be banned from donating blood?

This is another point that one of my sources made. He said black women are at growing risk for HIV and are not banned from blood donation and he believed gay men should also not be banned.

While not a homosexual male, I find myself in the same situation regarding donating blood. Growing up in a military family, I spent time in Europe. I am now banned from donating blood (along with everyone else who was in Europe in the 1990s) because... I might have mad cow disease?!?! It drives me crazy to hear urgent pleas for blood donations, only to be turned away. Unlike so many other people I know, I do not have a fear of needles and would happily become a regular blood donor. Shouldn't the FDA put a priority on figuring out good screening methods so that as many people as are willing have the ability to donate?

I've heard the same thing from people who travel abroad widely. Personally, I travel to India every year. But the FDA argues that they do use good screening methods now, and that they are trying to be extra-safe and protect the U.S. blood supply. Officials also say the current situation is not ideal and they are researching the situation now.

I admit to being really torn by this. Just like serving in the military, everyone should be able to "do the right thing" without judgment. However, blood-borne diseases are permanent, in that once transfused, you can't remove the offending problem. Having better testing for diseases isn't the fix for this one. One slip-up and someone dies. Or spends their life on meds. I have read that young men don't see AIDS as a death sentence any more, but as a chronic and manageable condition and are less careful about sex, etc. Maybe they wouldn't admit to the screener that they have the virus??

The issue of honesty during the questioning was brought up by a doctor I spoke with for the story. That can be an issue, for anyone, not just for gay men. However, if they actually had the virus and knew it, it would be picked up by the blood testing. In fact, if someone had the virus and didn't know it -- and had contracted it more than about 11 days ago -- the testing would tell them that they had the virus. And the blood would not be used.

I had no idea that gay men were prohibited from donating blood. This makes no sense to me. Last I checked, heterosexuals can also contract HIV. If their blood can be screened to deem it safe, why can't that of gay men? Seems a silly rule.

Several people I have spoken with share this view, although others say it's better to be safe when it comes to any group at higher-than-average risk of HIV. Your point about heterosexuals also contracting HIV was made to me any times, particularly by gay men in long-term, monogomous relationships who said they have heterosexual friends with multiple partners who are allowed to give blood.

In South Africa, where there is a high rate of HIV infection--mostly amongst women--the topic also arose. The defense given was simply that internationally gay men are deemed higher risk. The issue is not about gay or straight people. The issue is blood safety. Where critics get it wrong is simply that they don't acknowledge that heterosexuals partake in unsafe practices, including high risk anal sex, that not all gay men partake in anal sex, that heterosexuals are far more promiscuous (look at the divorce rate) and a host of other bias judgements. Ultimately, such ignorance poses a greater risk to blood safety than a person's sexual orientation.

Certainly several advocates I've talked to on the subject agree, pointing to the same issues you do about sexual practices versus populations. The FDA and its supporters argue that they are not discriminating against a particularly group, however, just trying to keep the blood supply safe.

Please explain the facts of this issue so I and others can better understand it. How advanced are new blood testing techniques in terms of accurately determining if a donor has HIV, hepatitis, or any transmittable disease? How long does it take for these tests to be done, and thus what is the potential time lapse between the test results and an undetected disease emerging? How much does the test cost and is this affordable for most blood donor centers?

My understanding is that if someone contracts the virus, there's a window of about 9-11 days when the most sensitive test (which is used in blood donation) cannot detect the virus in the person's blood. But if it was contracted before that, it will show up, even if the person does not know he or she is infected.

I believe that the blood services all are required to test for various STD's that can be transmitted by blood transfusions before the blood is used. What is the time elapsed time between when someone acquires various STD's, and AIDS, specifically, and when it shows up on the test? If the disease shows up on my test within, say, a week, shouldn't the screening question ask if I have had sex with another man within the past week, or maybe two just to be safe? Why ask "Have you EVER ...?" And the same issue applies to the "have you ever been paid to have sex?" question, doesn't it?

Other people I talked to asked the same question about why there is a lifetime ban when the window between contracting the virus and detecting it is less than two weeks. Some scientists who want to err on the safe side say it should be shortened to a matter of months since the last sexual encounter. England's rule on blood donation says a year. On the issue of payment for sex, that is to find out if someone may be a prostitute and therefore more likely to have sex with multiple partners and be more susceptible to HIV.

