In 2016, a mass shooter at Pulse, a gay nightclub in Orlando, Florida, killed 49 people and wounded another 53. The need for blood was urgent, and thousands of people lined up to donate. But some of those most eager to give were turned away for one reason: They were sexually active gay men.
The Food and Drug Administration’s rule barred blood donations from men who had engaged in carnal relations with other men in the previous year. In 2020, the agency reduced the time to three months. Today, the Red Cross reports the worst shortage of blood in more than 10 years due to the latest surge in COVID-19. But it is still obligated to reject many gay men who might donate. And the rationale for that ban grows less convincing all the time.
It dates back to the early years of the AIDS epidemic, when the disease was taking a terrible toll. Some people contracted HIV from transfusions, and it took time to develop tests to detect it in blood. So the FDA implored gay men not to donate, and in 1986, it barred them outright. Because tests couldn’t pick up all the infections, extreme caution was in order.
When AIDS emerged, it had the regrettable effect of aggravating homophobic views held by many Americans. Conservative polemicist Pat Buchanan wrote: “The poor homosexuals — they have declared war on nature, and now nature is exacting an awful retribution.” So the FDA wasn’t battling a tide of skepticism about a policy that singled out gay men.
But a lot has changed in the past 36 years. Medicines exist to make HIV a manageable condition rather than the death sentence it used to be. Those whose HIV has been suppressed by treatment can’t pass it on to others. Improved tests mean the virus can be detected except when it was contracted within the previous 10 to 16 days.
Broader shifts have also occurred. In 1986, the Supreme Court upheld a Georgia law making gay sex a crime, as nearly half the states had done. Discrimination against gays was far more common.
In 2003, however, the court struck down all sodomy laws. In 2015, it held that same-sex couples are constitutionally entitled to marry. In 2020, it ruled that the 1964 Civil Rights Act protects gays from employment discrimination.
After all this time, though, the FDA retains the ban — not from any apparent animus against gays, but from an excess of caution. At times like these, though, it becomes clear that the policy imposes real costs by reducing donations of blood and does little to prevent disease.
A study in 2020 found that when the agency reduced the 12-month restriction to three months, the number of blood donations contaminated with HIV did not increase. Tests, fortunately, serve to screen out the vast majority of the infected blood.
The grounds for rejecting any gay man who hasn’t been celibate for the past three months are shaky at best. The Human Rights Campaign, a LGBTQ advocacy group, argues that the FDA should focus on risky behaviors, not sexual orientation.
As things stand, it notes, “a man who has had protected oral sex with another man once in the 3 months currently barred from donating blood. Yet a woman who has had unprotected sex with multiple partners over the same time frame with no knowledge of their personal histories remains in the donor pool.”
Many countries no longer put any special restrictions on gay men. Among them are Britain, Italy, Israel and Spain — and, starting in March, France. “We are putting an end to an inequality that was no longer justified,” tweeted the French health minister. Other nations, notably Germany and the Netherlands, allow donations from those in monogamous relationships.
When the FDA cut the waiting period from 12 months to three, the American Medical Association gave one cheer. It urged the agency “to remove the categorical restrictions for blood donations by (men who have sex with men) so they are instead based on a person’s individual risk, consistent with the latest scientific evidence, to ensure blood donation criteria is equitably applied across all people.”
The American Red Cross agrees. Lifting the ban on sexually active gay men would undoubtedly attract more donors.
The lives of patients are at risk when the supply fails to keep up with the demand, which is why we should remove obstacles that keep people from giving blood. There’s never a downside in having too many donors. There’s always a downside in having too few.