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What Science Says About Gay Men Donating Blood

The FDA still bans men who have had sex with other men in the last year from donating.

After the horrifying mass shooting at a gay nightclub in Orlando that killed 50 people and injured dozens on Sunday, it's understandable that those in the LGBT community there would want to do anything they can to help the victims. But many gay and bisexual men are prohibited from doing one of the most influential acts to help: donating blood.

I have one of these types. I'm gay. Im not allowed to give blood. K Joffre ★June 12, 2016

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so it's legal to buy this in the US, but it would be illegal for me to donate blood? JonathanJune 13, 2016

The shooting has reignited a long debate over the Food and Drug Administration's blanket ban on men who have sex with men (or MSM, as it's commonly shortened) from donating blood. (The term MSM is widely used to be inclusive of men across the sexuality spectrum.) Though the lifelong ban, enacted in 1983, was reduced last year to one year from the last same-sex encounter, many argue that the remaining prohibitions are not based on the latest science, and are still driven by fear and stigma.

When you take a look at the facts, there's no good scientific basis to ban every man who's had sex with another man in the last year from donating blood. The practice looks more like a hangover of fear and stigma that discriminates against a group based on their sexuality than a risk-reducing necessity.

The ban is intended to prevent someone infected with HIV from donating blood. Not wanting HIV-infected blood in the donation pool is understandable, and it's the basis for other bans—intravenous drug users, who are at an increased risk of HIV infection, are also prohibited from donating blood, for example. It's also true that MSM have a higher prevalence of HIV infection than the general population: the Centers for Disease Control estimates 18 percent of MSM are HIV-positive, compared to less than 1 percent of the overall population.

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"The revised policy is still discriminatory."

But MSM aren't the only people who contract HIV, and all donated blood is screened for infectious diseases, including HIV. In fact, since HIV emerged, preventative measures have reduced the odds of contracting the virus through donated blood to about one in 2 million. So what's with the one year window—does it really take that long for HIV to turn up in your blood?

"Scientists and blood banks have made a huge effort to make the tests better and better, and they're able to detect infections that are as short as a few days old," Dr. Paul Volberding, the director of the AIDS Research Institute at the University of California, San Francisco, told me over the phone. "So a 12-month ban makes no sense at all."

Volberding said the window of time between being exposed to HIV and having that infection show up on tests is pretty narrow. He suggested the ban could be shortened to any man who has had sex with another man in the last week, and still be as safe as we are with the current restrictions (though he said a scientific debate should occur before deciding on an exact time limit).

In recent years, rapid tests have become more sensitive—meaning they can detect even low antibody levels, allowing for a quicker diagnosis—and drastically cut down the number of false negatives when people get tested. Even the most cautious of estimates for this window between exposure and positive testing are much shorter than a year: 98 percent of people have enough antibodies to test positive for HIV within three months of exposure, according to the San Francisco AIDS Foundation.

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Volberding also pointed out that the majority of HIV-positive Americans are aware of their status, and would be prohibited from donating through that knowledge. The CDC estimates 88 percent of HIV-positive Americans know their status, and Volberding said in some areas—like San Francisco—as much as 95 percent of HIV-positive individuals know they have the infection.

"So you can say, 'don't donate blood if you know you're infected,' and that's going to reduce the risk very substantially and then if you use the latest blood testing techniques, you can find the people who are infected but might not know it," Volberding said.

When it announced the one-year ban, the FDA said the decision was based on the latest science. But officials didn't go into specific details about how the one-year point was chosen, other than that other countries also have one-year bans for MSM donating blood. Advocacy groups, such as Gay Blood Drive, say that the gap between the window needed to test and the window imposed by the FDA is driven by stigma.

"The revised policy is still discriminatory," the group said in a statement at the time. Yesterday, it tweeted to encourage those who can donate to give blood but noted: "We find ourselves in a situation where the victims directly affected by this tragedy and in need of lifesaving blood are the very people banned from donating it."

Rather than a condensed weeks, or months-long ban, the Gay Blood Drive advocates for an individual risk assessment policy, where the lengthy questionnaire already used when collecting blood donations help mitigate any risk of HIV. In 2001, Italy did just that, allowing MSM to donate blood along with everyone else, while assessing HIV risk through personal reporting, and at least one study has shown this policy change did not increase the prevalence of HIV in donated blood.

The good news is that there's no shortage of willing donors in Orlando—local blood banks are overflowing after initial shortages and are even requesting people to go home and come back later in the week. But for many in the community, the donor ban remains salt in the wound during a time of mourning.