The timing of the announcement may have caused many to overlook it, but on Tuesday, December 23, the FDA delivered an early Christmas gift in announcing that it would lift the lifetime ban on blood donation by men who have sex with men.
Up to now, the FDA’s policy has been to permanently ban men who have had sex with other men, even once, since 1977 from donating blood. The ban has been in place since 1985, shortly after the HIV test first became available. There are strong reasons for the original policy. After all, the likelihood of transmission through blood is high – around 90%, and men who have sex with other men (MSM) were – and continue to be – at high risk of HIV infection.
However, things have also changed since the early years of the epidemic. An important one has been the development of more sensitive testing, which can test the presence of HIV at much lower levels, making it much more unlikely that a pint of infected blood will enter the blood supply. (We do not rely only on donors’ self-reports, because it is possible they may be infected, but not know it.) Moreover, antiretroviral treatment (first available in 1996) can reduce the HIV virus to undetectable levels, significantly reducing the likelihood of transmission. Effective treatment also has dramatically changed the outlook of someone infected with HIV, transforming a death sentence into a chronic disease with undiminished life expectancy.
Things have also changed for the blood supply. Shortages are chronic, in part, because fewer Americans are eligible to donate than previously and even fewer of those who are eligible donate. For almost a decade, representatives of the blood industry have sought to have the FDA’s lifetime ban lifted. The FDA has reconsidered the ban at least twice over the last decade, and, until now, has voted to retain the ban.
The ban has not been fully lifted. Rather, the FDA will adopt a 12-month deferral (i.e., men who have had sex with another man in the last 12 months will be deferred). This is consistent with other nations, such as Australia, the United Kingdom, Argentina, Japan, and Hungary, as well as the FDA policy on women who have had sex with men who have sex with other men. Nevertheless, the removal of the ban is significant; it eliminates a policy that many felt perpetuated outdated stereotypes about HIV while maintaining the safety of the blood supply. In this respect, it is a gift.
Leslie Wolf is the director of the Center for Law, Health & Society and a professor of law at Georgia State University College of Law. She conducts research in a variety of areas in health and public health law and ethics, including law and policy related to HIV/Aids.