FDA proposes new guidelines to ease restrictions on blood donations for ‘men who have sex with men’

Corbin Makar felt happy when they first saw the news about the Food and Drug Administration’s new proposed recommendations that would ease blood donation requirements for “men who have sex with men.”

“I think it’s a step in the right direction,” Makar, a junior communication rhetoric major, said. “But unfortunately, there still are restrictions.”

The FDA currently requires men who have sex with men to abstain from sex with men for three months prior to donating blood. Under the FDA’s proposed regulatory changes though, more gay and bisexual men, as well as women who have sex with these men, could be eligible to donate blood.

The new FDA guidance recommends screening all potential blood donors with a questionnaire to assess their individual risk of HIV. It would allow individuals who have had anal sex in the past three months to donate blood, as long as they do not report having new or multiple sexual partners within the last three months.

According to Bridget Keown, a teaching assistant professor in the Gender, Sexuality and Women’s Studies program, the FDA completely banned men who have sex with men from donating blood in 1985 due to the AIDS crisis.

“First and foremost, it is the remnants of the moral panic that happened around the AIDS crisis when it came out in the ‘80s that we’ve really never been able to overcome,” Keown said. “The concern is very much one that stems from having people donate blood whose lifestyles don’t align with traditional notions of family practices, sexual practices, identity and things like that.”

The FDA started to allow men who have sex with men to donate blood in 2015, enacting a one-year abstinence requirement. They then cut the abstinence period to three months during the COVID-19 pandemic in 2020 due to an “urgent and immediate” need for blood. According to Keown, the proportion of blood donations that had HIV infections did not increase in the U.S. when the restrictions eased in 2020.

“Clearly, whatever fears that were present were not actualized,” Keown said.

Through focusing blood donation restrictions on men who have sex with men, Keown said the FDA has limited the types of questions they ask to other groups of people. 

“The risk of sexually transmitted infections is the same for everyone purely based on with whom they are having sex and the levels of protection used,” Keown said. “Focusing on just this one category does nothing but increase the stigma against those categories of people. It makes it harder for them to feel like they are participating in caring for other people through the donation of blood.”

According to the proposed change, individuals taking oral medications to prevent HIV, such as PrEP, would have to wait three months from their last dose to donate blood and those taking injectable medications would have to wait two years.

Makar donated blood once in high school, but stopped once they started having romantic relationships in college because of the FDA guidelines. Makar, who is on PrEP, said it is “frustrating” those on the medication cannot donate. While Makar is a Student Government Board member, they said their experience is not reflective of their board position. 

“I understand the concern where they might not be able to detect HIV within the blood donations, but I don’t know because they really didn’t provide much alternative,” Makar said. “And it felt like, ‘Oh well, I still can’t donate.’ I’m taking the safeguards to prevent myself from contracting HIV, but I want to do even more good and donate blood, but I still can’t do that.”

Dr. Ken Ho, an assistant professor in the School of Medicine, said he understands how not allowing individuals currently taking medication to prevent HIV could be “potentially stigmatizing.” However, Ho said these medications interfere with the ability to test the blood supply. Entities that collect blood donations currently use pooled testing where they take many samples and test them at once, according to Ho.

“It’s not about stigmatizing people who are on those medications, so much as it is that, with our current method of testing the blood supply, it would just interfere and potentially compromise safety,” Ho said. “I think it just speaks to maybe just finding better ways of testing blood in a way that doesn’t use a whole lot of resources to do.”

The FDA guidelines are a “step in the right direction,” according to Ho, but there is still work to be done.

“I think it’s better from the standpoint of not potentially excluding and stigmatizing certain groups of people,” Ho said. “Where I think it is still a bit problematic is that, does that accurately capture HIV risk individually? It’s not perfect.”

Ho said it is a challenge to find a “perfect system or metric test” for determining individual risk.

“I think it speaks to the importance of maybe trying to come up with better ways of determining risk or, alternatively, just finding a way to ensure safe blood supply,” Ho said. “An example is just being able to test that blood right then and there. That’s also its own challenge as well.”