New blood donation rules leave room for LGBTQ stigma

The Food and Drug Administration (FDA)’s latest blood donation guidelines were issued last month aimed at making the LGBTQ community more inclusive, but community members say the agency has left the door open to stigma and discrimination. claims to be

Under the new guidelines, all donors, regardless of sexual orientation or gender, will answer a series of “personal risk-based questions.” However, there is an explicit deferment that people taking PrEP, an antiretroviral drug used to prevent HIV infection, are not allowed to donate blood.

Kendall Martinez-Wright is a policy maker for the Treatment Action Group (TAG), an advocacy group whose goal is to eradicate diseases such as HIV, tuberculosis and hepatitis. She said policies that exclude PrEP subjects create a “basis of discrimination.”

In its final guidance, the FDA raised concerns about “transfusion transmission of HIV” from drugs such as PrEP that cause false negatives. People taking oral PrEP who want to donate blood should abstain from taking it for three months, but those who take injections to prevent HIV infection should wait at least two years before donating blood. be.

Whitman Walker Health infectious disease physician and researcher Rupa Patel said that if a person taking PrEP develops a breakthrough HIV infection, he or she will not be tested for more than three months. It is possible that there will be no positive reaction.

She pointed out that in some cases, people who took oral PrEP did not test positive.

Traditional HIV tests look for antibodies made in response to HIV. If viruses were blunted by PrEP, their antibodies would never be made and false negatives could result.

“People who have been exposed to antiretroviral drugs have fundamentally different disease detection patterns,” Patel said.

When taken as prescribed, PrEP reduces the risk of HIV infection by 99%. In these best-case scenarios, Patel describes the drug as something like a “spacesuit” or “bubble” that doesn’t give the virus a chance to get inside.

“We have to acknowledge that concern,” Martinez Wright said of the postponement to PrEP participants. “The latest technology in blood banks could also be a gateway to new and innovative areas that could advance testing and diagnostics, and this is an ongoing effort.”

This opinion was echoed by the Congressional Equality Caucus when the rule was finalized, with Caucus Chairman Rep. We will continue to invest in improving testing and pathogen reduction technologies so that we can do so.” As such, it may still discourage some LGBTQI+ people from donating blood. ”

While Martinez-Wright understands the need for such a rule, the guidance could inadvertently spread the false narrative that PrEP is not very effective in reducing the risk of HIV infection. expressed concern.

Although the agency has aimed to make long-exclusionary communities more inclusive, the rules on PrEP still exclude most LGBTQ individuals. About 30 percent of people who could benefit from PrEP take the drug, according to the latest federal data.

The FDA advised people not to stop taking drugs to donate blood.

In addition to excluding those eligible for PrEP, donations will also be deferred for individuals who have had anal sex with a new partner within the past three months prior to donation.

Among the LGBTQ community, those who were in a monogamous relationship, had anal sex only with a monogamous partner in the 3 months prior to donation, and were not receiving PrEP met all other criteria. As long as you are, you should be eligible.

Torian Baskerville, HIV and Health Equity Director for Human Rights Campaign, said the rule requiring people to stop PrEP to participate in blood donations and other activities will support the US national goal of ending the HIV epidemic by 2030. said to be against.

“Blood donations cannot be sacrificed to end people’s health and ensure the epidemic is over by 2030,” Baskerville said.

Baskerville argues that guidance that requires an individual to change behavior in order to participate, whether explicit or implicit, still leaves room for discrimination because it suggests that the behavior is harmful in some way. said there is.

“Rather than actions, we focus on the technologies, systems and processes that enable more people to become donors, and on making sure the security of donations is safe for recipients. We need to focus,” he added.

Groups like the Red Cross are expected to implement the change as soon as this summer, but it remains unclear how many gay and bisexual men will line up to donate after years of policy blockages. Questions remain.

“They don’t want our blood. Why donate? Well, the whole idea is that we need to show that we’re here to donate. Me We want to help and hopefully show them that as many people as possible want to donate blood,” said Jordan James, founder of the LGBTQ blood advocacy group Blood is Blood.

“We have a community that is willing to work with us.”

James’ organization works with the Red Cross to hold regular blood donation drives. According to James, many gay and bisexual men often feel that they “didn’t want our blood then, but now they don’t get it.” But it’s also the first time this year that he’s started hearing from other organizations around the country that want to host blood drives like his, aimed at the gay community.

The Red Cross said it plans to put the new guidelines into force from 7 August. The American Blood Center said it would accept newly eligible donors “as soon as possible” shortly after the new rules were finalized.

Activists say how these blood centers adopt new rules and individual risk-based questions will also determine whether more members of the LGBTQ community donate blood.

“The FDA is not going to decide how blood banks will ask questions or what specific language will be used, so it will depend on how the questions are asked,” James said. “It’s also the next step … how it unfolds and how the community is actually asked. Will these questions be more inclusive?”