Here in Seattle, as well as nationally, the COVID-19 pandemic has led to a shortage of blood and plasma donations as people stay home and donation drives are canceled.
On April 2, 2020, in response to the national blood shortage from COVID-19, the US Food and Drug Administration (FDA) released revised guidelines which allow donation from gay men and other men who have sex with men (henceforth referred to as gay men) if they have been celibate for the previous 3 months, as well as shortening the waiting period for persons with recent tattoos and piercings, women who have had sex with a man who has sex with men, and persons who have traveled to malaria endemic areas.
This long-awaited change comes after a nearly four-decade-long, highly discriminatory policy initially put in place at the start of the HIV epidemic that prohibited gay men from donating for life.
In 2015, FDA guidance was updated to restrict gay men from blood donation unless they had been celibate for the previous 12 months. While these most recent FDA guideline changes are an important step in the right direction, this policy continues to stigmatize gay men and may have limited impact on their ability to donate.
A survey conducted among sexually active gay men in the Seattle area as part of the Centers for Disease Control (CDC)-funded National HIV Behavioral Surveillance survey found that 91 percent of these men reported sexual activity with another man in the last three months—and thus would remain ineligible for blood donation even under the new guidelines.
While this survey only included gay men who had sex in the last year, these data highlight that many gay men will still be prohibited from donating blood. Of note, all blood donors, regardless of sexual history, are tested for blood-borne diseases like HIV, hepatitis B, and hepatitis C, using highly sensitive diagnostics which dramatically reduces the risk of infection even if a donor is unaware of their own infection.
Furthermore, these FDA guidelines apply not just to standard blood and plasma donation, but also to urgent calls for plasma donation from persons who have recovered from COVID-19 (their plasma is desired right now because it can be used as an investigational therapy for those patients currently suffering from serious COVID-19 infection).
It is critical that we are as inclusive as is safe in allowing anyone willing and able to donate blood and/or plasma to do so, including individuals who have recovered from COVID-19 infection.
Given advances in diagnostic technologies, HIV treatment, and prevention, these most recent FDA guidelines continue to needlessly stigmatize gay men, many of whom would be willing to donate blood and plasma if given the chance. While there have been many calls over the years to revise the blood donation restrictions for gay men, including from our local Bloodworks Northwest, the National Red Cross, and America’s Blood Banks, this is a time when further change could be the difference we need between our current reserves and a blood shortage which increases the risk of death and complications for all individuals who need blood products.
Additional revisions that could expand our potential pool of donors could include following the lead of countries like Spain and Italy, which engage in open conversations about sexual behaviors and potential risk with all donors, not just gay men, to determine eligibility to donate (as risk for HIV is not inherently limited to a single population). The survey mentioned above found over half of gay men locally would be willing to answer such questions in order to donate blood. These inclusive approaches could not only increase our blood supply, but also reduce stigma for all potential donors—especially stigma toward gay men.
Now is the time to end the discrimination of the past and support our community by ensuring that all those who are able to donate blood can—and that people who have recovered from COVID-19 can donate their plasma, too.
Jen Balkus and Vivian Lyons work at the University of Washington Department of Epidemiology.