Lukus Estok knew something was wrong as soon as he saw the look in her eyes.
Estok, a 36-year-old New Yorker who recently recovered from COVID-19, signed up to donate plasma after he heard that Mount Sinai Hospital was conducting research using the antibodies of survivors to treat patients who are severely ill. It was good timing for Estok to participate. On April 2, the Food and Drug Administration announced it would loosen restrictions on men who have sex with men to allow donations from individuals who had refrained from same-sex sexual activity for three months. He fit those criteria and immediately filled out a donor questionnaire.
But after successfully completing several rounds of screenings, Estok was turned away by the New York Blood Center in mid-April. When he informed the female worker taking his information that he is a gay man, he said that the expression on her face “immediately changed.” Despite the fact that she had a mask on, her eyes turned “cold.” “You will not be donating today,” she responded.
Confused at what was happening, Estok explained that the FDA had relaxed its prior one-year deferral period for MSMs, which was viewed as a de facto lifetime ban for sexually active gay and bisexual men. The worker interrupted and said, “I don't know what you think you know, but you will not be donating here today.”
When he left the blood center, Estok told VICE that he felt “deflated by the entire experience.”
“I cried,” he said. “I felt less than. Right now, I spend 23 and a half hours a day inside my small, one-bedroom apartment and so anything that I could do that might be of assistance or have a positive impact feels incredibly important to me. I felt a need to do whatever I can to make someone else’s experience better than I had it—or at least make it so that it’s not significantly worse.”
Despite the recent changes in the FDA guidelines on giving blood, gay and bisexual men who meet the current standards say they have continued to be deferred from donation at a time when they are critically needed. In March, the American Red Cross announced it was facing a “critical blood shortage” after 2,700 donation drives were cancelled due to the COVID-19 pandemic, resulting in approximately 86,000 fewer pints of blood in the U.S. blood supply.
But gay and bisexual men who have stepped up to donate since the release of the FDA’s revised guidelines said they have been told blood centers aren’t prepared to implement them. Brennon Mendez, a 24-year-old law student, was turned away from the UCI Health Blood Donor Center in Orange, California, after a “receptionist told him the clinic wasn’t yet complying with the new FDA guidance,” as The Guardian reported.
“I felt stigmatized, and I also felt outraged that such a refusal to adapt to the urgent circumstances of this crisis would result in less blood being available to those who need it most,” Mendez told the publication.
John Murray, the assistant director of communications at UCI Health, said the clinic did not intend to “marginalize any person who wishes to donate blood or plasma.” He explained to VICE that the blood center’s ability to implement the new guidelines “depends on revision to and FDA approval of the American Association of Blood Bank’s donor history questionnaire.
“Once that is completed by AABB, UCI Health Blood Donor Center procedures can be revised to ensure compliance and staff retrained,” Murray said in an email.
The Red Cross and America’s Blood Centers, the latter of which oversees the New York Blood Center, have stated it could be months before they are prepared to comply with the revised FDA policies. Although the Red Cross said in a statement that it is “working aggressively” to roll out the updates, the organization added that the “process includes potentially thousands of individuals and involves complex system updates that will take time to implement.”
In a statement, America’s Blood Centers told VICE that donation centers “are actively working to implement the FDA-announced changes as quickly and diligently as possible but it will take time to change and adapt policies in compliance with regulatory requirements, recommendations, and good manufacturing practices.”
The organization’s CEO, Kate Fry, said it will take an average of “two to three months” for blood centers to adhere to the FDA guidelines, as The Guardian reported.
Some predicted it may take even longer for blood banks to allow gay and bisexual men to donate within the three-month window because of the strain COVID-19 has placed on health centers across the country. Jason Cianciotto, senior managing director of institutional development and strategy at Gay Men’s Health Crisis, said that “the bureaucracy involved in disseminating this policy out at a time of crisis ensures that whatever changes need to be made in systems aren’t going to be able to happen or they’re not going to be able to happen consistently.”
That means, for example, that a gay man who attempts to donate at one blood bank could be deferred while another individual is accepted at a different organization. “People are going to have different experiences when they go to different places to donate blood or plasma,” Cianciotto told VICE.
Experts said the controversy illustrates that the FDA’s updated donation policies, while a step in the right direction, are fundamentally flawed. Daniel Bruner, senior director of policy at Whitman-Walker Health, said his organization has encouraged policy makers to screen donors based on the “very specific sexual acts that engaged in within the last few weeks,” rather than singling out same-sex activity due to fears of HIV transmission. More than a dozen countries, including South Africa and Russia, have implemented individual assessments focusing on high-risk behavior.
Bruner said that donor policies which treat gay and bisexual men as a blanket group “just help to perpetuate misconceptions about HIV and how it’s actually transmitted.” “That's harmful to public health because people ought to have a very clear understanding of what’s risky and what’s not,” he told VICE.
Paul Volberding, director of the AIDS Research Institute at the University of California Los Angeles, said the FDA’s policies on MSM donations date “back to a period where people were very, very afraid of HIV.” Until 2015, gay and bisexual men were prohibited from giving blood at all because of a 1985 policy implemented during the height of the HIV/AIDS epidemic, when far less was known about the virus or how to screen for it. Early HIV testing, as Volberding explained, was “not very good and not as accurate as the ones we have now.”
But things have changed dramatically in the 35 years since the FDA’s ban. The Centers for Disease Control reports that nucleic acid testing “can usually tell you if you have HIV infection 10 to 33 days after an exposure.” Volberding said the test is “remarkably accurate,” adding that HIV screenings are “probably the most accurate tests we have in medicine.”
“We should not be limiting the supply of blood for reasons that have nothing to do with the safety of the blood,” he told VICE. “We should be encouraging people to donate.”
Estok feared that the current confusion regarding the roll-out of the FDA’s revised recommendation may have the opposite effect. LGBTQ+ advocacy groups like GLAAD have been critical of the fact that the new guidelines continue to effectively defer the majority of gay and bisexual men, who remain sexually active; Estok was also worried those who are eligible would be discouraged due to fear of experiencing the same mistreatment and discrimination he did.
Since Estok’s story first grabbed widespread attention, men across the country have told him that his experience was the last straw for them. “This is it,” he summarized for them. “This country deserves no more of me than I am forced to give them.”
“That feeling of defeat and that feeling of being less than has a profound psychological effect,” Estok said. “Right now, we’re all going through something deeply traumatic and additional trauma on top of that does not help. I have every reason to believe that this policy is dissuading people from attempting to donate at all.”