Less than a week after the Food and Drug Administration announced new guidance that would allow more gay and bisexual people to give blood, Wesley Milla went out to donate.
It’s been more than 10 years since he last gave blood. As a nurse, currently in graduate school to become a nurse anesthetist, the St. Paul resident sees first-hand the need for blood donations.
“When they made this ruling, and they made this decision, part of me was really excited that I could contribute and that I could give blood again,” he said.
But when he got to the Red Cross, he was told he’d still have to wait.
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“They, unfortunately, still had that three month period where you had to be abstinent, basically. And so I was rejected because of that,” he said.
While the FDA’s new guidance means that more people could give blood, it hasn't yet been implemented at donation centers in Minnesota, and across the country. Experts say that it could take months to implement the new guidance.
“I think every blood center in the United States is aiming for before the end of the year. But how much before the end of the year we can accomplish, it's really honestly too early to know,” said Dr. Jed Gorlin, medical director for Memorial Blood Centers.
Restrictions around gay and bisexual men donating blood go back to the 1980s, during the height of the AIDS epidemic. At that time, the FDA essentially banned men who have sex with men from donating blood in an effort to reduce the risk of transmission.
Over time, the agency has slowly relaxed those restrictions. In 2015, the deferral period was shortened to 12 months, meaning that men who have sex with men could now give blood, but would have to wait one year after having sex to do so. In 2020, that deferral period was shortened to three months.
For years, LGBTQ+ advocacy organizations, like GLAAD, criticized those policies as discriminatory, since sexual orientation doesn't inherently determine if someone will or will not contract HIV.
“I think for too long LGBTQ individuals, particularly gay and bisexual men, as well as trans women and other folks, have been prevented from donating blood simply because of their identity with no other factors considered into what their life looks like, what their health looks like, what their behaviors look like,” said Kat Rohn, executive director of OutFront Minnesota. “That is rooted in the notion that LGBTQ folks are somehow dangerous, and unfortunately, that stigma has carried through to things like blood donations, and all sorts of different aspects of our lives.”
The new, nonbinding FDA guidance, released in early May, instead assesses risks on an individual basis. It recommends that questionnaires be updated to ask potential donors about risk factors, like anal sex with new or multiple partners in the past three months. Depending on the answers, they potentially could be deferred for three months.
But the guidance opens possibilities about who can give blood, like gay and bisexual people in monogamous relationships. While advocates say these new rules are a step in the right direction, they could go further. One example advocates give is the new guidance defers people taking medications to prevent HIV infection, like PrEP.
“[The] deferral period for individuals on PrEP, an FDA-approved drug proven to prevent HIV acquisition, continues to erect barriers to LGBTQ blood donors,” said Sarah Kate Ellis, president and CEO of GLAAD, in a statement after the new guidelines were announced. “Placing potential blood donors taking PrEP in a separate line from every other donor adds unnecessary stigma. The bias embedded into this policy may, in fact, cost lives.”
One of the reasons cited in the FDA’s decision to exclude people on PrEP and PEP is the drugs “may delay detection of HIV by currently licensed screening tests for blood donations, potentially resulting in false negative results.”
Still, some argue that this guidance sends a confusing message about what safe practices are and are not.
“So, we're saying to somebody who has lots of partners, but now they haven't had sex for three months, [that] it's safer for them to give blood than somebody who is on PrEP and hasn’t had sex?” said Dr. Mary Jo Kasten, medical director at the Thrive clinic at the Aliveness Project. “That's where the disconnect is, I think.”
Despite that, Kasten said the broader changes to the FDA’s policy are a welcome and appropriate move.
“The wheels of government move slowly,” she said. “There's still a stigma behind being gay, or transgender, but this seems like definitely a step in the right direction. And that should help decrease, I hope, stigma in the long run.”
‘More time than anyone would like’
It’s not clear when these new rules will actually be implemented by donation centers, allowing newly-eligible people to be able to give blood.
In a statement, the American Red Cross said it’s “committed to implementing FDA’s final guidance as quickly as possible; however, it will likely take more time than anyone would like.” That’s due in part to the fact that donor questionnaires need to be updated as well as other processes.
Gorlin with Memorial Blood Centers said they must train staff and community members how to follow the new guidelines.
“This is a sensitive topic and we need to roll it out in a sensitive fashion. And so there's a lot of staff training, as well as blood drive coordinator training, involved so that people understand the safety of this decision,” he said.
Gorlin said they’ve been working with the FDA for “over a decade” to achieve this goal, and are glad to see it moving forward. But it’s important that each organization is prepared to roll it out, which could take till the end of this year.
“What they absolutely don't want is to walk into a blood center and not be treated appropriately and courteously,” he said. “And if that takes a little bit longer to make sure that it happens correctly, then it is in everyone's best interest. This is a long-term change. We want to make sure that as we reach out to more diverse donor groups, that we do it properly.”
Wesley Milla says he’s still planning to donate as soon as he’s able to.
“I'm really excited that change is coming. Change can be slow, but I'm glad that we're moving in the right direction,” he said. And I just hope that these organizations and these blood centers move things along quickly rather than slowly.”
“I mean, I’ve waited this long,” he said. “What’s an extra couple months?”