More gay and bisexual men can donate blood as donor eligibility policy catches up to science

Featured photo: Sec. Kody Kinsley celebrates after being able to donate his blood for the first time in years at the the Raleigh Red Cross Blood Donation Center on Aug. 7. He was newly eligible to donate blood after the FDA updated its blood donor eligibility policy — a change welcomed by LGBTQ+ advocates, public health officials and blood banks. (photo by Rachel Crumpler)

This story was originally published by North Carolina Health News, story by Rachel Crumpler

State Health and Human Services Secretary Kody Kinsley volunteered at blood drives before he was old enough to donate. Then he was a regular donor in high school and some of college.

But that was years ago. 

For the first time in more than a decade, Kinsley, 38, rolled up his sleeve to donate blood Monday afternoon. As the leading public health official in the state, he knows and preaches the value of blood donation — thousands of pints are needed every day to save lives.

Kinsley’s dry spell was not because he didn’t want to donate blood.

He’s been prohibited from donating since he came out while attending Brevard College in western North Carolina. For nearly 40 years, U.S. Food and Drug Administration rules have barred most gay and bisexual men from donating blood.

“When I came out as a gay man, I quickly became excluded from that process for really no good reason,” Kinsley told reporters before donating blood. “There was no explanation other than discrimination, and that weight of discrimination is disempowering. It’s frustrating. It pushes people apart. It also telegraphs to people in the community that gay and bisexual men are different and risky inherently in who they are. 

“And that’s just inaccurate.”

The FDA updated its donor eligibility criteria in May, moving from time-based deferrals based on sexual orientation to a more inclusive, risk-based individual assessment to determine if someone can donate blood.

The American Red Cross, the organization that provides about 40 percent of the U.S. blood supply, implemented the new policy on Monday, finally making Kinsley an eligible blood donor again. And Kinsley took the first opportunity he could to donate — happily getting back to his old habit of regularly donating blood.

“It’s a terrific moment for me personally to be able to donate once again — which I haven’t been able to do in a very long time … and play a small part to make a difference in my community,” Kinsley said.

Gov. Roy Cooper and State Health Director Elizabeth Cuervo Tilson also gave blood Monday afternoon at the Raleigh Red Cross Blood Donation Center to celebrate the expansion of the blood donor pool.

“A risk-based screening where we’re asking people about behaviors as opposed to who they are allows us to ensure that the blood supply is safe and secure,” Kinsley said. “It also brings more people into the fold.”

Discriminatory policy takes root

Increased restrictions for gay and bisexual blood donors date back to the 1980s.

In 1983, after the emergence of the AIDS epidemic, the FDA first instituted a rule blocking all men who have sex with men from donating blood. The rule was put in place to prevent the population hardest hit by the disease — which is transmitted through blood and other bodily fluids — from unknowingly donating blood containing the virus and thus spreading HIV through the blood supply.

The FDA’s lifetime ban against gay and bisexual donors stayed in place for decades, even as science and blood screening advanced.

Lee Storrow said the policy perpetuated stigma. He was a regular blood donor until he came out as gay in college at UNC Chapel Hill. He said he was sad to have to give up donating blood because his sexual identity put him at odds with the policy.

“I was smart enough to know that, from a public health perspective, that this was not a law grounded in science but also astute enough to know that this law was stigmatizing in sending a message to people about gay men and gay sexuality — that it was unhealthy, that it wasn’t clean, that it was dirty,” Storrow said.

In 2015, the FDA ended its decades-long lifetime ban against these donors, loosening restrictions slightly. Under that set of rules, men who have sex with men were allowed to donate blood if they hadn’t had sex with a man in one year. In 2020, the FDA relaxed the rules further to combat blood shortages during the COVID-19 pandemic, accepting male donors who hadn’t had sex with men for three months.

As restrictions gradually loosened, LGBTQ+ advocates and public health officials continued to push for the end of blanket bans for men who have sex with men — bans that eliminate willing and safe donors like Storrow and Kinsley.

Kinsley and Tilson, joined by officials from nine other states and the District of Columbia, wrote a letter in March 2022 calling on the FDA to update its policy. They urged that deferrals from blood donation should be based on risky behavior, not a person’s sexuality. 

That’s finally happened. 

New policy

Now at blood donation events, all donors will be assessed using the same set of individual risk-based questions.

“I think it’s really an important moment for blood donation. We can just have one standard for everyone,” said Troy Dang, ​​medical laboratory supervisor of UNC’s Blood Donation Center.

From the questions, all prospective donors who report having a new sexual partner or multiple sexual partners in the past three months, and also have anal sex in that timeframe, will be deferred from donating.

Dang explained that this deferral period is still needed to reduce the likelihood of donations by individuals with new or recent HIV infection who may be in the time window where the virus may not yet be detectable by the DNA testing techniques used.

The updated policy is in line with policies in the United Kingdom and Canada, among other countries. 

“The FDA has worked diligently to evaluate our policies and ensure we had the scientific evidence to support individual risk assessment for donor eligibility while maintaining appropriate safeguards to protect recipients of blood products,” said Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, in a statement when announcing the new policy. “The implementation of these recommendations will represent a significant milestone for the agency and the LGBTQI+ community.”

While the new policy is a major step forward, Storrow said he hopes the policy can be nuanced even further in the future, such as reevaluating whether donors taking medications to treat or prevent HIV infection still need to be deferred. 

Such pre-exposure prophylaxis (known as PrEP) medications, if taken regularly, prevent people from acquiring HIV, even if they are having sex with someone who is positive. But it’s unclear whether someone on PrEP might be able to acquire and transmit a small number of HIV viruses if they were to donate blood in the days after being exposed by their partners. 

“Over time, we’ll be able to learn more about the interaction between being on PrEP and the impact to how it could obscure our analysis around the robust safety of the blood supply. And the FDA will continue to do that analysis, and we’ll continue to push them to do that analysis,” Kinsley said, noting this exclusion could change in the future.

OneBlood, another major supplier of U.S. blood, will implement this new donor screening process starting on Aug. 21, according to its website. 

New pool of donors

Dang is hopeful this policy change will bring in new blood donors.

“With an expansion in the eligible donor population, I would hope that would improve the blood supply,” Dang said. “Nationwide, we’re always in a precarious position where we only have at any given moment enough blood for the next three days or so.” 

Storrow is one of those donors. He’s ready to roll up his sleeve, as he’s now in a monogamous relationship and no longer taking PrEP, making him eligible once again.

Kinsley’s already counting down the days until he can get back in the chair to donate blood. He told NC Health News he’s marking time in his calendar for his next chance to donate, basking in his ability to be a donor and not just encourage others, though he doesn’t have plans to stop that.

“Giving blood is something that most folks can do,” Kinsley said. “It’s something that they can give regardless of how much money they have or what communities that they come from. 

“This is an opportunity for everybody to come to the table in their community and to support one another. And I’m really glad for this move to allow more folks from the gay and bisexual community to be able to step forward and play their part.”

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.