Last year, the Food and Drug Administration made waves when it loosened a decades-old policy barring gay and bisexual men from donating blood. This week, the regulatory agency announced plans to potentially revisit the policy, leaving many optimistic that there will soon be an even more inclusive approach to blood donation.
The FDA called for public comment on Tuesday, a preliminary step in a possible process of amending the policy. Starting in 1985, blood deferral guidelines prevented men who have ever had sex with men from donating blood for life. The regulations were amended last December, preventing only men who have been sexually active with another man in the last 12 months from donating.
The shift was an initial victory for those who had pushed for an end to the ban, but many felt the policy change could have gone further.
"On one hand, I want to look at this optimistically, that a one year deferral is better than a lifetime ban," said Kelsey Louie, the CEO of Gay Men's Health Crisis. "However, it's hard to look at that as a positive thing when it's still a discriminatory policy.... The fact that the FDA is opening a period for public comment, I have to see that as a good thing."
When the lifetime ban was initially instituted in the 1980s, the US was in the midst of the early days of the HIV/AIDS epidemic, and little was known about the disease. Calls to make the donation system safer came as people contracted HIV because of infected blood used during transfusions.
At the time, the desire to make the blood system safer was understandable, says Dr. Paul Volberding, a professor at the University of California, San Francisco and director of the school's AIDS Research Institute. Since then, Volberding says, there have been dramatic scientific improvements, both in understanding the virus and detecting it.
"The policy has been under criticism for really many years, we've had really good tests for a really long period of time," said Volberding, who helped start the country's first AIDS treatment ward in San Francisco. "They've gotten even kind of better quite recently. The lifetime ban really didn't make sense once we had good blood tests."
'The majority of gay men in this country are HIV negative and should be able to donate blood that could increase our preparedness for disaster or terrorist attack.'
According to Volberding, even the one-year restriction doesn't make sense given scientific advances. Through the comment period he expects the FDA to receive evidence that will point them in the direction of a better policy with a much shorter window for potential exposure.
"I think it will be a more rational policy and will continue to provide a safe blood supply, which is the goal of all this," he said.
Sean Cahill, health policy research director at the Fenway Institute, said he was pleased the FDA opened a request for comment so soon after the 2015 change.
"The majority of gay men in this country are HIV negative and should be able to donate blood that could increase our preparedness for disaster or terrorist attack," he said.
Cahill and his colleagues at Fenway Institute would like to see a policy developed that looks at individual risk in the blood donation process. Currently, the policy focuses exclusively on men who have sex with men, without differentiating high-risk and low-risk sex within that community, or the population as a whole.
"What we're encouraging them to do... in the public comment period is to really move towards looking at individual risk behavior," he said. "To screen all donors for high-risk behavior and try to prevent high-risk individuals, whether they're gay men or heterosexual men and women [from donating]."
Both Cahill and Louie stressed the importance the FDA policy changes could have on reducing HIV stigma and eliminating a long-standing discriminatory policy against gay and bisexual men.
"A policy that applies only to certain people based on who they are and how they identify is the definition of discrimination," Louie said. "It perpetuates the idea that HIV is a gay disease."
Changes to the FDA policy could have a two-fold impact, increasing the number of people who can donate to the blood supply, while eliminating a discriminatory policy perpetuating a stigma that enables the epidemic, according to Volberding. While the panic of the 1980s has largely subsided, there are still 45,000 new HIV infections each year in the US alone.
"The more rational we can be about HIV the more we can reduce stigma and that's going to be important in ending the epidemic," he said. "I think this is a bigger issue in the number of units donated."
Follow Kayla Ruble on Twitter: @RubleKB