Thousands readily poured into blood banks following the Pulse Nightclub shooting on June 12th, 2016 in Orlando, Florida. Taking 49 lives and injuring over 50 more, the attack is believed to be the worst mass shooting recorded in American history. Yet despite the need for blood and a nationwide shortage, many men were turned away at the door—because they have sex with other men.


Regulations overseeing blood donations from men who have sex with other men (MSM) remain considerably contentious. Many find it surprising that, in the United States, the lifetime ban on blood donations from MSM was only lifted by the Food and Drug Administration (FDA) last year in December. Now, men who have had sex with other men must abstain for 12 months before they are allowed to donate—regardless of their sexual practices. Similar to the United States, Health Canada implemented a 12-month deferral period just this past August. Prior to this, between 2013 and 2016, MSM had to wait a full 5 years before becoming eligible to donate.

Many activist groups, medical personnel, and legislators argue that the current guidelines for blood donations are still discriminatory in nature. Gay men dispute a much higher quantity of blood would be available for distribution if such injunctions were alleviated, as many donation agencies struggle to meet ideal benchmarks. The FDA, however, maintains that their decision is founded on supportive scientific evidence and risk assessments aimed at protecting the public.

When an individual donates blood, about 450 mL is typically collected for transfusions, with a small amount reserved for screening purposes. Along with antibody detection, nucleic acid amplification technology (NAT) is presently used to screen for HIV, hepatitis C, and West Nile Virus. Blood samples from different donors are simultaneously tested in pools of 6 and if a pooled sample gives positive results, each of the 6 will then be tested individually to select for the infected one. The donor to which the sample belongs will be notified and all products isolated from that sample will ultimately be discarded. Based on this screening protocol, the current likelihood of transmitting HIV via blood transfusions is 1 in 1.5 million; however, the FDA estimates that this fraction could increase to 1 in 375,000—a proportion deemed to be exceedingly high—if the 1-year restriction is lifted. Furthermore, it must be remembered that recipients of blood donations can be extremely susceptible to infection. Comprising of not only wound victims, but also organ transplant and hemophilic patients, it is imperative that blood contributions be free of pathogenic contaminants.

Even with progressions in screening technology, all communicable diseases possess a “window period” where pathogen levels are so low in the patient that infection cannot be reliably detected. For HIV, this diagnostic period has been reduced to 10-15 days, but that assumes arduous testing was employed and that a typical patient was taken into consideration. Some cases may require even more extensive analyses.

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Compared to the average heterosexual individual, MSM are at a higher risk of contracting HIV, syphilis, hepatitis C, and chlamydia. It takes a minimum of 4-6 weeks for hepatitis C to become detectable and can take up to 3 months for antibodies to emerge in the blood. The symptoms of a hepatitis C infection—some of which include mild fever, joint aches, nausea, and loss of appetite—are difficult to recognize in its early stages and are often mistaken for some other more common illnesses. What sparks the most concern from donation agencies is that an infected individual may unknowingly make a blood donation during this elusive infectious phase of disease.

In addition, current screening procedures rely on the honesty of donors and accuracy of laboratory tests—both of which can be subject to error. With the intricate application process, screening procedures, and regulations, it is not uncommon for donors to lie. Individuals who oppose the 1-year restriction have openly admitted on public forums to putting down false information in order to donate—raising additional apprehension from blood banks.

Despite these arguments from the FDA, the American Red Cross and American Association of Blood Banks have both expressed discontent with the standing policies and have requested the FDA make further amendments. Sharing this view is Kelsey Louie, the CEO of Gay Men’s Health Crisis (GMHC), who states “it is time to create a blood donation policy that is inclusive and based on science, not stigma.”

One criticism of the current protocols in place highlights the fact that a heterosexual male with many sexual partners possesses a higher risk of HIV transmission than a gay or bisexual man in a monogamous relationship where both partners have been certified to be HIV-negative. Issues have also arisen on the subject of women and their roles in HIV transmission. According to the Public Health Agency of Canada, 24.6% of new HIV cases in 2014 were found in women. While the current guidelines ban women who have had sexual contact with a MSM from donating for 12 months, women who have engaged in sexual activity with other women are not considered a high-risk group for HIV and are allowed to donate. But what about a woman who has engaged in sexual activity with a woman who has been in sexual contact with a MSM? One wonders where the line is drawn.

What’s next? Canadian Blood Services and other organizations are looking towards transitioning to “behaviour-based screening” for all individuals as opposed to the time-based practices currently in place. Working with LGBTQ communities, medical professionals, analytics scientists, and various patient groups, donation agencies are contemplating potential methods of identifying low-risk sexually active MSM. Likewise, the FDA will be diligently keeping an eye on the effects of their new alterations whilst continuing to revise policies to most accurately reflect the latest scientific findings. Working with the National Heart, Lung, and Blood Institute, the FDA has created a new nationally representative safety monitoring system to garner information on blood supplies. The barriers MSM face in donating blood will unquestionably be overcome—it is only a question of when.


References:

  1. Callaway E. US to lift ban on blood donations from gay men. Nature News. Published online Dec 24, 2016.
  2. Deadliest Mass Shootings in US History Fast Facts. CNN Library. Updated online June 13, 2016.
  3. Donor Screening: Men Who Have Sex with Men. Canadian Blood Services.
  4. Hayes A. Gay Men’s Health Crisis Condemns Terrorist Attack in Orlando. GMHC. Published online June 13, 2016.
  5. Howard J. FDA to re-evaluate controversial ban on gay men donating blood. CNN. Published online July 28, 2016.
  6. Victor D. Blood Donors Needed, but Many Gay Men Appear Likely to be Left Out. New York Times. Published online June 12, 2016.
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Sharon Ling

Sharon is an MSc candidate within the lab of Dr. Rae Yeung in the Department of Immunology at the University of Toronto. Outside of the lab, Sharon enjoys watercolour painting, working out, and grabbing weekly dim-sum with her grandma.

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