Alternatives to the ban
In lieu of a permanent and categorical ban or the proposed deferral, the FDA should shift to an "Assess and Test" screening system. After assessing the donor's personal sexual practices, a deferral may be given only for those in whom a risk of infection has been identified, such as individuals who have engaged in frequent, unprotected sex with multiple partners since their prior HIV test. For this risky group, a short period of abstinence may be appropriate to allow for reliable test results. For donors who are not high risk, the deferral should be eliminated altogether.
This model can be applied to both homosexual and heterosexual donors and would not consider monogamous or safe sex to be risky, mirroring the current protocol for straight donors.
As has been the standard since 1985, all blood is tested for HIV after donation, so these initial screening questions serve as only the first step in an Assess and Test approach.
24Under current testing protocol, the risk of transfusion-transmission of HIV is one in two million.
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The United States is not alone in its treatment of MSM. South Africa uses a six-month deferral period, while the UK, Australia, and Sweden defer for twelve months. Canada and New Zealand defer MSM for five years.
26 As with the FDA's stipulations, these policies require celibacy during the deferral period, maintaining illusory associations between HIV and gay sex, rather than between HIV and risky sex. Italy, however, has adopted an Assess and Test model that uses "risk behavior" screening questions and blood testing, which it applies to all donors, regardless of sexual orientation.
27 It defers individuals who are flagged by screening, not by lifestyle. Italy has not experienced an increase in infected donations since implementing this policy.
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This approach can identify individuals, rather than categories, who may present a risk to the blood supply. AABB, America's Blood Centers, and the American Red Cross have advocated for the adoption of similarly comprehensive approaches.
29 Unlike the ban on MSM donors or the new deferral, the Assess and Test approach uses rational and scientifically based deferral periods, applied fairly, to maximize the donor pool and minimize risk.
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