FEATURE
myth: Gay Men’s Blood Is Dangerous
Jesse M. Ehrenfeld, MD, MPH, director of Vander-
bilt University Medical Center’s Program for LGBTI
Health, seems to be a perfect candidate for a blood
donor: He is one half of a monogamous married
couple, is young, and is in good health – and he
happens to be a professor of anesthesiology, surgery,
biomedical informatics, and health policy at Vander-
bilt University in Nashville, Tennessee.
But Dr. Ehrenfeld is excluded from giving blood,
based on the FDA’s 12-month deferral policy for
men who have sex with men (MSM), meaning MSM
donors must wait at least 12 months after their last
sexual contact with a man before donating.
The ban originated during the HIV/AIDS epi-
demic of the 1980s. When a 1983 study strongly sug-
gested that AIDS was caused by a bloodborne patho-
gen, concerns rose worldwide that this unidentified,
potentially lethal pathogen could have contaminated
the nation’s blood bank supplies. Because HIV/AIDS
was more prevalent among gay men than the general
population, the FDA issued a blanket, lifetime ban of
MSM donations. In 2015, the FDA revised its policy
to the present 12-month deferral policy.
“I am ‘Client A.’ I am a gay, married man who
is monogamous. Because of my service in the U.S.
Navy, I get routinely tested for HIV, and I am HIV-
negative. Yet, I am still not able to donate blood,”
period” – the time from when an individual is
infected with the virus to when a test can detect it
– and that have much better sensitivity. The fourth
generation of HIV testing offers a near-100 percent
sensitivity, and every blood donation is tested for
HIV, for a nine- to 14-day window. 12
Dr. Sacks noted that, “With updated tests, the
risk of HIV transmission has decreased to one in
1.5 million. These advances in blood safety have
everything to do with improved testing technology
and nothing to do with progress in deferral practic-
es.” They called for revised blood screening policies
that rely “on our current best evidence rather than
remaining mired in a history of our worst fears.”
Dr. Ehrenfeld favors replacing the blanket
restriction with individual risk-assessment policies
and categorizing MSM into those with low or high
risk for HIV. “Under this model, Client A would
be deemed a safer candidate for blood donation
because he is in a long-term monogamous relation-
ship,” he explained. “This individual assessment
policy assesses potential donors strictly based on
what is described as ‘risky sexual behavior,’ regard-
less of their sexual orientation.”
Implementing individual risk assessment is a chal-
lenge, though, especially in the large-scale U.S. blood
donation system, Dr. Ehrenfeld noted. “That is one
barrier prohibiting this concept from moving forward.”
“[Disaster donations are] not necessarily
good for the sustainability of the blood
supply. ... We hope to educate people to
look beyond the disaster.”
—STEVE BOLTON, America’s Blood Centers
her baby has Rh-positive blood, the Rh antibodies can
cross the placenta and lead to the potentially fatal condi-
tion of hemolytic anemia in the infant. 14
“This condition, which is entirely preventable,
can be devastating to the unborn baby,” Dr. James
emphasized. “The extended typing of RBC antigens,
which is now done routinely to some extent in other
countries in Europe and Australia, could ensure that
a pregnant woman, or any woman with childbearing
potential, is not given Rh (D, C, E, c, e), Kell, or pos-
sibly Kidd, Duffy, or Ss mismatched blood.”
Dr. Ehrenfeld emphasized that the growing use
of pre-exposure prophylaxis (PrEP) for HIV preven-
tion, in homosexual and heterosexual communi-
ties, may affect blood donation policies. A potential
blood donor on PrEP who becomes unknowingly
infected with HIV – known as a PrEP breakthrough
infection – can have suppressed viral replication. 15
“That means the viral load is undetectable even by
the most sensitive HIV test. Failure to seroconvert also
has been observed with second-, third-, and fourth-gen-
eration screening tests,” Dr. Ehrenfeld noted. “You can
imagine if a person on PrEP was tested during blood
donation, the results could be difficult to interpret.”
However, excluding people on PrEP from
donating is not necessarily the answer. “PrEP
breakthrough infection is a rare circumstance, and
the risk is not zero, so that needs to be balanced as
policy as developed,” Dr. Ehrenfeld said.
Everyone agreed that balance is key for any change
in blood-donation policy, keeping in mind the dual
goals of increasing the pool of eligible blood donors
in the U.S. and maintaining the safety of anyone who
receives donated blood. While questions about the
value of recruitment efforts or monetary incentives for
repeat donors remain under investigation, clearing up
the myths, misconceptions, and uncertainties about
who can donate could put the U.S. blood supply on
more stable footing.—By Shalmali Pal ●
REFERENCES
Dr. Ehrenfeld said. “The FDA policy doesn’t allow
for someone like me who is low risk and willing
and able to donate blood.”
He was referring to a 2016 New England Journal
of Medicine editorial that criticized the “flawed logic”
of the 12-month deferral policy. “Client A, a married,
monogamous gay man who, along with his husband,
has for decades repeatedly tested negative for HIV can-
not donate blood,” author Chana Sacks, MD, posited.
“However, Client B, a heterosexual man who has
had unprotected sex in the past month with multiple
women of unknown HIV status is allowed to donate.” 12
Client B has the higher chance of introducing HIV
into the blood supply, she continued, yet “Client A has
been told unequivocally that the medical community
sees his blood as unclean, not because of high-risk
behavior but because of the sex of his spouse.”
“There were also other groups of people that we
now recognize as high-risk donors – prison i