While gay men are willing to donate blood, the Food and Drug Administration (FDA) imposes discriminatory blood donation restrictions on gay men. This practice started in 1983, at the height of the AIDS epidemic, when the FDA imposed a lifetime blood donation ban on all men who have sex with men (MSM), regardless of sexual orientation or gender identity. This lifetime ban did not apply to other populations, such as people who inject drugs or exchange sex for money.
Despite advancements in blood product screening for bloodborne infections, including HIV, this lifetime ban continued to be enforced by the FDA for more than three decades. In 2015, the FDA relaxed the ban, allowing MSM to donate blood if they had been abstinent from sexual activity for at least a year, even if they were in a mutually monogamous relationship with an HIV-negative partner. In April 2020, considering the COVID-19 pandemic, the FDA decreased this yearlong restriction to three months. Despite such policy revisions, the continued restrictions imposed on blood donation by MSM perpetuate stigma and further limit the already inadequate U.S. blood supply. In a recent study of more than 1,500 Australian MSM (Transfusion, May 2020), almost all respondents were unwilling to abstain from sex for the 12 months required to donate, while 77.7% reported a willingness to donate blood if this deferral policy was removed.
In the early days of the AIDS epidemic, the FDA implemented blood donation restrictions among MSM because gay men are disproportionately affected by HIV. But is the current time-based restriction scientifically sound even if shortened from one year to three months? Grebe and colleagues (Blood, September 10, 2020) demonstrated that HIV incidence among first-time donors was similar before and after the yearlong deferral of blood donation had been implemented among MSM. Furthermore, HIV screening tests have improved, allowing detection of HIV between 10 and 30 days after exposure. As there has been an increase in routine HIV screening among MSM and an increased uptake of preexposure prophylaxis (PrEP), which reduces an individual's risk of getting HIV from sex by about 99%, more gay men are now aware of their HIV-negative status.
Nurses are strategically positioned to address this discriminatory practice. In the early 20th century, Mary Eliza Mahoney sought to improve Black nurses' working conditions, and Lillian Wald and Mary Brewster created health care programs for immigrants living on the Lower East Side of Manhattan. Nurses pledge to advocate for their patients and social justice advocacy is a natural extension of this pledge.
Today, nursing advocacy extends across several social justice issues-access to care, racial injustice, environmental protections, and full practice autonomy, to name a few. Nurses are the largest group in the health care workforce (approximately 3.6 to 4.2 million) in the United States. Sharing perspective pieces like this with legislators can bring this issue to the forefront and invite grassroots political advocacy.
Three of the largest U.S. blood donation centers are conducting a pilot study: the Assessing Donor Variability and New Concepts in Eligibility (ADVANCE) study. According to its website, the study aims to determine the effect of an alternate donor deferral policy on the safety of the nation's blood supply as a first step in providing data for the FDA to consider in modifying the current donor eligibility questionnaire.
In light of substantive improvements in current blood screening capabilities, we believe that disease panel testing of all donors-augmented by evidence-based, individualized screening-must be implemented. This includes updating the current questionnaire that marginalizes people based on their sexual orientation or gender identity. Turning away eligible donors further perpetuates blood product shortages while revealing the homophobia and discrimination that underlies such restrictions. Nurses have an ethical obligation to advocate for the community while denouncing ineffective practices. Collective political advocacy will be necessary to make an immediate impact.