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Tyler K. Anderson, DPT(ASCP)

CM

Professor Harris-Ramsby
English 2010-406
July 13, 2015

The Next Step for Gay Blood Donors

In January 2015, the United States Food and Drug Administration announced
that they would be altering the ban on men-who-have-sex-with-men (MSM) from
donating blood. The actual struggle of MSM donors from being able to donate is a long
and curious story, filled with decades of research, debate, protests, and political actions;
its an issue that most of the general public didnt even know was happening. But that is
not what I will be discussing here. The subject of this paper refers to the next steps to
be taken now that the ban is being augmented. This includes educating MSM donors
about the new regulations to continue to keep the blood supply safe; and also, on
occasion, educating a skeptical public which may not feel comfortable having MSM
blood in the supply.
Beginning in 1983, the ban on MSM blood donors was implemented when it was
discovered that HIV and AIDS were able to be spread through blood transfusions from
infected donors. Sexually active MSM have predominantly been at higher odds for
contracting HIV; the FDA cite these statistics on a frequently asked questions website
about MSM blood donors: Men who have had sex with other men represent
approximately 2% of the US population, yet are the population most severely affected
by HIV. In 2010, MSM accounted for at least 61% of all new HIV infections in the US

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and an estimated 77% of diagnosed HIV infections among males were attributed to
male-to-male sexual contact (FDA). Because of these high rates of infection among
the MSM population, the FDA had placed an indefinite deferral on all men who had
had sexual contact with another man, even once, since 1977. These men were not able
to donate blood intended for transfusion to another person, and technically, as of the
time of my writing this, they still are not allowed to donate blood. The FDA still has not
announced the exact date the deferral policy will change, they only stated it would be in
2015.
For now, myself, and the blood collection center I work for in Salt Lake City, are
now reviewing what the FDA call a Guidance for Industry. This document is the firstdraft of what will eventually become the law in the land of blood donations. Blood
centers across the country were sent this document, which spells out the new rules
regarding MSM donors, in April. Our job now is to review, give feedback, and prepare to
implement these new regulations. The main point of this guidance is very clear: we are
to allow MSM donors to donate after the 1-year wait from last sexual contact with
another man; but, we must stress to all donors that there is still reason and a need for
an MSM deferral, and I am in the process of setting up outreach programs among
various groups containing members of the MSM population. I have been speaking to
LGBT groups at various college and high school campuses about providing them
information or coming to talk about the new deferral, and also the importance of
complying with it still. I have been in contact with the Utah PRIDE Foundation, and the
Utah AIDS Foundation about helping me spread this informationthis even lead me to

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start volunteering monthly at the Utah AIDS Foundation, helping with HIV testing,
stocking shelves at their food bank, and planting/weeding in their community garden.

The FDA based their decision to change the MSM deferral on a lot of scientific
research since the deferrals implementation. Id like to briefly list three studies the FDA
reviewed below, and follow each with what I personally am doing with this information to
help educate a new MSM donors prior to the change of the policy change.

The information from the first study, published in Transfusion medical journal by
Clive R. Seed, et al. in 2010, was both key to the FDAs decision, and to my helping one
LGBT high school group in particular, show their HOSA club classmates that the two
clubs could host a blood drive together. Seed, et al. write about the HIV infection rates
in Australia following their MSM deferral change; they state that by the year 2000 all
regions of Australia had changed their MSM deferral from indefinite to a 1-year wait
following the last MSM sexual contact. They continue with listing data from 5 years preimplementation to 5 years post-implementation of the new MSM deferral, they show that
the number of HIV-positive donors did not increase; the pre-implementation period
showed 16 HIV-positive out of 2.1 million male donors, as opposed to 13 HIV-positive
out of 2.5 million in the post-implementation period (2725). I liked showing some
concerned students and instructor that there is no evidence that allowing MSM to
donate increases the risk of transfusion related infection. But at the same time I stress
the importance to MSM donors that blood donation is not the way to get a confidential

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testing done if they are concerned about it (an issue I will discuss below), and I also
provide information from the Utah AIDS Foundation, who do free HIV testing weekly.

