The History of MSM Discrimination
As the University Blood Initiative continues to advocate for more accessible, equitable blood donation, we are turning our attention to one of its most infamous, hotly contested barriers. For the next week, we will be discussing the history, impacts, and future of MSM blood donor discrimination, from the AIDS epidemic to the COVID-19 pandemic.
Today, we are focusing on the origins of the FDA's MSM (men who have sex with men) donation bans, which continue to exist, in a modified form, as of 2020.
In 1981, the United States reported its first cases of AIDS. The earliest cases, all linked to gay men, swiftly branded it “gay-related immune disease” (GRID), establishing a homophobic stigma that has never been entirely overcome. Though studies have since shown that HIV/AIDS is more prevalent among certain demographics--notably young gay and bisexual men, also disproportionately impacting Black and Latino communities--it is not, by any means, a “gay disease.” By 1982 and 1983, the US began to identify HIV/AIDS cases in heterosexual patients, largely “intravenous drug users, hemophiliacs, and women who had sex with men,” but the damage had been done.
Unknown and mostly untreatable, HIV/AIDS decimated queer communities throughout the country--San Francisco is most notable for the scope of its deadly outbreak, but countless other cities, including New York and Chicago, suffered the loss of a near-entire generation alongside it. In the spring of 1983, an emergency effort to quell the spread of the disease, which is both sexually-transmitted and bloodborne, the FDA issued a lifetime ban on blood and plasma donation from “persons who might be at increased risk of transmitting AIDS”-- gay and bisexual men, referred to as “MSM,” who had had sex with another man after 1977.
As a temporary emergency measure, the restrictions, though harsh and discriminatory, make some sense: limit the chances of spreading a disease still widely considered a death sentence until it is better understood and treatable. However, it was not a temporary measure. HIV is now largely treatable, known to not be linked exclusively to MSM, and can be detected by testing any donated blood before it is used in transfusion. The early epidemic-induced panic has worn off, and, though stigma remains, the HIV/AIDS outbreak is now comparatively under control.
But the blood donation bans have not been lifted.
In 2015, the lifetime ban became a 12-month deferral period of mandatory abstinence, which was shortened again under a recent COVID-related FDA ruling (which we will discuss more in an upcoming installment of this series), but the barriers remain. Even female donors who have been sexually active with MSM must adhere to the deferral, further reinforcing stigmas and inhibiting the blood supply.
The Red Cross’s blood donation website maintains stringent eligibility requirements buried under a series of FAQs and appointment scheduling, which appears to intentionally obscure the limitations. Would-be blood donors are routinely turned away on account of their personal, private, and medically irrelevant history. There is no longer a good argument for these regulations; they are now effectively antiquated, discriminatory, and counter-productive, and studies have proven that removing them would not significantly impact spread of HIV in the blood supply. Lifting the ban entirely, as studied by UCLA’s Williams Institute, would likely contribute to some 360,000 men donating 615,300 pints of blood, creating a 2-4% increase in overall blood donation. Without archaic restrictions in place, we have the power to save over a million additional lives.
The enduring, needless, and harmful restrictions on MSM blood donors exemplify the insidious reach of homophobia across the country. We are long overdue to change them.