July 14, 2013 at 10:42 AM ET
David Dassey is one of the healthiest men in Los Angeles. At 62, he can still run a sub-four marathon. Last April he competed in Boston for the fourth time and almost made it to the finish -- just past the 25-mile mark -- when the bombs exploded. Many of his fellow runners sprinted to the nearest blood donation centers, fearing the worst. Dassey, a doctor who works for the county's public health department, didn't join them. "I've known for 30 years that I can't donate," he says. "It doesn't even go through my head anymore."
Like millions of other gay men, Dassey used to give blood a few times a year without a second thought. And he still remembers the day nearly three decades ago when he saw the survey question first appear, the one all potential donors still answer every time they give blood. "From 1977 to the present," it reads, "have you had sexual contact with another male, even once?"
If you are a gay man, and you answer that question truthfully, the result is a lifetime ban.
"Occasionally I see calls on TV for blood donations," Dassey says. "I shrug my shoulders and say it's too bad. I'd still be doing it if I were eligible."
The FDA classifies all gay men in the highest-risk blood-donor category -- the same category as IV drug users and people who've spent more than five years since 1980 in a country that has mad cow disease. Even with a clean bill of health, a gay man is considered more of a threat to the blood supply than a straight man who was treated for chlamydia, syphilis, gonorrhea, venereal warts, and genital herpes within the past year. (Everyone is at risk for STD transmission. Get the facts you need to Lower Your STD Odds.)
In 40 states, a man can even give blood immediately after getting a tattoo. He can give blood after sleeping with a prostitute -- provided he waits 12 months. The FDA, in other words, considers the sort of man who pays women for sex to be healthier -- and his blood less of a risk to you -- than a man who last had sex with another man 30 years ago.
That's because gay men, the FDA argues, are at "increased risk of certain transfusion transmissible infections" like AIDS and hepatitis B. And that argument isn't necessarily without merit: Gay men make up roughly half of the patients living with HIV in the United States, despite accounting for just four percent of the population. The CDC reports that 63 percent of new HIV infections occur among MSM -- the agency's shorthand for "Men Who Have Sex With Men." (A 2011 Florida Department of Health study estimated that approximately 7.1 million MSM live in the United States.)
Much of this fear dates back to 1983, not long before the ban went into effect, when some patients being treated for hemophilia started displaying AIDS-related symptoms after receiving routine blood transfusions. It was a clear sign that HIV-positive donors were, knowingly or not, infecting the national blood supply. (Two years later, 14-year-old hemophiliac Ryan White would put a public face to the scourge after receiving infected blood.)
Part of the problem was that hemophiliacs ran a much higher risk of acquiring HIV. "Hemophiliacs received clotting factor transfusions every month," says Barry Zingman, M.D., medical director of the AIDS Center at Montefiore Medical Center and a professor at Albert Einstein College of Medicine. "And the more regularly you received blood, the higher your risk of infection." They also relied on a specific blood-clotting treatment called Factor VIII concentrate -- one dose could contain the plasma of up to 22,000 donors. Likewise, someone with hemophilia would risk contracting HIV if just one of those donors were infected. (Today, clotting agents like Factor VIII are created synthetically in labs, and there hasn't been an HIV transmission from a plasma-derived product since 1987.)
Worse, the FDA had no way of testing blood or plasma for HIV prior to March 1985. Then came the first available antibody tests, known as the EIA, or enzyme immunoassays.
Pressured to take action, the FDA did the only thing possible and banned the group of people most likely to spread the virus: sexually active gay men. Much of the world followed. In addition to the United States, several other countries still have lifetime bans against gay blood donors in place, including France, Germany, Switzerland, Norway, and Denmark. More recently, however, other parts of the world have started to reconsider the policy's relevance.
Italy and Spain, for example, no longer specifically exclude gay men. Australia, Brazil, and Japan defer one year from sexual contact. In 2011, the United Kingdom also replaced its lifetime ban with a one-year deferral. And last May, Canada, too, reversed its lifetime ban, cutting it to a five-year deferral.
As awareness of the policy grows in the United States, so do the calls for a meaningful revision. "Even what Canada did recently is questionable, but a step in the right direction," Zingman says. "That's closer to reality than a lifetime ban, but still a long and conservative window."
Blood tests are among the many marvels of modern medicine. They are the crux of every argument for overturning the ban on gay donors worldwide. When the first HIV tests arrived in 1985, they were relatively rudimentary, designed to detect high levels of antibodies in the blood -- which was only effective if HIV had evolved beyond its "window period." If the infection was new, it could go undetected. "There was a 45-day window, approximately, between when we believed a donor was infected and how long it took them to produce antibodies," says Susan Stramer, Ph.D, executive scientific officer of the American Red Cross and president of the American Association of Blood Banks (AABB).
