Opinion: Will new blood donation rules finally stop stigmatizing gay men?

As a sophomore in school in 2011, I used to be deferred from donating blood for being a homosexual man. I used to be confronting the homophobia constructed into the FDA’s blood donation ban for males who’ve intercourse with males.

After imposing that rule in 1985 and making a number of minor revisions since, the FDA is in the end contemplating significant updates to contemplate donors primarily based on their sexual conduct no matter their orientation. The brand new laws would permit homosexual and bisexual males to donate blood — if they’re monogamous. The proposal would additionally for the primary time defer anybody from donating if they’ve had new or a number of companions prior to now three months and had anal intercourse throughout that point.

It’s progress that officers are revisiting insurance policies which have enshrined stigma and prejudice. The modifications would open the door to many homosexual and bisexual males who had been beforehand — and wrongly — excluded, serving to shore up the U.S.’s lagging blood provide.

However we want additional modifications. The brand new coverage’s slender concentrate on anal intercourse and monogamy nonetheless fails to evaluate sexual danger for HIV precisely, and it continues to stigmatize individuals primarily based on their sexual exercise.

First, because the FDA’s proposal highlights, not all sorts of intercourse are equal in terms of HIV danger. The best such danger is from unprotected anal intercourse with an HIV-positive associate who has a detectable viral load. However danger differs considerably primarily based on place — whether or not somebody is the receptive or insertive associate. Unprotected receptive vaginal intercourse and unprotected insertive anal intercourse have a comparable danger of HIV transmission, that means a coverage focus solely on the latter displays some subjective judgment of sexual exercise dangers.

Monogamy can be not essentially a dependable technique of stopping sexually transmitted infections, given the fact of sexual exercise exterior of presumed monogamous relationships. Analysis exhibits that people in consensual nonmonogamous (e.g. open) relationships are literally extra more likely to get HIV and STI testing and use condoms than those that report monogamy. They could subsequently be extra more likely to precisely assess their very own HIV danger earlier than donating blood.

No matter the kind of intercourse individuals are having, or their variety of companions, HIV danger could be just about eradicated by means of prevention strategies corresponding to constant and dependable condom utilization and taking pre-exposure prophylaxis (PrEP) medicine.

But the FDA’s revised pointers don’t take into consideration these different protecting behaviors. The truth is, they’d proceed to require people to be off PrEP for 3 months earlier than donating due to issues that taking the medicine will increase your chance of getting a false adverse HIV take a look at. However a donation coverage inclusive of people that commonly take PrEP might assist guarantee a safer blood provide. And to stop the principally hypothetical danger of a false adverse HIV take a look at, blood from these potential donors could possibly be individually screened utilizing nucleic acid testing.

The newly proposed guidelines additionally proceed to particularly defer people who’ve had any sort of intercourse for cash and medicines from donating for 3 months. Although transactional intercourse is usually greater danger for HIV resulting from decreased condom utilization, blanket deferrals with out evaluation of precise behavioral danger appears primarily based extra on prejudice towards intercourse work, substance use and poverty than on proof.

Generalizations about intercourse won’t really measure HIV danger — however it should perpetuate stigma. Quite than lean on assumptions, up to date FDA pointers ought to ask extra detailed behavior-based questions that mirror the science of HIV transmission.

Past bettering the blood donation course of, higher questionnaires might help educate extra Individuals about HIV danger. Many colleges don’t present complete sexual well being schooling, and even fewer present info inclusive of LGBTQ well being. Donation screenings provide a strong academic alternative and could be the primary time individuals rigorously assess their very own sexual behaviors. They need to get the information on easy methods to precisely consider HIV danger and shield themselves, not oversimplifications that will result in misinformation.

The FDA is clearly attempting to create extra inclusive and evidence-backed insurance policies. The proposed modifications will doubtless scale back stigma for some Individuals and probably scale back the variety of younger males who’re outed at work and faculty throughout blood donation drives.

But as a health care provider, I’m upset by the dearth of nuance that also exists within the new donation guidelines — and I hope to see additional modifications. As a homosexual man, I’m relieved to see the FDA work towards ending a ban primarily based on sexual orientation. I stay up for after I can donate blood and contribute to the availability my sufferers depend on.

Eric Kutscher is a major care and dependancy medication physician in New York Metropolis.