Knocking down myths regarding blood donation policy

In response to a significant drop in blood donations during the first few months of the COVID pandemic, the FDA modified its donor deferral policy to allow donations from gay and bisexual men who remained sexually abstinent for three months prior to donation—another step in the right direction, but still unrealistic for many. Happily, the FDA is currently conducting a study that would allow it to implement a policy based on individualized risk rather than sexual orientation or gender identity.

As we head toward a truly non-discriminatory blood donation policy (it’s only taken three decades), it seems worthwhile to address some of the misplaced arguments and erroneous ideas that have been advanced by well-meaning celebrity advocates over the past couple of years. (As much of a consumer of celebrity/pop culture as anyone—and still imagining myself marrying one of these well-intentioned celebs—I am not going to name names.)

Myth #1: All donated blood is tested, so there is no risk of HIV transmission through blood donation.

While it is true that all donated blood is tested for a range of blood borne pathogens, including HIV, the FDA’s donor deferral policy is designed to address the strong likelihood that a relatively recent infection would not be detected by these tests. People who point to the testing of blood donations as a reason to completely lift the deferral for gay and bisexual men misunderstand the purpose of the deferral.

Blood donations have been tested for HIV—and other pathogens like hepatitis C—for decades. With early versions of the test, it took as long as six months for a new HIV infection to be detected. But the testing technologies have advanced over time, and now a new HIV infection can be detected within 9–11 days after exposure (note that testing in clinical settings may not be as sensitive). Other pathogens, like hepatitis B, can still take up to 20–25 days to detect. The donor deferral policy is designed to address the risk of an undetected new infection as a result of this “window period,” as it is called.

Myth #2: A straight guy who had condomless sex with a woman a week before donating blood presents the same risk as a gay guy who had condomless sex with a guy a week before donating blood.

This is inaccurate for two reasons. First, not all sexual activities present the same degree of risk. In fact, the receptive partner during anal sex is at over 12 times greater risk than the insertive partner during anal sex or a receptive partner during vaginal sex. The insertive partner during vaginal sex has an even lower risk. The much higher risk through receptive anal sex helps explain why HIV is much more prevalent among gay and bisexual men.

While it is true that all donated blood is tested for a range of blood borne pathogens, including HIV, the FDA’s donor deferral policy is designed to address the strong likelihood that a relatively recent infection would not be detected by these tests.

The prevalence of HIV within the group of potential partners is the other major factor influencing the degree of risk of HIV acquisition. If 200 out of 1,000 potential partners is HIV-positive (approximate prevalence for gay men in major cities) versus four out of every 1,000 potential partners (approximate prevalence of HIV in the general population), then the risk is going to be 50 times higher for the gay guy in the example above. And that is before taking into account the relative risk of the sexual activity in which each guy has engaged.

Myth #3: Monogamy would be a good criterion for allowing gay and bisexual men to donate blood without a deferral.

When I hear people suggest this, I want to say, “What are you thinking?!?” Unless they spend 24/7 with their partners, people do not know that they are in a monogamous relationship. And this is not a rap on gay and bisexual men, because a study on which the FDA has relied shows that 25% of heterosexual people who believed they were in a monogamous relationship were in fact not.

The criteria upon which the donor deferral policies rely should be things that are within the personal knowledge of the donor, such as the number of partners and the type of sexual activities in which the person has engaged. Perceived monogamy is not a good indicator of actual risk.

Myth #4: When the FDA implements a non-discriminatory donor deferral policy, all gay and bisexual men will be able to donate blood without restriction.

This misperception is the most anxiety producing, because it could lead to real disappointment on the part of sexually active gay and bisexual men when the policy finally changes. A non-discriminatory donor deferral policy would be based on an individual risk assessment using some of the criteria described above, such as number of partners and types of sexual activity in the month or two prior to donation. While that should bring a significant number of gay and bisexual men into the eligible donor pool, it will not be all gay and bisexual men.

A policy that excludes some gay and bisexual men—as well as some straight people—based on their individual risk is not discriminatory. It is the very thing we want—a policy that ensures the safety of the blood supply without relying upon stereotypes or generalizations about gay and bisexual men.

Scott Schoettes is an attorney and advocate who lives openly with HIV. He engages in impact litigation, public policy work, and education to protect, enhance, and advance the rights of everyone living with HIV.