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This shift in policy is long overdue, yet imperfect as it excludes those on PrEP, an HIV drug, writes Perry N. HalkitisPerry N. Halkitis is dean, Hunterdon Professor of Public Health and Health Equity, and Distinguished Professor of Biostatistics and Epidemiology, at the Rutgers School of Public Health.
On May 11, 2023, the Food and Drug Administration (FDA) announced its intention to update its blood donation policy, specifically focusing on who is allowed to donate blood.
For nearly four decades, gay and bisexual men have been denied this right because of rules established under the Reagan-Bush administration at the onset of the AIDS epidemic in the 1980’s.
This anachronistic policy, which has been outdated for decades, has not only put an unnecessary burden on the nation’s blood supply but also perpetuated the stigma experienced by sexual minority men.
The new blood donation guidance, first proposed in January 2023, comes after years of debate and discussion with scientist-activists like myself who have lobbied against the 1980’s policy— rooted in antiquated science regarding HIV, as well as, in ignorance and hate.
The final step will be for the FDA to vote on accepting the guidance—which will occur in the near future—at which point the policy will be enacted.
As we all know, anyone can become infected with HIV, and thus, the guidance proposed by the FDA shifts screening from identity to risk behavior.
All individuals who want to donate blood will be asked a set of risk questions. Specifically, the risk-based assessment will ask whether the person has had anal sex with a new sexual partner (the riskiest of sexual acts for the transmission of HIV) or more than one sexual partner within the past three months.
Those who indicate these behaviors will be asked to wait three months before blood can be donated. The individual risk assessment questions will be exactly the same for every donor regardless of sexual orientation, sex, or gender.
This shift in policy is long overdue, yet imperfect.
It denies those on pre-exposure prophylaxis, also known as PrEP (a daily pill that prevents the transmission of the virus by as much as 99%), for fear that the use of it may mask an HIV infection.
But perfect is often the enemy of the good. The recommendations of the FDA are a huge step forward in our fight to destigmatize the lives of gay and bisexual men and the LGBTQ+ populations more broadly.
For decades, science has documented the effect of stigma in undermining the health of LGBTQ+ people. These experiences of stigma - perpetuated by experiences of discrimination - including state sanctioned laws and policies, create stressors in the lives of LGBTQ+ people, undermining our physical, psychological, and social health.
This condition is exacerbated by these facts: all too many of us - some 16% - experience this type of discrimination from healthcare providers; these providers are rarely qualified to provide competent LGBTQ+ care; one in five of us avoid healthcare for this reason; and one in eight of us live in states where providers can refuse to treat us.
The result of these conditions is that LGBTQ+ people experience worse health outcomes simply because of our identities. This is the experience of 7.2% of us who identify as a sexual and/or gender minority people.
For the people of the U.S. state of Florida, where these attacks are so blatant yet sadly applauded by many of its citizens, the situation is much worse, leading to a travel warning being issued for any LGBTQ+ person considering visiting the “Sunshine” State.
The conditions are even more gruesome for Black and Latinx LGBTQ+ individuals who face multiple forms of discrimination at the hands of Ron DeSantis and his cronies.
This is all to say that it is within this context that the new FDA proposal must be viewed. At a time when our lives as LGBTQ+ people are constantly under attack, this shift in the blood donation policy comes as a small yet significant victory in honoring our lives and improving our health.
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