Let’s Assess Sexual Behavior Rather Than Sexual Orientation
In May 2023, the United States lifted its longstanding restrictions on blood donations from men who have sex with men, marking a significant victory for the LGBTQ+ community. This policy change represented a major step forward in addressing the injustices that had persisted for decades, as it replaced the previous deferral period with a more inclusive approach based on individual risk assessments rather than sexual orientation. This policy shift not only corrected a historical wrong but also highlighted the enduring impact of advocacy in combating prejudice and advancing equality. However, years of stigma and discrimination associated with restrictions on blood donations had unjustly marginalized gay and bisexual men, perpetuating harmful stereotypes and limiting their ability to contribute to vital blood supplies.
Blood Donation Bans in Response to the AIDS Crisis
Previously, we touched upon the impact of the AIDS crisis in the 1980s—a devastating period that predominantly affected gay men. As a response to the crisis, in 1983, the U.S. Food and Drug Administration (FDA) enacted a ban that prohibited gay and bisexual men from donating blood. The rationale behind this decision was to protect recipients of blood transfusions from the potential risk of contracting HIV.
The ban was not just a temporary precaution. Unlike other restrictions that might allow for eventual eligibility, such as a period of celibacy, the FDA's stance was absolute: any man who had ever engaged in sexual activity with another man, whether anal or oral, was indefinitely barred from donating blood. This policy was mirrored by many countries worldwide, leading to a global pattern of discrimination against gay and bisexual men in blood donation practices.
While the initial implementation of the ban might be understandable, given the limited knowledge about HIV/AIDS transmission during the early years of the epidemic, the persistence of these restrictions long after advancements in medical understanding and testing for HIV raised critical questions about their fairness and necessity.
Advancements in HIV Testing and Prevention
In the early 1980s, HIV testing was a lengthy and often uncertain process. The first generation of HIV tests required patients to wait months before the virus markers reached detectable levels in their blood. According to the Association for Diagnostics & Laboratory Medicine, a positive screening often meant patients had to return for further testing, adding to the confusion and uncertainty surrounding an HIV diagnosis.
Testing methods at the time were not only time-consuming but also lacked the high level of accuracy we expect today, which often required repeat testing to confirm results and contributed to a great deal of anxiety and uncertainty for individuals awaiting their HIV status.
However, the landscape of HIV testing has dramatically changed since then. Advances in technology have given rise to newer generations of tests that deliver results much more quickly and accurately. Today’s HIV tests are between 99% to 100% accurate and can deliver results within just a few days. Rapid tests are even more efficient, providing results in as little as 30 minutes with approximately 99% accuracy.
Furthermore, nucleic acid tests (NAT) can detect HIV exposure that occurred as recently as two weeks before testing. For instance, if someone is exposed to HIV on a given day, known as "day one," they can be tested on day 15, and receive accurate results shortly thereafter. This improvement underscores how far HIV testing has come from the 1980s, offering not only quicker results but also greater peace of mind with enhanced accuracy.
Additionally, PrEP (Pre-exposure prophylaxis) emerged in the early 2010s as a groundbreaking HIV prevention method involving a daily pill that is 99% effective at preventing HIV transmission when taken correctly. Initially approved by the FDA in 2012, it was quickly embraced by the gay community as an empowering tool to take control of their sexual health and reduce the stigma associated with HIV. By providing a highly effective barrier against the virus, PrEP has been a pivotal factor in transforming HIV prevention strategies among gay men, fostering a sense of security and opening up conversations about safe sex practices.
Despite these advancements, restrictions on blood donations from men who have sex with men continued to persist, rooted in outdated assumptions from the early days of the HIV epidemic. While the science behind HIV testing evolved significantly, policies surrounding blood donation had not fully caught up, continuing to enforce bans that many argued were based on stigma rather than current medical understanding.
The Easing of Blood Donation Restrictions for Gay and Bisexual Men
Even with significant progress in testing and prevention, the FDA was slow to update its policies. It wasn’t until December 2015—32 years after the initial ban—that the FDA revised its policy, allowing gay and bisexual men to donate blood, but only if they had abstained from sexual contact with another man for at least one year. While this change was a step forward, it still singled out gay and bisexual men, requiring them to abstain from sex in a way not expected of heterosexual individuals. For instance, a straight person in a monogamous relationship would not be asked to abstain from sex to donate blood, while a gay man in a monogamous same-sex relationship would.
Advocates like Kelsey Louie, then head of Gay Men's Health Crisis, argued that these restrictions perpetuated the stereotype that HIV is a "gay disease." This belief was damaging, especially given that many straight individuals could engage in high-risk sexual behaviors without facing the same restrictions. Meanwhile, gay men who are often more vigilant about their sexual health, routinely getting tested, and even using preventative measures like PrEP, were still subjected to deferral periods based solely on their sexual orientation.
In April 2020, amid a critical blood shortage during the COVID-19 pandemic, the FDA revised its guidelines again regarding blood donations from men who have sex with men. The new criteria required men who have sex with men to abstain from sexual activity for three months before being eligible to donate blood.
While this policy marked another improvement over previous restrictions, it still faced criticism for being discriminatory, as it targeted individuals based on sexual orientation rather than actual sexual behavior. For example, a gay man in a monogamous relationship would still be barred from donating blood if sexually active, while a straight person with multiple sexual partners could donate without any required abstinence period, even if they had never been tested or were unaware of their HIV status.
The Stigma Associated with Blood Donation Policies
Some may wonder why these policies are significant. First, during critical times like the COVID-19 pandemic, when blood shortages were severe, the inability of gay men to donate—even those who had recovered from COVID-19 and could contribute valuable antibodies—underscored the irrationality of these restrictions. Second, these bans perpetuate the stigma that HIV is a "gay disease," contributing to feelings of shame and internalized homophobia among LGBTQ+ individuals. Lastly, these policies also have practical implications: some companies offer incentives, like paid time off, for employees who donate blood, but these benefits may be inaccessible to gay men who are unable to participate due to the deferral period.
Fortunately, advocacy groups like the Human Rights Campaign (HRC) continued to push for further revisions to the FDA's blood donation guidelines, arguing that the donor questionnaire should evaluate the risk based on specific sexual behaviors rather than generalizing based on who a person loves or their gender identity. For example, a gay man on PrEP should not face additional barriers compared to a straight individual whose sexual behaviors may pose a similar or even greater risk.
The Importance of Advocacy and Awareness
As we celebrate these hard-won changes, it’s essential to continue raising awareness, particularly among allies who might not be aware of ongoing disparities. The gains in LGBTQ+ rights, such as workplace protections and the lifting of blood donation restrictions, were achieved through tireless advocacy and shared stories that brought these issues to light. The legacy of that advocacy serves as a powerful reminder of the impact of collective action and the ongoing need to challenge inequalities wherever they persist. Sharing this history and these ongoing struggles with others, especially straight allies, is a critical step in ensuring that the fight for true equality continues, drawing from the lessons learned and the victories won along the way.
And remember. Every day is all we have, so you've got to make your own happiness.
For more information on this topic, listen to Episode 14. The Ban on Gay Blood Donations.
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