FDA: Base blood donation policy on science, not stigma

As a doctor, I have dedicated my life to saving the lives of others. But as a gay doctor, I have long been unable to do one simple thing that saves lives: donate blood.

For more than 30 years, policies in the United States have banned gay and bisexual men from donating blood. That could change — ending decades of discrimination — if the Food and Drug Administration’s newly announced proposal for blood donation is made permanent.

In 1985, the FDA placed a lifetime ban on gay and bisexual men donating blood in the U.S. That policy, based on fear and misconceptions of HIV and AIDS at the time, remained in place until December 2015, when the FDA revised the ban and replaced it with a one-year deferral period: Gay and bisexual men were allowed to donate blood if they had not engaged in any sexual activity with other men in the year prior to the donation. In April 2020, because of the Covid-19 pandemic and massive blood shortages, the FDA shortened the deferral period to three months. It is important to note that, under this policy, men who did not identify as having sexual contact with other men were not asked about sexual activity and did not have to undergo any waiting period before donating blood.

But even this three-month deferral stigmatized men who have sex with men by not imposing the same requirement for all blood donors. This policy reinforced negative stereotypes about gay and bisexual people, particularly that HIV is a “gay disease” when it affects people of all sexualities. It also supported the false perception that heterosexual people are at low risk for HIV infection.

Heterosexual people made up 22% of new HIV infections in the U.S. in 2019, the last year with complete statistics. This shows that HIV does not affect just gay men, and strikes down the basis for discriminating against gay and bisexual men in blood donation. In addition, medical interventions such as pre-exposure prophylactic medications (PrEP) have been shown to be highly effective at reducing the risk of HIV infection from sex by about 99%. More than 300,000 Americans now use PrEP for HIV prevention, further undermining any justification for the three-month deferral.

UCLA’s Williams Institute once estimated that the ban on gay men donating blood meant that as many as 615,000 pints of blood are not collected each year. That much blood could help save the lives of more than 1 million people a year.

Even though I have been married to my husband of 10 years, I have faced discrimination and have been banned from donating blood, while a heterosexual male could engage in sexual behavior with multiple female partners and freely donate blood. This is not only unjust, but it is also detrimental to the health and well-being of the people who need blood donations.

The stigma related to sexual orientation also has negative effects on the mental and physical health of gay and bisexual men, including high rates of mental health concerns, negative interactions with the health system that lead to delays or avoidance of care, and higher rates of substance use among LGBTQ+ adolescents and young adults. Widening donation criteria is a concrete move to combat these deleterious effects.

Removing restrictions on blood donation by gay and bisexual men allows the opportunity to engage in a community-focused behavior that builds strength and resilience and could buffer the negative impact of stress. In fact, blood donation has been found to have positive effects on mood, with donors reporting lower levels of expected nervousness, higher expectations of good feelings, and an increased sense of social integration.

As a pediatrician and an adolescent medicine physician at Children’s Hospital of Philadelphia, I have authored medical textbooks and teach medical students the importance of providing patient-centered care by asking patients about their actions and behavior. I emphasize it is vital to not make assumptions based on an individual’s sexual orientation or gender identity.

The new FDA guidance on blood donation would establish new eligibility that would be based on an individual’s risk, consistent with the latest scientific evidence, and does not focus solely on sexual orientation, a practice that has long perpetuated homophobia and stigma.

With its proposed change, the FDA would finally align its policy with science, not stigma. As a gay doctor, I will be proud to finally be able to give back in this small but meaningful way. It’s time for the federal government to recognize that discrimination has no place in the U.S. medical system, and that decisions should be guided by science.

I urge the FDA to put the guidance into effect, and encourage others to join me in commenting in support of it.

Scott Jelinek is a fellow physician in the Division of Adolescent Medicine at Children’s Hospital of Philadelphia, an affiliate trainee in the hospital’s PolicyLab, and an associate fellow with the Leonard Davis Institute of Heath Economics at the University of Pennsylvania.