Below is an academic argument that I wrote last semester for my English Composition course. I feel like it needs to be shared now more than ever. We could increase our national blood supply by changing the donor criteria.
10 November 2019
The U.S. Must Eliminate the Deferral Policy on MSM Blood Donations
The United States is constantly in need of blood donations. Blood drives have begun taking place at offices, community centers, and even local festivals; the American Red Cross is constantly promoting the good behavior of donating blood. A study in 2013 indicated that the public chooses to donate blood because it makes them feel like they are contributing to society, thus making them feel “good” (Sturrock & Mucklow). Studies indicate that the need for blood donations will only continue to grow as advancements in modern medicine increase the general population’s life expectancy, which typically requires more blood consuming medical procedures. Unfortunately, the experts have yet to perfect what has been described as “synthetic blood”, so the blood banks rely on blood donations from the public to sustain these needs (Bonig, et. al., 1; Jubran, et. al. 434.). However, the catch is, not everyone who wants to donate is being permitted to do so. One group that is being excluded is men who sleep with men (MSM). Over 30 years ago, when the AIDS virus was found across different blood supplies in the U.S., the initial ban was medically necessary. However, given scientific evidence, the current 1-year deferral for MSM blood donations appears to be overly cautious. The United States must adopt blood donation criteria similar to Italy or Spain; both countries utilize an individual assessment that does not factor in sexuality, followed by the standard screening of the blood donation (Jubran, Bellal, et al., 434; Cahill & Wang, 2).
In the 1980s, the AIDS epidemic invoked the need to implement more restrictive guidelines when donating blood in order to prevent any transmission of disease. At this point, medical professionals did not have any of the screening tools that exist today. It appeared that the only logical solution was to err on the side of caution. In 1983, Don Francis, CDC epidemiologist, spearheaded the push to update donor guidelines to prevent further transmission of contaminated blood. In January of 1983, at a meeting with blood banks and public health officials, Francis cited data linking the outbreaks to the gay community, people who inject drugs and patients with hemophilia. Francis pointed to this data as a justification for a ban on blood donations from these three demographic groups. However, there was push back at that time and the ban wasn’t officially implemented until 1985. Coincidentally, this was the same year that the first screening test for HIV came into existence (Sacks, et. al., 175).
Fast forward to the present day and the advances made in blood screening can detect HIV between 10 and 30 days of the initial transmission. This was unthinkable in the 1980s. Nucleic acid amplification testing or NAAT is what makes detecting the virus within ten days possible; in addition to the NAAT test, we are also on the fourth generation of standard HIV screening, which can detect the virus within one month (Cahill & Wang, 3; Sturrock & Mucklow, 305). This has led to the question of whether the one-year deferral for MSM is still medically necessary or if it has become outdated and borderline discrimination.
The trend in countries similar to the United States, such as Canada, has been to decrease the deferral time every couple of years, following an evaluation of the previous decrease in deferral time. The countries that have implemented a decrease in deferral times have shown no substantial changes in the amount of contaminated blood. For evidence of this, we can point to the study completed in Australia between 1996 and 2000. The researchers evaluated the outcome after the country transitioned from an MSM blood ban to a 1-year deferral. It was discovered that there was “no evidence for increased risk of transfusion-transmitted human immunodeficiency virus in Australia” (Jubran et al, 428). We can also look at Italy and Spain for additional evidence. A study performed in 2013 by the National Institutes of Health and the Bologna Local Health Authority stated that “the results – showed that unprotected heterosexual — not homosexual — contact remained the main mode of HIV transmission both among blood donors” (Jubran, et al., 434). Lastly, we can also point to study in Canada “in 2014 that showed that the second most important exposure to HIV among adults in Canada was through heterosexual representing approximately one-third of the new positive HIV tests” (Jubran et. al, 432).
The counterargument for allowing the one-year deferral to remain in effect is that relaxing the donor criteria will inevitably lead to an increase of contaminated blood donations. However, this doesn’t necessarily mean these blood donations will then be used for a transfusion. Current standards require the blood donation to be screened at the time of collection, followed by a post-donation screening, after the window period, which refers to the ten days where the virus is undetectable. (Cohen et. al, 3.)
