Blood With Baggage: Prejudice Underlies Current FDA Regulations for ‘MSM’ Blood Donors

The FDA recently revised blood donor regulations, a rapid change two medical school students say highlights discriminatory policies against the LGBTQ+ community.

In 1983, the Centers for Disease Control and Prevention popularized the concept of the “4 H’s”—homosexuals, Haitian Americans, heroin use and hemophilia—as groups at high risk of HIV/AIDS, and ever since it has cast a shadow of bias and discrimination throughout biomedical literature, discourse and policy.

The forces that continue to perpetuate discrimination against these groups are numerous and complex. However, a salient example of bias against LGBTQ+ people, in particular, persists through the Food and Drug Administration’s blood donation regulations, which require a mandatory three-month deferral period for men who have sex with men, or “MSM.”

In order to understand the current FDA restrictions, it is important to understand the history of “MSM” as a term used in HIV/AIDS discourse. “MSM” was originally used in the public health community as “men who have sex with men but do not identify as gay.” Epidemiologists created this term as an attempt to include those outside of the self-identified “gay” community—particularly non-white, non-“Western” men—in HIV prevention efforts. However, biomedical literature eventually shifted to discussing “MSM” as an identity term that included men within the gay community. This transformed “MSM” from a term of inclusion to a shorthand phrase that erases LGBTQ+ persons’ own identities and replaces them with sterile, palatable jargon that has become entrenched in medical discourse.

Colin Yost, Dr. Alexis Peedin and Adam Cohen-Nowak in the Jefferson Blood Donor Center during the Ally Blood Drive.
Colin Yost, Dr. Alexis Peedin and Adam Cohen-Nowak in the Jefferson Blood Donor Center during the Ally Blood Drive.

The association between “homosexuals” and the AIDS epidemic, as well as the popularization of the term “MSM” in medical literature, led to a lifetime ban on blood donation from “MSM” by the FDA, which was shortened to a 12-month deferral period in 2015.

However, in the face of a national blood shortage heightened by the ongoing COVID-19 pandemic, the FDA further relaxed the deferral for “MSM” to three months in an attempt to bolster the blood supply, along with other similar time-based policy changes. This rapid change in FDA requirements previously portrayed as “biological rules” without newly published data highlights the discriminatory nature of “MSM” deferrals and demonstrates that everyone stands to gain from their elimination.

The arbitrary nature of the FDA’s “MSM” deferral policy is further underscored by the variety of international approaches to “MSM” donors. While the United States employs a time-based deferral for all self-identified “MSM,” other countries such as Italy and Spain employ risk-based deferrals. In this system, donors are asked about sexual partners regardless of their sex and are subsequently deferred for sexual behaviors deemed “high risk” for HIV transmission, such as a new partner, multiple partners or casual partners.

Unfortunately, this system is not standardized nationally across blood donation centers, and these countries’ blood supplies tend to have a higher rate of HIV than countries with time-based deferrals for “MSM” donors. However, in the United States, which does have a nationally standardized donor screening system, non-“MSM” donors currently undergo a risk-based screening system for sexual behaviors, while anyone who identifies themselves as “MSM” is immediately deferred from donating. This double standard for “MSM” donors is rooted in homophobic assumptions that any and all sexual contact for “MSM” is “high risk” and squanders a multitude of potential donations from LGBTQ+ individuals who would otherwise be eligible to give blood, such as men in monogamous same-sex relationships.

It is time—especially in the face of a national blood shortage—to move beyond archaic policies rooted in decades of homophobia that continue to weaken the nation’s blood supply.

In hopes of continuing the momentum from recent FDA policy changes, the Jefferson Blood Donor Center is holding its inaugural LGBTQ+ Ally Blood Drive from Oct. 12-16, inspired by a similar effort at Washington University in St. Louis. During this event, those donating on behalf of someone who is not eligible according to current FDA regulations can self-identify as part of the drive, and a tally will be kept of how many more donations could be made without the restrictions on “MSM” donors.

In preparation for the drive, Drs. Alexis Peedin and Julie Karp at the Jefferson Blood Donor Center led trainings for LGBTQ+/ally health ambassadors. In these sessions, Sidney Kimmel Medical College students who self-identified as LGBTQ+ or allies learned about the basics of blood donation medicine, current FDA policies surrounding blood donors, and global perspectives on “MSM” blood-donor screening. In addition to providing students with the tools to recruit donors for the Ally Blood Drive, the trainings established an open and affirming dialogue between LGBTQ+ people and blood bank medical professionals.

By elevating the voices of the LGBTQ+ community and allies through the Ally Blood Drive, we hope to foster a more LGBTQ+ affirming conversation about blood donation practices in the medical community in the United States and worldwide. It is time—especially in the face of a national blood shortage—to move beyond archaic policies rooted in decades of homophobia that continue to weaken the nation’s blood supply. Ultimately, we envision a future in which individualized, risk-based blood donor screenings are standardized across the United States, allowing all LGBTQ+ people the right to donate blood and the joy of helping save a life.

Colin Yost and Adam Cohen-Nowak are medical students at Jefferson’s Sidney Kimmel Medical College.

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