Minnesota seeks to end blood donation discrimination
Christopher Johns got into the habit of donating blood when he was in high school.
But after graduation and coming out as gay, he was surprised to learn that blood banks would refuse donations from him and other gay men who were sexually active.
“I was very caught off guard by it,” he said. “I didn’t understand it. It led to more questions than answers.”
Now a fourth-year medical student at the University of Minnesota, Johns has devoted part of his studies to understanding the ban and how lifting the ban might affect blood donations of other men who have male sexual partners.
Along with some colleagues, he surveyed nearly 600 men and found that most would donate blood if the ban were lifted. Currently, gay men have to abstain from sex for 90 days before they become eligible to make life-saving donations.
Johns’ research indicates that there is an untapped pool of donors at a time when blood banks in the past few weeks said blood supplies are still critically low — continuing a crisis that began at the start of the COVID-19 pandemic.
Blood donations plummeted as workplaces and schools shut down and with them the blood drives that they hosted. Blood banks were still accepting donations at their facilities, but many potential donors were reluctant to visit for fear of being exposed to COVID-19, especially before vaccines became widely available.
By January, the American Red Cross said the blood shortage was the worst in a decade, calling it a “national blood crisis.”
Medical organizations, advocacy groups, politicians and state governments are increasingly calling on the U.S. Food and Drug Administration, which sets blood donation policies, to end its exclusion of sexually active gay men and instead implement better risk-based screening, regardless of sexual orientation.
In a rare public criticism of federal policy, the Minnesota Department of Health said that federal regulations around gay men and blood donations are discriminatory and not supported by scientific evidence.
“It’s really an outdated policy that needs to be revisited, which is why we decided it was important for Minnesota to sign onto this” burgeoning movement to end the exclusion, said MDH spokesman Doug Schultz.
Ostensibly, the FDA policy is meant to protect the nation’s blood supply from the HIV virus, but critics say that donor eligibility guidelines have not kept pace with advancements in HIV blood testing, HIV treatment and a better epidemiological understanding of how AIDS is transmitted.
“It is based on outdated belief systems,” said Alex Sheldon, executive director of the Gay and Lesbian Medical Association. “Any policy governing blood donations should be crafted without membership in any group and should instead focus on the individual potential risk.”
Nine out of 10 people surveyed by Johns and colleagues would be willing to donate blood if they could do so immediately, instead of waiting three months, according to the research published in Transfusion Medicine Reviews.
Despite the screening, about 8% of those surveyed were successful at donating blood despite not abstaining from sex the three months’ prior — a finding that has been replicated in other studies. This raises questions about the effectiveness of the screening. But 11% were turned away during the screening process — an experience that some said was humiliating, demoralizing or embarrassing.
The blood banking industry also wants changes made to the ban, as its supply comes solely from volunteers. The donations make it possible to have blood on hand for emergency and scheduled surgeries, as well as for transfusions for those with anemia, blood disorders, cancer treatments and other needs.
As a recent drop-off in donations put pressure on the nation’s blood supply, there have been more calls for the FDA to change its blood donation policy, including from Sen. Tammy Baldwin, D-Wisconsin, joined by Minnesota DFL Senators Amy Klobuchar and Tina Smith.
In North Carolina, the state’s head of the health and human services department was asked in January if he would donate blood as part of an effort to get political leaders to lead by example.
“I had to explain about the long-standing exclusion for gay and bisexual men who have participated in sexual acts to not donate blood,” said Secretary Kody Kinsley, who is gay. “It was not the first time I have had this conversation in the workplace.”
He decided to turn a “very sobering experience” into action, which eventually led to an appeal — signed by health officials in the District of Columbia and nine states, including Minnesota — to FDA Commissioner Robert Califf.
Kinsley noted that it has been 40 years since the FDA first restricted gay and bisexual blood donations. Although there have been some changes, by and large it has remained a “cudgel,” despite advances in HIV testing and understanding of transmission and prevention.
“It continues to reinforce this stigma that by virtue of being gay you have this equal risk,” Kinsley said.
The FDA has ratcheted down its restrictions on gay and bisexual men in recent years, however. In 2015, it jettisoned a lifetime ban on men who had ever had sexual contact with another man and replaced it with a one-year lookback period. In April 2020, that was replaced with a 90-day window.
Several other countries — including Spain, Italy, England, Israel and France — have already moved away from excluding gay men from giving blood. The United States is still turning away some gay and bisexual men who want to donate, including those in monogamous relationships and men who practiced safe sex, prompting more calls for change.
The FDA is funding a study, known as ADVANCE, which will test different donor screening policies to see how effective they are at protecting the blood supply. Enrollment in the study, which is being conducted by three of the nation’s largest blood banks, recently closed.
But it is unclear when it will publish results, and whether the FDA will abandon its blanket prohibition and move to a system that is based on risk.
Regulators would have to consider whether a new risk-based system would turn away still other potential donors.
The standard screening routine already asks dozens of questions, including some that are about sexual partners, including whether they have tested positive for HIV, have used intravenous drugs or are sex workers.
Studies by Canada’s health agency found that a more risk-focused approach that required a few more intrusive questions — about multiple partners and anal sex, for instance — would result in a loss of some donors.
Still, Canada recently changed its guidelines because it projects a net gain.
“By being more inclusive you will get more donors… that would offset those losses,” said Dr. Jed Gorlin, medical director for St. Paul-based Memorial Blood Centers.
“I see us getting there,” Gorlin said. “I think it is a matter of time and a matter of validating which questions are the most useful.”
Johns hopes that gay men can donate blood without restrictions by the time he leaves medical school.
“I have a significant other and we are in a monogamous relationship and I am really hopeful by the time I graduate, come eight to nine more months, there would be something in the works,” he said. “I feel it is important to give back to the community… and now more than ever given such a blood shortage.”