The second is a study by Marion Vermeulen, et al. published 2009 in

Transfusion. This study documented the high rates of HIV among the black population
of South Africa, and how between 1998-2005 the government of South Africa accepted
only blood donations from white donors and repeat black donors to be used for
transfusion. By using this selective donor deferral, Vermeulen, et al. claim, the
prevalence of [HIV] in the donor population was reduced to 0.08% in 2002 (1115). The
study goes on to show that in 2005 the country was finally able to start using high
quality HIV testing, which was able to reduce the risk of HIV infection from transfusion
better than the preference of white donors and the deferral based on race was ended.
I use this study to emphasize to LGBT groups that, yes, better testing is a big
reason behind this deferral being changed. Every unit of blood is rigorously tested for a
variety of viruses, bacteria, and parasites such as Hepatitis B and C, Syphilis, Chagas,
and HIV. Sometimes these various bloodborne pathogens get missed by testing. I
inform these groups that, while rare, the biggest reason that viruses are missed, by
even this advanced testing, is what is known as window period testing. Between the
point that a person is infected with a virus, to the point that virus is detectable by testing,
is referred to as the window period; people can be able to spread these viruses to
others but still test negative during this time. That is why it is so important that donors
are honest about their sexual and health histories when donating blood. The first line of

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defense for a safe blood supply is to ensure donors have not had any high risk activity
during potential window periods.

I always want to ask if anyone in the group Im communicating with has lied to
donate before, just out of curiosity, but I dont. However, this third study, by Steven A.
Anderson, et al., did just that. Published in 2009 in Transfusion, the study was a survey
conducted on MSM from the San Francisco, California area. In this survey the men
were asked if theyd ever lied about MSM sexual contact to be able to donate blood.
While not a large percentage said they had lied to donate, a large percentage of those
surveyed said theyd be more likely to be compliant with a 1-year deferral, as opposed
to a 5-year, or the current, indefinite deferral. I like to use this study to show young
MSM that 1 year is a long deferral time to wait to donate, but it is now the same amount
of time as a heterosexual couple that have had at risk sexual exposures. At risk
donors are defined as those who have a history of Hepatitis, HIV, IV drug use, and a few
other things. A woman that has had sexual contact with an at risk positive man is
deferred for 1 year following the last sexual contact; the same will now be applicable to
MSM donors.

Through these outreach groups I have been able to help educate a new donor
population to continue to help keep blood safe for people receiving transfusions in Utah.

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Works Cited
Anderson, Steven A., et al. "Quantitative Estimate Of The Risks And Benefits Of
Possible Alternative Blood Donor Deferral Strategies For Men Who Have Had
Sex With Men." Transfusion 49.6 (2009): 1102-1114. Academic Search Premier.
Web. 5 July 2015.
Seed, Clive R., et al. "No Evidence Of A Significantly Increased Risk Of
Transfusion-Transmitted Human Immunodeficiency Virus Infection In Australia
Subsequent To Implementing A 12-Month Deferral For Men Who Have Had Sex
With Men (CME)." Transfusion 50.12 (2010): 2722-2730. Academic Search
Premier. Web. 5 July 2015
United States. Food and Drug Administration (FDA). Blood Donations from Men Who
Have Sex with Other Men Questions and Answers. 19 Aug. 2013. United States'
Food and Drug Administration. Web. 05 July 2015.
Vermeulen, Marion, et al. "Impact Of Individual-Donation Nucleic Acid Testing On Risk
Of Human Immunodeficiency Virus, Hepatitis B Virus, And Hepatitis C Virus
Transmission By Blood Transfusion In South Africa." Transfusion 49.6 (2009):
1115-1125. Academic Search Premier. Web. 5 July 2015.