Who will be affected by the changes to blood donation guidelines?

The FDA’s guidance will affect everyone who wants to donate blood in the United States. But the biggest change will be felt by gay and bisexual men in monogamous relationships, who in the past were not allowed to give blood unless they had abstained from anal sex. The guidelines no longer focus on sexual orientation and instead change the questions all donors will be asked before giving blood. Now, everyone will be asked questions about their sexual behavior to assess the potential risk that a donor could be infected with HIV. It will take a few weeks before blood banks can start to accept newly eligible donors under the finalized guidelines from the FDA. For years, LGBT rights organizations and blood banks have been calling for the FDA to remove rules that prevented most men who have sex with men from donating blood. Bruce Walker, the director of the Ragon Institute of Massachusetts General Hospital, MIT and Harvard, said in January that the drafted guidance from the FDA reflects advances in testing and a fuller understanding of viruses such as HIV. “It’s been very unequal, and it’s been based on sexual orientation,” Walker said. “The reality is, if you’re having unprotected sex, you’re at risk for becoming infected.”

What questions will I be asked?

Once blood banks in the United States update their questionnaires, every potential donor will be asked the same questions, starting with whether they’ve had sex with a new partner in the past three months. If the answer is yes, they will be asked if they’ve engaged in anal sex. A yes to both questions would disqualify them from giving blood. Potential donors will also be asked: In the past three months, have you had more than one sexual partner? Having multiple sex partners will not disqualify you. But if you’ve also engaged in anal sex with any of those partners, you will also not be allowed to give blood. Couples who have anal sex and have been monogamous for more than three months will be allowed to give blood, which is a significant change in the rules. Canada and the United Kingdom have already adopted blood donation policies that screen for sexual behavior, not someone’s gender or sexual orientation.

Why is anal sex among heterosexuals disqualifying?

While many gay men will be newly empowered to give blood, heterosexual men and women will be banned if they recently had anal sex with a new partner. The FDA said the move is justified because HIV is far more likely to spread during anal sex than vaginal sex. Receiving partners are at much greater risk during anal sex than insertive partners, according to the Centers for Disease Control and Prevention. While some activists lauded the move for focusing on behavior rather than identity, the risk is not equal across demographic groups. Gay and bisexual men typically have smaller sexual networks and have higher rates of HIV infection, making them more likely to be exposed to the virus. In recent years, nearly 70 percent of new HIV diagnoses were attributed to male-to-male sexual contact, while about 20 percent were attributed to heterosexual contact, and most of the remaining cases were related to injection drug use, according to CDC data .

Can I give blood if I practice safe sex or use PrEP?

Even if you use condoms or test negative for HIV, you will be asked the same set of questions as everyone else. People who take daily pills called PrEP that reduce the risk of contracting HIV will not be allowed to give blood regardless of how they answer the questions. Experts say the reason is that while PrEP is highly effective at reducing the chances of someone getting HIV, it also makes it difficult for a blood test to detect whether a sample of blood from a potential donor contains HIV. “The presence of PrEP in the blood donation reduces the HIV screen’s ability to identify or detect HIV in that sample,” said Benjamin Brooks, associate director of policy and education at Whitman-Walker, a D.C.-based LGBT health-care organization. “It’s not that being on PrEP means you might have HIV, it’s that being on PrEP means the screen can’t reliably find HIV in the sample.” The FDA said people should not stop taking PrEP to donate blood. Anyone who’s sexually active with multiple or new partners should continue to take PrEP to reduce the risk of contracting HIV, said Sean Cahill, the director of health policy research at the Fenway Institute, a Boston-based group that serves the LGBT community “If you’re having sex without condoms, with multiple partners, you should be on PrEP, and you shouldn’t worry about donating blood right now,” Cahill said. “And maybe in a different point in your life you may be able to donate.” U.S. Rep. Mike Quigley (D-Ill.), who pushed the FDA to revise its policy, said in January that he expects the agency to further relax its restrictions to eventually allow more PrEP users to donate. “I get it,” Quigley said. “I’m frustrated, but we’ve come a long way.”

Who still won’t be able to donate blood under the new rules?

People with a range of medical conditions, including heart disease, diabetes or other chronic illnesses, typically are allowed to give blood, but there are certain medical conditions that might disqualify a person. Donors who are pregnant or who gave birth within six weeks will not be eligible. Every blood donation site will have its own screening program, but in general, the following people won’t be allowed to give blood, according to the Red Cross eligibility guidelines . Previous bans against people who lived in Britain at the height of the Mad Cow Disease scare have also been lifted recently.

How will these changes affect the U.S. blood supply?

Experts say the guidelines will expand the potential pool of donors, and will also help ensure the safety of the U.S. blood supply because everyone, regardless of sexual orientation, will be subject to the same risk assessment. Every unit of blood donated in the United States is tested for HIV using a nucleic acid test, a highly sensitive test that can detect HIV in a blood sample within 10 to 33 days of infection. The three-month deferral for those who have had anal sex with new or multiple partners is an added buffer of protection. The guidelines also could help shore up the blood supply against a national shortage that got worse during the pandemic, experts say. Over a year ago, the American Red Cross declared its “ first-ever national blood crisis .” “We just don’t have enough blood,” said Stefan Baral, a professor in the department of epidemiology at Johns Hopkins University. “It’s just getting harder and harder to encourage people to donate blood.” A 2014 UCLA study estimated lifting the ban on blood donations from men who have sex with men could add up to 600,000 pints of blood each year. Experts say that’s a small but meaningful contribution to the blood supply. U.S. blood centers and hospitals collect about 14 million units of blood each year, according to the Centers for Disease Control and Prevention.

Can I give blood if I’ve been sick recently?

Anyone donating blood must be in good health, with no fever and a pulse and blood pressure within acceptable limits, according to the FDA. If you’ve recently contracted covid-19, you must be “fully recovered” from the coronavirus and be symptom-free for at least 10 days before donating blood, according to the Red Cross . Other blood donation centers may have their own guidance. If you’ve tested positive for the coronavirus but are not experiencing any symptoms, you’ll still need to wait 10 days to donate. If you’ve recently received a vaccination or booster for the virus, you don’t need to wait to donate blood as long as you’re not experiencing any symptoms, according the Red Cross . But, when you arrive at the blood bank, you may need to provide the name of the manufacturer of the vaccine you received.

Who can donate blood? What to know about FDA’s new guidelines

The FDA’s guidelines affect everyone, but also mean gay and bisexual men will no longer be forced to abstain from sex to donate blood

By Teddy Amenabar

Fenit Nirappil

and

Laurie McGinley

May 12, 2023 at 10:43 a.m. EDT

9 min

The Food and Drug Administration updated its guidelines this week regarding who can donate blood in the United States, eliminating a decades-old rules stemming from the AIDS crisis that prohibited men who have sex with men from donating.

The finalized guidelines pose the same questions to every donor — regardless of gender or sexual orientation — including whether potential donors have had anal sex with new partners in the last three months, which carries a higher risk of HIV transmission than other forms of sex. The FDA first proposed the changes in January.

FDA to ease blood donation ban

Here are answers to a few common questions about how the guidelines could affect eligibility to donate blood in the United States.

Who can donate blood? What to know about FDA’s new guidelines

The FDA’s guidelines affect everyone, but also mean gay and bisexual men will no longer be forced to abstain from sex to donate blood

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