Why so many gay and bisexual men can’t donate blood in the U.S.

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Sam Brinton appears in Washington, D.C. Photo by Ivette Feliciano and Zachary Green/PBS NewsHour

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By Ivette Feliciano and Zachary Green

This past June, the U.S. experienced its biggest mass shooting to date, when a lone gunman opened fire in an Orlando nightclub. Over 100 people were shot, 49 fatally.

In the aftermath of the shooting at the club — a popular hangout spot for the local LGBT community — thousands of people lined up around the block to donate blood. But even as outpourings of sympathy and condolences were sent to members of the gay community, hundreds of gay and bisexual men who wished to donate were turned away from local blood banks.

While many people were outraged by this turn of events, the fact is that gay men have been legally barred from donating blood in the US for the past 30 years. In the midst of the AIDS epidemic in the mid-1980s, the U.S. Food and Drug Administration, which oversees federal blood donation policies, authored guidelines that restricted blood banks from accepting donations from men who had sex with men. These restrictions were held in place until December 2015, when the FDA lifted its lifetime ban on gay and bisexual men donating blood. The new guidelines stipulate that men can only donate if they have refrained from sexual activity with other men for a period of no less than twelve months.

Kelsey Louie, CFO of the Gay Men’s Health Crisis, which was formed in the early years of the AIDS epidemic, said that this policy is based more on prejudice than scientific evidence. “By banning a group of people from partaking in an activity based on who they are and how they identify, that is discrimination,” he said. “If you think about it, what this policy is saying is that a gay man who is in a monogamous relationship is at higher risk than a heterosexual person who is having unprotected sex with several partners. And that just isn’t accurate. That’s not true. We’re looking for a fair and science-based approach.”

But researchers and medical experts point out that men who have sex with men are at a higher risk of contracting the AIDS virus than others. In 2014, gay and bisexual men accounted for 67% of HIV diagnoses.

Brian Custer is a medical investigator who helped to write several studies that the FDA used in coming up with its new guidelines. He said that the emphasis should be on keeping the blood supply safe for recipients. “There are many acts, many reasons why we don’t allow individuals to donate,” he says. “Not because they belong to a specific group, but because that group or that issue or that behavior could truly pose a risk to a blood recipient. And if it could, that’s where we err. We err on that side.”

Last month the FDA announced that it will be reevaluating its policy yet again and is asking the public to submit any new scientific research that will help in its decision making.

This report contains discussions of a sexual nature, including clinically explicit language, that may not be appropriate for all viewers. Read the full transcript below:

IVETTE FELICIANO: On a recent Friday morning, in Sterling, Virginia, the staff at Inova Blood Donor Services is gearing up for a blood drive at a Washington Nationals baseball game. Inova supplies blood products to 25 hospitals in Washington D.C., Maryland and Virginia.

A.J HUGHES: It would be great if these were completely filled. Ugh, that one is empty.

IVETTE FELICIANO: Manager A.J. Hughes estimates the drive will net the center 400 donations, helping replenish its low blood supply.

A.J. HUGHES: Summer is always kind of a tough time for us. We have a really tough time getting donors in.

IVETTE FELICIANO: 28-year-old Sam Brinton would like to donate to the Inova Center, but can’t, because of a 33-year-old government ban preventing men who have sex with men from donating blood.

The policy, implemented by the Food and Drug Administration at the start of the AIDS epidemic, requires gay and bisexual men like Brinton to affirm they’ve abstained from sex for a whole year before giving blood.

SAM BRINTON: As a bisexual, if I were to sleep with women for the next year, FDA says, “Way to go, you’re an awesome person, you’re allowed to give blood.” If I sleep with my boyfriend for the next year, “You’re a horrible person, and you’re not allowed to give to those who you might want to give.” Now they’re not saying it in such explicit terms, but limitation provides stigma.

IVETTE FELICIANO: A national spotlight fell on the FDA’s blood donation restriction after the mass shooting inside a gay nightclub in Orlando, Florida, in June. The morning after 102 people were shot, 49 fatally, there were long lines to give blood. Hundreds of gay men were turned away.

SAM BRINTON: I went to go try to give blood and again was told, ‘No.’ You see on the television people, your brothers and sisters, bleeding in the streets. You saw that video. And there’s nothing you can do. You’re being told, ‘No, your blood is not worthy.’

IVETTE FELICIANO: For Brinton, the rejection was especially painful. Two good friends, Drew Leinonen and Juan Guerrero, had been killed inside the club.

SAM BRINTON: Drew and Juan had been dating. I had literally seen them the week before.

IVETTE FELICIANO: Until recently, the ban was even stricter. In fact, it was permanent. The policy dates back to 1982, when a abby was infected with AIDS through a blood transfusion given at the University of California San Francisco hospital Shortly after, the FDA, which regulates the nation’s blood supply, instituted a lifetime ban on blood donations from all men who admitted having sex with other men. Since then, advancements in testing technology have greatly improved.

Today, blood banks screen for HIV, the virus that causes AIDS, with an acucracy rate of 99.99%, according to the FDA. Typically, all blood donations are screened for HIV twice. One test checks for the direct presence of HIV genetic material and the other looks for antibodies produced by the immune system to fight HIV. Today, the odds of getting an HIV infection through a blood transfusion are one in 1.5 million, less likely than being struck by lightning.

