Managing the Blood Banks
July 29, 2013 12:33 PM
The blood bank quandary
When epidemiologists at the US Centers for Disease Control and Prevention (CDC) in Atlanta correctly suggested in 1982 that AIDS could be spread by blood transfusions, many blood bank officials reacted with skepticism. After all, the cause of AIDS was still a mystery, so there was no way to screen blood for the pathogen in question. 
Nonetheless, the CDC began asking groups considered even then at high-risk for AIDS—mainly intravenous drug users and gay men—to refrain from donating blood. The US Food and Drug Administration adopted the recommendations a year later to safeguard the nation’s blood supply. Other countries did the same.
The measure made perfect public health sense at the time and officials were rightly worried that HIV was invading the national blood supply. But are such restrictions needed today?
Gay activists, city health departments and the American Red Cross have felt for some time now that the rules prohibiting gay men from giving blood because of their sexual orientation are unnecessary and conducive to prejudice.
With critical shortages at local blood banks a national problem—summertime is an especially lean period for blood donation—the FDA guidelines seem, they contend, especially counter-productive.
The Gay Men’s Health Crisis (GMHC)—which longtime AIDS activist Larry Kramer helped start in 1982, in response to the AIDS epidemic—has been front and center in the fight to persuade the FDA to stop what has become a perpetual ban on gay men donating blood.
As it now reads, the FDA recommendation bars any man who has had sex with another man since 1977 from giving blood, regardless of whether that person has been in a long-term, monogamous relationship.
This makes no sense, says GMHC Director of Public Policy Jason Cianciotto. He says a better way to screen potential blood donors would be to quiz them about any recent risky behavior, whether it is heterosexual or homosexual sex. “Right now, if I am a heterosexual man and I admit I had unprotected sex with a [commercial] sex worker I am subject to a 12-month deferral from giving blood,” said Cianciotto. “But the gay or bisexual man, even if he is monogamous and HIV-negative, is banned for life.”
Other countries have loosened their restrictions in recent years, though it’s unclear whether such changes have boosted blood collection, and whether the changes themselves make sense.
In the UK and Australia, for instance, men who have sex with men have to abstain from sex for one year in order to give blood; in South Africa it’s six months. Yet those restrictions sound downright reasonable compared to Canada, which this summer lifted its lifetime ban and replaced it with one that now allows gay men to donate blood … as long as they have not had sex with another man in the previous five years.
As of July, 21 countries have replaced lifetime blood-donation bans of this kind with deferral periods for MSM that vary in length from six months to five years, according to the GMHC. Only Spain and Italy have adopted deferral policies based on comprehensive assessments that ask all prospective donors, regardless of sexual orientation, specific questions about high-risk practices.
Though only 2% of Americans say they engage in male homosexual sex, the group remains the most affected by HIV in the US. It accounts for about 61% of new HIV infections in the US, and the pace of new infections among people between the ages of 13 and 24 in this group has risen 12% in recent years. This may partly be why the FDA remains so reluctant to change its guidelines.
Still, the regulatory agency is, once again, reviewing its longstanding blood donation recommendations. At the urging of lawmakers, including former US Sen. John Kerry (now US President Barack Obama’s Secretary of State), the Federal Advisory Committee on Blood Safety and Availability held several meetings on the matter in June and is expected to make a recommendation soon to the Secretary of the Department of Health and Human Services, which oversees the FDA.
“As an organization providing HIV prevention and outreach services, we want to see a decrease in risk in contracting HIV through blood banks,” said Cianciotto. “But when you stigmatize a population of people, you contribute to stigma that leads to increase risk of HIV.”
Is Cianciotto optimistic things will change?
Given the gridlock in the US Congress, and the looming budget fights this fall, Cianciotto fears issues like this will linger on the sidelines indefinitely.
In other words, don’t bank on it.
Nonetheless, the CDC began asking groups considered even then at high-risk for AIDS—mainly intravenous drug users and gay men—to refrain from donating blood. The US Food and Drug Administration adopted the recommendations a year later to safeguard the nation’s blood supply. Other countries did the same.
The measure made perfect public health sense at the time and officials were rightly worried that HIV was invading the national blood supply. But are such restrictions needed today?
Gay activists, city health departments and the American Red Cross have felt for some time now that the rules prohibiting gay men from giving blood because of their sexual orientation are unnecessary and conducive to prejudice.
With critical shortages at local blood banks a national problem—summertime is an especially lean period for blood donation—the FDA guidelines seem, they contend, especially counter-productive.
The Gay Men’s Health Crisis (GMHC)—which longtime AIDS activist Larry Kramer helped start in 1982, in response to the AIDS epidemic—has been front and center in the fight to persuade the FDA to stop what has become a perpetual ban on gay men donating blood.
As it now reads, the FDA recommendation bars any man who has had sex with another man since 1977 from giving blood, regardless of whether that person has been in a long-term, monogamous relationship.
This makes no sense, says GMHC Director of Public Policy Jason Cianciotto. He says a better way to screen potential blood donors would be to quiz them about any recent risky behavior, whether it is heterosexual or homosexual sex. “Right now, if I am a heterosexual man and I admit I had unprotected sex with a [commercial] sex worker I am subject to a 12-month deferral from giving blood,” said Cianciotto. “But the gay or bisexual man, even if he is monogamous and HIV-negative, is banned for life.”
Other countries have loosened their restrictions in recent years, though it’s unclear whether such changes have boosted blood collection, and whether the changes themselves make sense.
In the UK and Australia, for instance, men who have sex with men have to abstain from sex for one year in order to give blood; in South Africa it’s six months. Yet those restrictions sound downright reasonable compared to Canada, which this summer lifted its lifetime ban and replaced it with one that now allows gay men to donate blood … as long as they have not had sex with another man in the previous five years.
As of July, 21 countries have replaced lifetime blood-donation bans of this kind with deferral periods for MSM that vary in length from six months to five years, according to the GMHC. Only Spain and Italy have adopted deferral policies based on comprehensive assessments that ask all prospective donors, regardless of sexual orientation, specific questions about high-risk practices.
Though only 2% of Americans say they engage in male homosexual sex, the group remains the most affected by HIV in the US. It accounts for about 61% of new HIV infections in the US, and the pace of new infections among people between the ages of 13 and 24 in this group has risen 12% in recent years. This may partly be why the FDA remains so reluctant to change its guidelines.
Still, the regulatory agency is, once again, reviewing its longstanding blood donation recommendations. At the urging of lawmakers, including former US Sen. John Kerry (now US President Barack Obama’s Secretary of State), the Federal Advisory Committee on Blood Safety and Availability held several meetings on the matter in June and is expected to make a recommendation soon to the Secretary of the Department of Health and Human Services, which oversees the FDA.
“As an organization providing HIV prevention and outreach services, we want to see a decrease in risk in contracting HIV through blood banks,” said Cianciotto. “But when you stigmatize a population of people, you contribute to stigma that leads to increase risk of HIV.”
Is Cianciotto optimistic things will change?
Given the gridlock in the US Congress, and the looming budget fights this fall, Cianciotto fears issues like this will linger on the sidelines indefinitely.
In other words, don’t bank on it.
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