Critics and supporters discuss new FDA recommendation on MSM blood donation

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nurse-1-1158314-mIn what is being hailed by some as a historic decision, the FDA has decided to change its recommendations for blood donations from gay and bisexual men. In 1983, during the height of the AIDS crisis, the FDA recommended no blood donations be accepted from a man who had sex with another man (MSM) since 1977. This now three decades old decision has long been criticized as discriminatory and many are now applauding the FDA for finally modifying this decision.

However, the new policy is not without its own controversy and criticism. The FDA is now advising that before donating blood, a gay or bisexual man must have abstained from sex with a man for a period of one year. In essence the change reduces a lifetime ban on blood from MSM donors to a one year ban.

David Stacy of the Human Rights Campaign asserts the policy is still discriminatory: This policy prevents men from donating life-saving blood based solely on their sexual orientation rather than actual risk to the blood supply. It simply cannot be justified in light of current scientific research and updated blood screening technology.

Mr. Stacy brings up a good question: is this decision based on current scientific research? Let s look have a look.

Before donating blood, you must answer a series of questions concerning your medical, drug and sexual history. Regardless of your answers to these questions, your blood is still going to be screened for hepatitis C (twice), HIV (twice) and hepatitis B (thrice) among other conditions. So its arguable that there is a substantial enough safety net to catch those whose blood is unknowingly contaminated.

Not so fast. There is a window in which a person can be harboring the virus, but a test for them will generate a false negative. For HIV it can be up to 6 months (hep C is up to 9). Furthermore, the the incidence in the MSM community of HIV is still high, as they account for 63 percent of all new HIV infections in America. Therefore, the FDA s new policy appears to have some sound science, although the full year appears to be taking it to an extra layer of precaution.

This policy is not unique to MSM donors, nor is it unique to America. A year of MSM abstinence before donating blood is the policy for many other countries including Japan, the UK and Australia. Also similar restrictions are put on drug users for the same fear that the virus can go undetected in the blood for extended periods.

Louis Katz, MD, chief medical officer of America s Blood Centers, is very supportive of the new policy, saying It s doing the best we can with imperfect tools, but he also offered some hope for critics that in the future the abstinence period could be changed: We ve taken an incredible step to go from a lifetime ban to a one-year deferral. Once we have a data set from this change, we ll look at what else is possible.

ACSH s Josh Bloom has a different take: I ve said this before: there are newer assays that are so sensitive that they can detect minuscule amounts of the RNA from the virus. The problem is that groups like the Red Cross are using older antibody tests, which can take six months to reveal the presence of the virus. PCR tests detect genetic material from the virus itself, are extremely accurate and much faster. These tests require only a 10-12 days to determine if the virus is present. Furthermore, when the quantity of virus is so low that it can t be measured (this is called below detectable limits ) the chances of transmission are far lower.

Either way, the FDA website states that your odds of contracting HIV from a blood transfusion are 1 per 2 million units of blood transfused.