A push by activists to ease the 30-year-old blanket ban on blood donations from gay and bisexual men faces a key test this week as a federal panel hears results of the latest research. The findings will be released amid growing pressure from politicians and advocates, including college students, to change the policy.
Critics say the ban is a hangover from the early, fear-filled days of AIDS, stigmatizing gay men and ignoring advances in treatment and detection in the decades since.
Supporters of the policy say politics, not science, is driving the proposed change, which would heighten the risk of spreading HIV, the virus that causes AIDS, when the medical demand for blood donations is decreasing.
Under Food and Drug Administration rules, men who have had sex with men (MSM) since 1977 are ineligible to donate blood. An acknowledgment of having male homosexual relations at any time in one's life is enough to disqualify a potential donor.
"This policy is discriminatory and inadequate," said a petition drive at WhiteHouse.gov started in early November by students at the University of Michigan.
The students' solution is to change the questionnaire to ask prospective blood donors, "Have you had unprotected sexual contact with a new partner in the past 12 weeks?"
A "yes" answer would trigger a deferral "based on the window period of HIV," the petition said. "This change avoids discrimination and addresses risky behaviors that presently go overlooked. All individuals should be eligible to donate if they otherwise pass all of the FDA's requirements, including a disease-free status," the petition said.
Others say safety must remain the priority.
"The pressure for change is coming not because of a shortage of blood, but because of the politics of sexual orientation," said Peter Sprigg, senior fellow for policy studies at the Family Research Council.
Such politicization "should not play any role in the decision making on a health-related issue, on protecting the health of the American people," he said.
Weighing the evidence
On Thursday, members of the Department of Health and Human Services Advisory Committee on Blood and Tissue Safety and Availability will hear seven presentations on the MSM blood-donor issue.
In 2010, the advisory group agreed that the ban on MSM blood donations was "suboptimal" but kept it in place pending additional research to "create a road map forward," as one panelist said.
This week's presentations will provide updates about the blood-donor questionnaire, "quarantined" blood units and related studies designed to help craft a new MSM policy.
The FDA established the policy in 1985 after public health officials realized that thousands of hemophiliacs were receiving — and dying from — transfusions of HIV/AIDS-infected blood. Among the most famous victims: tennis star Arthur Ashe, believed to have received the disease from a transfusion during a coronary bypass operation.
Men who have sex with other men are at high risk for HIV acquisition: In 2011, MSM "accounted for at least half of persons diagnosed with HIV in all but two states," the Centers for Disease Control and Prevention said in a report released Friday.
Moreover, the percentage of MSM reporting at least one incidence of unprotected anal sex — a major risk factor for HIV infection — in the past 12 months rose from 48 percent in 2005 to 57 percent in 2011.
Gay or bisexual women are not banned from giving blood unless they fall into other deferral categories.
The National Hemophilia Foundation and other advocacy groups for blood users — who note that patients bear 100 percent of the risk in blood transfusion and any changes in the donor policy must be based solely on scientific evidence — are monitoring the issue closely.
Dozens of members of Congress have urged HHS Secretary Kathleen Sebelius to expedite the process to change the MSM ban, citing in part a vote in June by the American Medical Association.
"We feel that the AMA's recent vote in opposition to the current policy provides even greater impetus for HHS to move swiftly with its research and revision of the current ban," Sen. Tammy Baldwin, Wisconsin Democrat; Rep. Mike Quigley, Illinois Democrat; and 84 other members of Congress said in an Aug. 1 letter. Sen. Michael B. Enzi of Wyoming was the only Republican who signed the letter to Mrs. Sebelius.
Seeking a new standard
A major area of discussion is how to change the policy.
Potential reforms could permit MSM donors who have not had sex with men for five years, as in Canada, or for one year, as in Britain.
"With any ban, active MSMs will remain ineligible to donate blood," America's Blood Centers, the American Red Cross and AABB, formerly known as the American Association of Blood Banks, said in a June statement.
Gay-rights advocates say such abstinence policies perpetuate the stigma that gay people are dangerous to public health and that there is not much difference between the lifetime ban and a five-year "no-sex" deferral policy.
The Gay Men's Health Crisis recommends a policy that permits people who are sexually active but engage in "low-risk sexual practices like condom usage or monogamy" to donate blood.
Thus "all potential donors are screened for high-risk behavior, regardless of sexual orientation," the organization said.
With advances in blood testing, deferral periods need not be years or even months, said Josh Bloom, director of chemical and pharmaceutical sciences at the American Council on Science and Health.
"I understand, with the emotional issue of HIV, why people want to be super-careful," Mr. Bloom said. But the ban "implies that everybody walking around gay is HIV-positive, and that's certainly not the case."
Also, a new test for HIV "measures the genetic material from the virus directly," instead of antibodies to the virus, said Mr. Bloom, who holds a doctorate in organic chemistry.
This HIV method is accurate and fast. So, if the questions are answered correctly, "it makes no sense scientifically" to exclude these donors, he said.
Federal officials said at an August meeting of the FDA that some strains of HIV may be difficult to detect and noted that Germans have reported a few "transfusion transmissions" in recent years.
HIV transfusion incidents are rare in the U.S.: In 2008, a patient acquired HIV from a Missouri blood transfusion. The donor, a middle-aged married man, was found to have had anonymous sex with both men and women.
That transfusion-transmitted HIV infection was the first reported since 2002, the CDC said.
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