Porter Brockway and Al Derus have been married for two years. The couple, who live in Silver Spring, share everything — even the same blood type. And yet, current FDA guidance would prevent either from donating blood or tissue to save the other’s life.
The prohibition affecting Brockway and Derus previously existed as a lifetime deferral for any men who had sex with men (MSM), regardless of whether or not they were monogamous. Enacted at the height of the AIDS epidemic, the indefinite deferral was enforced as a way of keeping the nation’s blood supply as free of HIV antibodies as possible. Even as advances in HIV testing technology advanced, the deferral stayed in place until last month, when the FDA changed the period to one year from the time of last sexual contact.
Initially, when the first news reports came out, Brockway was pleased to see headlines stating that what essentially constituted a lifetime ban on gay and bisexual men had been lifted.
“The first time I read about it, it seemed like, ‘Oh, cool, we can just donate blood,’ and then reading into it, I saw about the one-year waiting period,” says Brockway. “I thought it was progress, but it’s not enough.”
Derus understands that the special deferrals for MSM come from good intentions, as blood collectors want to limit the possibility that blood donation could become a vector for HIV, but believes the concept of different guidelines based solely on sexual orientation is outdated.
“All of the same risky behaviors can be happening with partners of different sexes,” says Derus.
Dan Bruner, senior director of policy at Whitman-Walker Health, says that the change to the new policy guidance was long overdue, as the FDA was under pressure to do something. But the new one-year deferral period is viewed as insufficient and discriminatory by many in the medical profession — including Whitman-Walker Health.
“The reason the FDA gives for one year, rather than some other time period, from what we can tell [is] based on one argument,” he says. “About five or six years ago, Australia went to a one-year ban for gay and bisexual men, and there had been studies of the safety of the blood supply in Australia that say the move from essentially a lifetime ban to one-year ban has not resulted in the blood supply being any less safe.”
Bruner adds that blood is routinely tested for HIV after it is collected anyway. As a result, the only risk posed to the blood supply is if someone has contracted the virus during the “window period,” the time when somebody becomes infected and the virus can be detected through blood tests. According to the FDA, that window period is only nine days.
“Our argument was that the ban should be no longer than 30 days,” Bruner says of the suggestions Whitman-Walker made during the FDA’s public comment period. “Some groups, just to try to be even more conservative, were suggesting a ban of several months. But certainly not a year.”
The fairest solution, says Bruner, would be a deferral period of anywhere from 14 days to a month from the last sexual contact, applied equally to all donors, regardless of sexual orientation or risk behavior. Logistically, however, that solution would likely be unworkable, as blood collection agencies would be worried that most people wouldn’t donate under the more stringent restrictions.
Moreover, blood collection agencies, such as the American Red Cross, AABB and America’s Blood Centers, would have to revise their risk questionnaire to reflect the new policy which could take months to carry out.
Kara Lusk Dudley, a spokeswoman for the American Red Cross, says her organization will follow the FDA guidance for a one-year deferral, and will also follow FDA guidelines allowing transgender donors to be assessed based on their self-reported gender identity.
“The Red Cross is working diligently to determine a process for the reinstatement of eligible donors, and we are working on a detailed plan that will outline all the steps needed to implement this change,” Dudley said in a prepared statement. But she also noted that the change will take several months to “update our computer systems, modify processes and procedures, train staff, and implement these changes.”
The most significant change to the policy will be the revision of the donor health history questionnaire, which will be amended to reflect the updated guidelines while also reducing the risk of transmission of HIV and other bloodborne diseases.
Dr. Oladipo Alao, medical director of Amida Care, a special needs health insurer that deals with people with chronic health conditions such as HIV, acknowledges the criticisms that have been lodged against the FDA’s new guidance, but also notes that blood banks practice “pooled testing,” where they collect blood from six to 16 individuals and test the pooled sample of blood for HIV. Alao says this approach is more practical than testing each individually-collected sample.
“The alternative would be to test someone, and then retest them in nine days, asking them to abstain from risky activities between the two testing points,” Alao says. “If you look at what the science is, that would probably be the optimal way of eliminating the risk of HIV from blood transfusions as a whole. But I think what has been said is that, from a viewpoint of being cost-effective, that is not feasible, because the costs associated with it might be too high, and, again, you can’t be sure, during that within that nine-day period, they’ve abstained from risky activities.”
But Doug Wirth, the CEO of Amida Care, still hopes to eventually move to a behavior-based risk assessment. Wirth says the current policy is an improvement, but doesn’t go far enough.
“I think the fact that it promotes a certain kind of stereotype that all gay and bisexual men are inherently dangerous is not okay,” says Wirth, who worked as a health advisor to former New York City Mayors David Dinkins and Rudy Giuliani. “It’s unacceptable, it’s stigmatizing, it’s stereotyping. It is, in fact, a remnant of the past. I think the LGBT community, and the HIV/AIDS community must speak out and drive health agencies and organizations at the state and federal level to embrace zero tolerance for stigmatizing policy.”
Wirth says the approach to blood donation deferrals should be based on science, taking into account important safeguards, improvements in testing, and the reduced risk of HIV transmission due to improvements in HIV treatment and prevention. He urges the United States adopt a forward-looking policy rather than rely on other nations to set the standard for medical providers around the world.
“We believe that the United States, if it wants to assume its rightful position as a world leader, should get out in front of these other countries and demonstrate true leadership, as opposed to getting to ‘as good a place as’ the United Kingdom, New Zealand and Australia,” he says. “We can do better than that.”
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