Another point to consider, there are non-compliant donors who currently withhold their sexual identity so that they can donate. One study uncovered a few reasons for volunteers being non-compliant and a few of them included: the donor was aware of their HIV status, the donor executed safe sex practices, or the donor felt that the exclusion was discriminatory (Sturrock and Mucklow 305). This brings into question the efficacy of the one-year deferral; if potential donors are withholding their sexual identity to be permitted to donate, it may be arguable that the current policy may not be serving its intended purpose. Other documentation demonstrates that the younger generation is even more in favor of decreasing deferral periods, a study showed that 8 in 10 students favored this motion (Jubran, et al, 430).
Another fault in the current 12-month deferral policy is the lack of consideration it gives to men who may be married or in a monogamous relationship with their partner. Presently a man married to another man is still asked to abstain from having sex with this partner for one full year before they would become eligible as a blood donor. This is faulty logic as the same isn’t asked for a heterosexual married couple.
Many people have felt the shame that comes with being denied the opportunity to donate blood. I imagine it makes them feel like a social pariah, undervalued, not good enough. This is a feeling that is felt often by those in the LGBTQ+ community. Many of us have always felt different, and although society has made great strides, the act of giving blood needs to be re-evaluated to fit today’s contemporary beliefs and values. There simply is not enough scientific evidence to justify a one-year deferral for those in the LGBT community. The American Red Cross, America’s Blood Centers, and the American Association of Blood Banks have come out and publicly opposed the ban, claiming that it is “medically and scientifically unwarranted” (Cohen, et al, 1).
In conclusion, the United States has made great strides to achieve equality for all Americans, but the work is far from complete. The current blood deferral policy is no longer justifiable as we can scientifically ascertain if HIV is present in a blood donation. As previously stated, the NAT test can detect HIV within 10 days of transmission, followed by a post-donation screening that takes place after the window period. Given the extreme need for blood donations, it seems we would be doing the country a disservice if we don’t open up the community of eligible blood donors to everyone.
Bönig, Halvard, et al. “Sufficient Blood, Safe Blood: Can we have both?” BMC Medicine, vol. 10, 2012, ProQuest, search.proquest.com.ezproxy.hacc.edu/docview/1000401698?accountid=11302, doi:http://dx.doi.org.ezproxy.hacc.edu/10.1186/1741-7015-10-29
Cahill, Sean, and Timothy Wang. “An End to Lifetime Blood Donation Ban in Israel for MSM would be a Major Step Toward a Science-Based Policy that Reduces Stigma.” Israel Journal of Health Policy Research, vol. 6, 2017. ProQuest, search.proquest.com.ezproxy.hacc.edu/docview/1884989771?accountid=11302, doi:http://dx.doi.org.ezproxy.hacc.edu/10.1186/s13584-017-0139-2.
Cohen, I.Glenn, et al. “Reconsideration of the Lifetime Ban on Blood Donation by Men Who Have Sex with Men.” JAMA: Journal of the American Medical Association, vol. 312, no. 4, July 2014, pp. 337–338. EBSCOhost, DOI:10.1001/jama.2014.8037.
Jubran, Bellal, et al. “Reevaluating Canada’s Policy for Blood Donations from Men Who Have Sex with Men (MSM).” Journal of Public Health Policy, vol. 37, no. 4, 2016, pp. 428-439. ProQuest, search.proquest.com.ezproxy.hacc.edu/docview/1868464910?accountid=11302, doi:http://dx.doi.org.ezproxy.hacc.edu/10.1057/s41271-016-0032-1.
McCarthy, Michael. “US Lifts 30 Year Ban and Allows some Gay Men to Donate Blood.” BMJ: British Medical Journal (Online), vol. 351, 2015. ProQuest, search.proquest.com.ezproxy.hacc.edu/docview/1777830362?accountid=11302, doi:http://dx.doi.org.ezproxy.hacc.edu/10.1136/bmj.h6982.
Sacks, Chana A., Robert H. Goldstein, and Rochelle P. Walensky. “Rethinking the Ban — the U.S. Blood Supply and Men Who have Sex with Men.” The New England Journal of Medicine, vol. 376, no. 2, 2017, pp. 174-177. ProQuest, search.proquest.com.ezproxy.hacc.edu/docview/1858132172?accountid=11302, doi:http://dx.doi.org.ezproxy.hacc.edu/10.1056/NEJMms1613425.
Sturrock, Beattie R. H., and Stuart Mucklow. “What Is the Evidence for the Change in the Blood Donation Deferral Period for High-Risk Groups and Does It Go Far Enough?” Clinical Medicine, vol. 18, no. 4, Aug. 2018, pp. 304–307. EBSCOhost, DOI:10.7861/clinmedicine.18-4-304.