That changed in 1999 thanks to a faster and far more accurate process called Nucleic Acid Testing -- NAT, for short. Unlike the EIA test, the NAT can detect the amount of actual virus in the bloodstream, not just the antibodies produced to fight it. "People often say it's like finding a needle in a haystack," says Attila Lorincz, Ph.D., professor of molecular epidemiology at Wolfson Institute of Preventive Medicine in London and author of Nucleic Acid Testing for Human Disease. "Now just imagine if you could send millions of tiny robots into the haystack to find that needle for you. When one of them finds the virus, we instruct it to make roughly 100 million copies. It's like a miniature nuclear explosion inside the test tube. All of a sudden, a positive result becomes very easy for us to see."
Every sample of blood collected at blood banks in the United States is now screened this way for at least eight diseases -- including HIV, HTLV, hepatitis B and C, West Nile virus, Chagas disease, and syphilis, and in some cases cytomegalovirus (CMV) -- using a combination of NAT and antibody tests. And as those tests have improved, so has the amount of time it takes to tell if a particular sample of blood is clean.
(Discover which Seven Blood Tests Every Man Should Get.)
"Within seven to 10 days, we can say with 99.9 percent accuracy whether or not a blood sample is HIV-positive. The chance of an HIV-positive blood sample testing negative after the 7 to-10-day window is about 1 in 2 million," says Zingman. "That's why, if you've had unsafe sex within the past 10 days, it might be reasonable for us to send you home. But a lifetime ban -- or even a one-year ban, for that matter -- is kind of ridiculous. It takes a week or two to diagnose HIV, not a lifetime. Medically speaking, there is no doubt in my mind that this ban doesn't stand on good footing."
While the FDA supports those odds, they still consider that level of risk -- however miniscule it may seem to the average person -- to be too high. "During the 'window period' a person infected with HIV may not have enough virus or antibodies to be detected by tests. They could test negative even when they're HIV-positive and infectious," says Curtis Allen, an FDA spokesman. "Also, the blood that has already been collected and stored in a blood bank may be given accidentally to a patient in error before testing is completed." (The members of the FDA's Blood Products Advisory Committee declined to speak with Men's Health.)
(How dangerous is AIDS now? Here's What You Need to Know About HIV.)
This is part of the reason why the AABB, America's Blood Centers (ABC), and the Red Cross support a one-year deferral -- the "window period" never lasts as long as one year. The blood banks argue the tests and safeguards can easily detect HIV and controls are in place in blood banks to prevent the release of inappropriate units. The FDA counters that errors could occur. This stalemate between the FDA and the blood banks dates back to 1997 -- three years before one of the worst blood shortages in American history. In 2000, those shortages led to postponements of elective surgeries in Philadelphia, Atlanta, and Los Angeles. At the time, all hospitals combined needed about 80,000 units of blood daily, but the Red Cross could deliver only 36,000.
Blood banks have managed to close the gap since then, but they still continue to advocate on behalf of gay donors. The plea for a more tolerant and nuanced policy was never made more explicit than during a March 2006 meeting of the FDA's Blood Products Advisory Committee, when Steven Kleinman, M.D., then a medical advisor to the AABB, made a statement on behalf of the Red Cross, ABC, and the AABB.
"The vast majority of donors with prevalent infections will be positive by both antibody tests and NAT tests," he told the panel. "The lifetime deferral for MSM is medically and scientifically unwarranted."
Meanwhile, students and even administrators on high school and college campuses across the country -- where blood banks collect almost 20 percent of their donations -- began protesting the ban, discouraging people from giving until the FDA agreed to lift it.
One notable example occurred in when 2008 San Jose State University president Don Kassing banned blood drives on the school's campus. "The FDA's lifetime blood donor deferral affecting gay men violates our nondiscrimination policy," Kassing wrote in a memo to the campus community.
And that momentum has only continued to build. The following year, California assemblyman Tom Ammiano demanded Presidential intervention. "Blood has no sexual orientation, and the FDA should have no discrimination," he said. "I hope President Obama hears our call to change this shameful and discriminatory practice immediately so we can save more lives."
The Department of Health and Human Services, under which the FDA operates, last considered changing the ban in June 2010. After reviewing the data, the FDA's Blood Safety and Availability Advisory Committee said, once again, that they found the proposed changes "suboptimal" and voted to keep the current policy in place.
