FDA considers deferring gay blood donors based on risk

The Food and Drug Administration is seeking public comment on a proposed change to the rules governing when gay men can donate blood. 

Last December, the FDA lifted a 30-year ban on gay men giving blood. The updated policy says gay and bisexual men can donate blood, provided they are HIV-free and have not had sex with another man for at least one year.

Now, the FDA is inviting people to comment on possibly changing this time-based deferral policy, to one that assesses an individual's risk of transmitting HIV through blood donation. The new assessment would involve asking a donor a series of questions designed to identify those who engage in high-risk behaviors, according to the agency.

The public can comment through Friday, either online or by mail. 

An FDA spokeswoman said the 2015 policy was based on the best scientific information then available. She said the agency is committed to reevaluating the policy as new scientific information becomes available.

"The FDA is continuing work to gather additional information needed to further progress the policy," spokeswoman Lyndsay Meyer said, adding the agency could not share a timeline for when any changes would take effect.

Specifically, the FDA is seeking input on what questions would most effectively identify people who engage in high-risk behaviors. It is also asking for feedback on how specific the questions can be regarding sexual practices and how willing donors would be to accurately answer such questions.

Gay rights activists welcomed the opportunity to again weigh in on the blood donation policy.

"Even though it was a great move to go from a lifetime ban to a one-year deferral – that was a hard-fought battle and the small change was a victory – we do still feel the current policy is more discriminatory and not fully based on current science," said Michael Czaczkes, director of policy and public affairs at Gay Men's Health Crisis, a service provider and advocate for HIV/AIDS prevention and care.

He said in order for gay men to donate blood, they must abstain from sex for a year, regardless of whether they are in a monogamous relationship or take a daily medication to prevent HIV infection. Meanwhile, he said, heterosexual people can donate blood even if they engage in such high-risk behavior as having multiple sexual partners, having anal sex or refraining from using condoms consistently.

Gay Men’s Health Crisis is urging the FDA to reduce the donation deferral period from one year to three months. Czaczkes said a three-month deferral period is "more than enough" time to identify any infections.

There could also be public health benefits in developing a blood donation policy based on an assessment of someone's risk of spreading HIV, said Brad Sears, director of the Williams Institute, a UCLA School of Law think tank focused on sexual orientation and gender identity law and public policy.

"Tens of millions of people donate blood each year and they can either receive an education about HIV risk or miseducation," Sears said. "Right now, they're receiving miseducation; they're receiving the message that who you are makes you at risk for HIV, instead of what you do."

Dr. Jeffrey Klausner, a UCLA professor of medicine and public health, said people who engage in high-risk sexual behavior should be screened the same way as people who have traveled abroad or have chronic medical conditions, regardless of their sexual orientation, skin color, race or ethnicity.

"All people who are anticipating donating blood or blood products should be evaluated based on their actual risk of spreading an infectious disease," Klausner said.

He explained that donation centers already test blood for infectious diseases, including HIV and hepatitis. The tests can identify HIV and hepatitis within two weeks of infection, he said, so the series of questions being discussed would be helpful in identifying people who could have been infected within that two-week window.