The Centers for Disease Control and Prevention estimates there were more than 9,000 transfusion-related HIV transmissions between 1981 ad 1985. Then, as testing methods improved, the numbers dropped to the single digits per year. Since 2000, there have been only 4 confirmed cases in the U.S.

Still, as of 2014, 636,000 Americans had died from AIDS. 1.2 million people in the U.S. have the disease, according to the CDC.

Dr. Peter Marks is the director of the FDA’s Center for Biologics Evaluation and Research.

IVETTE FELICIANO: Do you believe that the FDA’s policy is discriminatory?

DR. PETER MARKS: I don’t believe it’s discriminatory, because I believe it’s not a policy that’s based on a sexual orientation; it’s based on keeping the blood supply safe.

IVETTE FELICIANO: While gay and bisexual men have the highest rates of new HIV infections, accounting for 67 percent of all diagnoses in 2014, Marks says the term “gay” isn’t used in the policy because many men who sleep with men don’t always identify as gay or bisexual.

DR. PETER MARKS: It’s not a gay blood ban. It’s not about what you call yourself. It’s about a behavior. And that behavior is associated with certain risk. At the risk of blushing before camera, the clear thing that’s most highly associated with the transmission of HIV is anal receptive intercourse. And there’s no way around that.

IVETTE FELICIANO: But clearly men who have sex with men aren’t the only people engaging in that sort of sex.

DR. PETER MARKS: That’s correct, except that they’re the ones that are involved with the highest risks of transmitting it through that mode. And unfortunately we know that anal receptive intercourse is associated with a relatively high condom failure rate each episode. I understand, people want to be able to donate blood. And feel that they’re doing good. And I’ve heard, “Well we use protection,” or, “I’m monogamous.” The problem is that if you use protection each time, you may not know that it failed. And unfortunately you could have become infected then.

IVETTE FELICIANO: Another important player in this debate is Brian Custer, a senior investigator at San Francisco’s Blood Systems Research Institute, one of the nation’s largest blood collectors. Custer spearheaded several studies, which led the FDA just last December to amend its lifetime ban on blood donations from men who have sex with men to a 12-month deferral, meaning donors must have abstained from sex with men during that time.

BRIAN CUSTER:There are many acts, many reasons why we don’t allow individuals to donate. Not because they belong to a specific group, but because that group or that issue or that behavior could truly pose a risk to a blood recipient. And if it could, that’s where we err. We err on that side.

IVETTE FELICIANO: In fact, Custer says only 4 in 10 Americans are eligible to donate blood at any given time because of a host of ever-changing FDA bans and deferrals. Like the restrictions for people who have traveled to countries with Zika outbreaks, people with Hepatitis C, sex workers, intravenous drug users, and anyone who recently got a tattoo or piercing.

The Gay Men’s Health Crisis, a New York-based advocacy group that formed in the early years of the AIDS epidemic, considers the FDA rules for men who have sex with men discriminatory. Kelsey Louie is the organization’s CFO.

KELSEY LOUIE: By banning a group of people from partaking in an activity based on who they are and how they identify, that is discrimination. How would you feel if you were told that you would still have to wait a year before you could donate blood? A year where you had to be celibate before you could donate blood? It’s still unfair. It’s not based in science.

IVETTE FELICIANO: Louie believes all potential donors should have their risk factors evaluated individuals, such as whether a man or a woman has multiple sexual partners, has unprotected sex of any kind, and lacks awareness of his or her HIV status.

KELSEY LOUIE: If you think about it, what this policy is saying is that a gay man who is in a monogamous relationship is at higher risk than a heterosexual person who is having unprotected sex with several partners. And that just isn’t accurate. That’s not true. We’re looking for a fair and science-based approach.

IVETTE FELICIANO: Brian Custer, who advocated for the new 12-month deferral, stopped short of recommending completely lifting the ban. In part, because research shows that HIV-positive blood donors were more likely to report a history of male to male sexual contact than donors without HIV. And even though tests are now highly accurate, there is a so-called “window period” of up to 10 days when a person could test negative for HIV, even when they are actually positive.

BRIAN CUSTER: It’s not trying to say that all men who have sex with men, even if they’re sexually active, are at high risk for HIV acquisition or anything like this. But it is trying to say that in total, there is a higher risk there, and for that reason, this was sort of the place to start a change in this deferral.

IVETTE FELICIANO: While it is a felony in many states to knowingly donate HIV-infected blood, blood banking questionnaires used to screen potential donors depend on the honor system.

AJ HUGHES: They answer a series of about 50 questions that cover anything from their health history, travel history, sexual history. No stone unturned.

IVETTE FELICIANO: Yet, researchers at the University of Wisconsin and the FDA have found many men who have sex “knowingly donate despite the deferral.” The FDA’s data shows HIV rates for those donors are much lower than expected.

DR. PETER MARKS: It is clear that men who have sex with men who come to donate blood seem to have self-selected in some way. That being said, even with that self-selection, their risk is many-fold higher than a person who has sex with an individual of the opposite sex, even with multiple individuals of the opposite sex, who comes to donate.

IVETTE FELICIANO: Last month, the FDA announced it is re-evaluating its blood donation policy yet again. Sam Brinton is hopeful that ultimately the ban will be lifted.

IVETTE FELICIANO: Why is your blood safe?

SAM BRINTON: In the end, it’s safe because I’m safe. I make decisions about my sexual desires and my sexual activities from a place of intelligence. We recognize that risks exist. No person that is giving blood doesn’t think that risk exists. We just want it to be managed in a way that is respectful.

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