I'm technically banned from giving blood because I lived in England, and there is a concern for spreading mad cow disease. But as a vegetarian, I haven't been exposed possibly-infected meat. So, quite frankly, I lie about this question on the form. I talked to a friend who has worked at blood drives and she agrees that it's okay for me to claim I haven't lived in England. What would you think about a gay man who is low-risk lying about his sexuality in order to donate?

I can't really give an opinion. But a doctor I spoke with did bring up the issue of lying when asked the blood donation questions. Some people do it, but doctors view this as very dangerous. There are some states with laws against lying in such cases, in fact.

Why should the medical profession play Russian roulette with patients lives by giving them any blood with any risk attached?

The FDA and its supporters point to the same issue, about safety being paramount. But critics of this blood policy say there's many instances of risk. For example, a heterosexual person who has multiple partners may be at risk for HIV, but that would most likely not come up in the questioning.

I had a 16-year-old charged with car theft. His mother met with me and sobbed out the story that his younger brother really stole the car - but that the one in jail was taking the blame because the thief had been infected with AIDS through a blood transfusion. This was the late 90s. The younger teenager was dying because he also had cancer (hence the transfusion). His mother said "his body can't fight both. He could survive the cancer, but the AIDS is killing him." The older brother wouldn't admit he was trying to spare the younger one. ANY risk, no matter how minimal, should keep sexually active gay men from donating blood. The 14-year-old who was dying changed my mind about this forever - as did the 16-year-old who went to jail to protect his dying brother.

Certainly some of the people I spoke with would agree with you. But several people pointed out that things were much different in the 1990s. Screening and testing for HIV was not as good, and HIV represented a much greater threat to the blood supply then. You may recall the case of Ryan White, the Indiana teen who developed AIDS from a blood transfusion. But such cases are extremely rare these days.

Thank you for hosting a chat about this. As someone who donates every 60 days, I am always perplexed when I get to section of questions about HIV transmission. I understand the concern and the ban; but, if blood sceening can pick-up dormant (I'm not sure how else to describe it) HIV, then I'm not sure that the ban is needed. Especially since all blood is tested before it's used.

Several people I spoke with expressed this same view. There is a small window in which someone can have the virus, but the test will not pick it up. But in the vast majority of cases, testing would pick it up.

How do you suggest a change in such policy should be made given the history of the HIV/AIDS crisis from infected blood donations in the 1980s, and the heavy burden of HIV that still exists in the MSM community and the small percentage of the population they account for? From a public health perspective do the means to a 'fair' blood donation system (additional testing, questioning, etc.) justify the ends?

I can't really suggest a change in policy, given that I'm a nuetral journalist. But many in the public health community -- and some doctors I spoke with -- said the most important thing is to keep the U.S. blood supply safe and err on the side of safety. And the FDA argues it is not being discriminatory, just trying to keep the blood supply safe.

"For example, a heterosexual person who has multiple partners may be at risk for HIV, but that would most likely not come up in the questioning." Any person having sex is at risk for HIV. What I think you mean is a 'heterosexual person who has multiple partners may be at a HIGH risk for HIV than a homosexual person with one monogomous partner for the last 10 years'.

Yes, that is what I mean -- higher-than-average risk. Having a high number of multiple partners puts someone at high risk. And you're right; anyone having sex would be at risk for HIV.

Aren't gay men 200 times more likely to carry HIV than straight men? How can any gay man thus be low-risk?

I have not seen the "200 times" figure, but the federal government does say the prevalance is much higher among men who have sex with men than among the general population. However, several gay men, and some medical professionals I spoke with, said they consider gay men in long-term, monogomous relationships who are tested regularly for HIV to be at lower risk than, for example, heterosexuals with many multiple partners.

So if they're worried about that 9-11 day window, how about you give blood, and then two weeks later go back for a re-test? If you pass that, they release your previously donated blood. Sexual orientation has nothing to do with it, and I third the previous comments about heterosexuals engaging in high-risk activities.

Several people brought up the issue of heterosexuals engaging in high-risk activities -- particularly promiscuity -- and said they don't think it's fair that they are allowed to donate blood when men who have sex with men are not, even if they have one long-term partner.

Thanks for your questions, everyone. I've got to go now, but it's been a great conversation.

In This Chat
Laura Ungar
Laura Ungar, the Courier-Journal's medical writer, has been a journalist for over 20 years and has won national, regional and local awards for her work in Connecticut, Delaware and Kentucky. Ungar lives in Louisville with her husband, Stu, and two children.
Recent Chats
  • Next: