LGBTQ+ Health Expert's Take on FDA's Updates to Blood Donation Guidelines

In the height of the AIDS epidemic, the United States (US) Public Health Service issued exclusionary recommendations for blood donation, stating that “sexually active homosexual and bisexual men with multiple partners” were not advised to donate blood. Later, in 1986, a formal ban was implemented.

Medical professionals and advocates for LGBTQ+ rights disputed the ban as discriminatory and not justified by scientific evidence. In 2015, after almost three decades, the US Food and Drug Administration (US FDA) reversed its policy by permitting men who have sex with men (MSM) to donate blood, but only if they hadn’t had sexual contact in 12 months. This period was reduced to three months in 2020.

In January, the US FDA announced its proposal to update its approach for assessing blood donor eligibility. This change would include using a set of individual risk-based questions that are the same for every single donor, regardless of their sex, gender or sexual orientation.

Earlier this month, the organization finalized its recommendations for adopting the new policy, stating it “is based on the best available scientific evidence and is in line with policies in place in countries like the United Kingdom and Canada.”

Under the new policy, time-based deferrals and screening questions that are specific to MSM and women who have sex with MSM will be eliminated, a move that has been welcomed as a “huge step in the right direction” by the likes of the American Medical Association and advocates for LGBTQ+ populations, including the renowned Professor Perry N. Halkitis.

Halkitis is currently Dean, Hunterdon Professor of Public Health and Health Equity and distinguished professor of biostatistics and epidemiology at the Rutgers School of Public Health. He is also the founder and director of the Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), where the overarching mission is to advance research and knowledge to improve the lives of individuals affected by HIV and other health conditions.

In addition to receiving many prestigious accolades and research grants, Halkitis has also authored several books, the most recent being “Out in Time: The Public Lives of Gay Men from Stonewall to the Queer Generation”. He is currently working on his new book, People, Politics, & Public Health: How Americans Created the HIV, COVID-19, and Other Modern-Day Pandemics, which will be published by Johns Hopkins Press. This book will illustrate how our inadequate responses to pathogens, directed predominantly by a biomedical paradigm, have underestimated the role that humans play in creating pandemics.

A researcher highly commended and respected for his consistent fight for the health rights of LGBTQ+ populations, Halkitis recently spoke with Technology Networks to share his views on the US FDA’s reversal of its policy, and to discuss how medical policies rooted in hate can risk the lives of so many people.

Molly Campbell (MC): You are widely known and respected for your research on the health of LGBTQ+ people. Can you talk about how this research focus and passion evolved?

Perry N. Halkitis (PH): I am an applied statistician by training, and in the early 90s, I was working in the field of applied statistics at various testing companies in New York City. At the same time, the AIDS epidemic was wreaking havoc on my friends in my community. In fact, several of my friends died of AIDS. As a result of that, I realized that I needed to make a change in my career.

In 1996, I started working as the director of research at Gay Men's Health Crisis, also known as GMHC. That started my career as an HIV researcher, and I conducted work in HIV for decades. More recently my research has become broader, looking at LGBTQ+ health in general, of which HIV is only one small part. The focus of my work recently has been on the delivery of health care and the inadequate preparation of the medical profession to provide health care to LGBTQ+ people, including advocating for the inclusion of sexual and gender identity items on intake forms at medical institutions.

MC: Please can you talk about the history of the US FDA’s blood donor eligibility screening rules and why they have been condemned as homophobic?

PH: Early on in the HIV epidemic, gay man were disproportionately affected by HIV, and the fact is that gay men continue to be disproportionately affected by it, with some 60% of new infections occurring in gay and bisexual men, especially in gay and bisexual men of color.

Because, at the time, HIV was primarily but not exclusively confined to gay and bisexual men, a decision was made in the 1980s under the Reagan Bush administration to ban the donation of blood by gay and bisexual men as a means of controlling the disease, as it was determined that blood transfusions could be a source of disease transmission.

However, this decision was rooted in faulty thinking; it assumed that somebody who was not gay and bisexual could not get HIV, and what we know for a fact is that it's not the case, anybody can become infected with HIV. Discriminating against gay and bisexual men, simply because of their sexual orientation, is a faulty scientific logic.

MC: The US FDA has now finalized its move to recommend individual risk assessments for determining blood donation eligibility. Why is this change so important, and how do you feel about it?  

PH: What is so significant about the recent decision by the FDA is that it moves the conversation from one identity to one behavior, and we know that all people – regardless of their sexual identity – engage in risky behavior. As a result, the decision to assess the risk of individuals sexually is a much more scientifically based approach to deciding on whether somebody can donate blood, not based on their sexual identity alone.

Making decisions based on someone's racial or sexual identity in and of itself is not enough to prevent them from donating blood. The focus must always be on health BEHAVIORS. So, the FDA move is heralded as the right move, it takes away the stigma that gay and bisexual men face on an ongoing basis. It is particularly heralded in this moment, when governors and lawmakers including DeSantis of Florida are passing legislation that do nothing but undermine the health of LGBTQ+ people.

Dr. Perry N. Halkitis, Dean, Rutgers School of Public Health. Credit: Raymond Clinkscale, Rutgers School of Public Health.

MC: The change in screening processes is now in line with existing policies in countries such as the United Kingdom and Canada. Why do you think it has taken the US longer to make this change?

PH: It's not clear to me why the US took so long, other than the fact that we are being super cautious and the fact that there are political forces in this country that utilize hate and discrimination against LGBTQ+ people. Too often, hate is a root cause of public health disasters and public health decisions, and hate seems to have been a big factor that perpetuated the ongoing ban of donations of blood for gay and bisexual men.

MC: In your opinion, what more can be done to improve the rights of LGBTQ+ people, at least from a medical and/ or research perspective? 

PH: In the US, one in five people who are LGBTQ+ avoid healthcare, because they're discriminated against or because they see doctors who know nothing about the health of LGBTQ+ people. If we want to enhance the health of people in this country, there's a couple of things we have to do. We must continue to fight against legislation that chips away at the rights of LGBTQ+ people, like the types of legislation that are being passed in Florida. Those only function to undermine the health of people.

Secondly, we need to ensure that doctors, nurses and other healthcare providers are adequately trained around the health issues that affect the LGBTQ+ population broadly.

Those two factors in and of themselves will help to advance the wellbeing of the people in our country who are LGBTQ+. Political decisions that deny these rights are going to be detrimental to the health of the people, this includes but is not limited to the recent decision of Reed O'Connor, a district judge in Texas, who decided that pre-exposure prophylaxis to prevent the transmission of HIV does not have to be covered by private companies. This decision is a policy decision the health of many people at risk.

MC: Where can readers learn more about your work?

PH: Readers that are interested in my work can visit my website.

Professor Perry N. Halkitis was speaking to Molly Campbell, Senior Science Writer for Technology Networks.