The panel voiced its concerns -- among them, that the screening systems in place weren't adequate to protect people should the policy be revised. As a result, a study is currently under way to evaluate alternative screening strategies and to propose even more safeguards.
Some activists, meanwhile, have stopped waiting for the FDA to take action. Blake Lynch, a 22-year-old nursing student in Florida, found out about the ban last February. He'd driven to the local donation center after his friend, Emmy Derisbrun, spoke to his nursing class at Seminole State College. Derisbrun has sickle cell disease, one of the world's most common genetic diseases. Sickle cell affects more than 90,000 people in the U.S., predominantly African Americans like Derisbrun. And when sickle cell flares up, the symptoms can be extremely painful. Blood transfusions are often a necessary part of the treatment.
"The pain is excruciating," she says. "If I need blood, I like to know it's there. My blood type -- O negative -- is rare, and the hospitals are always running low. If there's ever a shortage, I could die."
Moved by her story, Lynch decided he would try to help. Later that day, he drove to the blood bank and filled out the questionnaire. Afterward, an administrator called him into a private room to review his answers. "He asked me if I'd answered truthfully,'" Lynch says. "I told him I had. And then he explained the ban. I was shocked. I'm not a prostitute or a drug user -- I'm a healthy guy. As I like to tell people now, the H in HIV stands for 'Human' -- not 'Homosexual'."
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Embarrassed, Lynch left the clinic without a word. Later that night at home, he told his partner, Brett Donnelly. As he explained what happened at the clinic, Lynch's anger boiled over. That night, Lynch and Donnelly decided they would form an organization, Banned4Life, to help raise awareness of the policy. Rather than protest and discourage people from donating, however, Banned4Life took a more proactive approach: Those who are eligible to donate, they said, should donate blood on behalf of someone who can't. "It's astounding how unaware people are of this policy," Donnelly says. "There's no social pressure for the FDA to change because nobody knows about it."
Gradually, organizations like Banned4Life are working to change that. In April, Banned4Life submitted a resolution to the National Student Nurses' Association that called for a revision of the MSM policy. "It passed with 91 percent of the votes," Lynch says, "and a standing ovation."
Banned4Life even found support from the one place they least expected it: the blood banks. "At first we wanted to protest them," Lynch says. "Until we realized they were actually on our side." Banned4Life is now working closely with America's Blood Centers and OneBlood in Florida to create a nationwide Banned4Life blood drive program. The leadership of groups such as the AABB, the Red Cross, and ABC -- which combined oversee nearly all of the donation centers in the U.S. -- have in fact made no attempt to conceal their exasperation with the FDA.
The U.S. Department of Health & Human Services for Blood Safety and Availability Advisory Committee voted in 2010 not to recommend a change to the FDA policy. They met again on the issue in 2012 but once again failed to make any new recommendations. The Red Cross calls the ban "unwarranted," saying "Donor deferral criteria should be modified and made comparable with criteria for other groups at increased risk for transmission of transfusion-transmitted infections."
Stramer is more blunt in her assessment. "The ban just doesn't make sense," she says. "Blood centers now have the capability to deal with HIV-positive donors, and it's time for us to harmonize our deferral policies."
Many of the world's leading AIDS researchers echo her sentiments. "Just because you're gay doesn't make you higher risk than someone who isn't," Zingman says. "Lots of heterosexual people pose a high risk and don't face a lifetime ban. This is about behavior; it's not about being gay. The policy stigmatizes gay men. It limits the donation pool, it's not medically justified, and it's not right."
It also ignores a fundamental flaw in the process: You can't force potential donors to tell the truth. "I started giving blood in college, and I didn't come out as a gay man until I was 39," says Bill S., a donor from Philadelphia who spoke to Men's Health anonymously. "I've been giving blood for years, and when I saw that question, I knew I was going to lie. I'm comfortable with it because I don't engage in any high-risk activity, no matter what the FDA says. I'm extremely healthy, and I've never felt weird about it."
Such disclosures are troubling to the FDA, which has commissioned a separate study to find out what motivates men with MSM behavioral history to donate and whether they'd be likely to comply with modified deferral criteria. For donors like Bill S., though, the answer is simple: "It's an easy thing for me to do," he says. "It takes an hour of my time, and it saves lives."
More importantly, as an overwhelming body of evidence now suggests, it can save lives without endangering others.
As Emmy Derisbrun, the woman who inspired the Banned4Life movement, put it, "I'll never ask, 'Is that gay blood?' I only care if it's healthy blood."