The current FDA policy is discriminatory and not based in science.
A few weeks ago, I came down with a mild cough and a runny nose. I heard seasonal allergies were starting early and didn’t think much of it.
The next day, I was exhausted and had a splitting headache. As a doctor, I was required to get tested for Covid-19 before I could go back to work in the emergency room. The result was positive.
Fortunately, I’m already back to feeling like myself. I was one of the lucky people with relatively mild symptoms.
Now that I’m well, my blood could be used as an experimental cure for the new coronavirus. But because of homophobia, that won’t happen.
How plasma transfusions could treat coronavirus patients
New research published in the Journal of the American Medical Association (JAMA) describes an experimental treatment for those dying from Covid-19 called convalescent plasma transfusion. The procedure starts with collecting blood from people who have recovered from the virus. These donors have Covid-19-fighting antibodies that circulate in their blood, proteins made by the immune system that can bind to and neutralize the virus.
Once the blood donation is collected, researchers remove all the cells, and the result is plasma: a protein-rich solution that contains the anti-Covid-19 antibodies. This plasma is then transfused into the bloodstream of patients dying from the virus.
The thinking goes that the antibodies in the plasma will bind to the coronavirus, neutralize it, and help the patient recover. Similar strategies have been used for infectious diseases going as far back as the 1918 flu pandemic.
In the JAMA study, five critically ill patients were treated with the intervention, and by 12 days after the treatment, none had detectable virus in their bloodstream. A second study of 10 patients in the journal PNAS showed similar promise. The data we have so far on the treatment’s efficacy is preliminary, and we still need high-quality controlled trials. But it could save lives.
Researchers are so excited about this approach as a potential treatment that there are now at least 10 clinical trials ongoing around the world. In collaboration with the Food and Drug Administration, the Red Cross is actively recruiting plasma donors who have recovered from the disease. You can sign up here. That is, unless, you’re gay.
The current FDA policy is discriminatory and not based in science
The FDA says I can’t donate blood or plasma because I’m gay. In 1985, during the AIDS epidemic, the FDA placed a lifetime blood donation ban on all men who have ever had sex with men.
The policy was created to prevent blood banks from collecting blood that contains HIV. Since the AIDS crisis though, the US has instituted extensive procedures to test blood donations for infectious diseases, including HIV, to minimize this risk. It’s true that gay and bisexual men account for a large proportion of new HIV infections each year. It’s also true that tests to screen blood aren’t perfect. The risk of contracting HIV from a blood transfusion isn’t zero. But it is currently around 1 in 1.5 million.
The problem is that being gay isn’t the real risk factor here. Why should a monogamous gay man who has sex only with his husband be barred from donating blood when a heterosexual man who had condomless sex with 100 female partners in the past three months can? The latter is at dramatically greater risk of HIV infection.
In 2014, Sen. Tammy Baldwin (D-WI) led more than 75 members of Congress in calling for an end to the ban, joining extensive lobbying from LGBTQ rights organizations in putting pressure on the administration for a change. In 2015, the Obama FDA reduced the lifetime ban to a 12-month ban on gay sex before donating.
Earlier this month, the FDA shortened the ban to three months of abstinence from sex with other men, due in large part to the drastic drop in blood donations since the start of the coronavirus pandemic. (Just prior, Baldwin and other senators, including Elizabeth Warren, Bernie Sanders, Cory Booker, and Kamala Harris, submitted another letter to the FDA asking them to end the discriminatory policy entirely.)
The new FDA guidance is a good but insufficient step forward. It’s still going to leave out the vast majority of men who have sex with men. And it still promotes the internalized homophobia many gay men experience from growing up in a homophobic society: You can only be good and pure if you don’t have gay sex. This is psychologically damaging, unscientific, and wrong.
The rules need to change and be based on scientific behavioral risk factors. “Instead of a blanket ban on recent sex between men, we need to explore an approach that asks all donors about their recent behaviors, including condom use, number of partners, and use of preexposure prophylaxis, which we know is highly effective in preventing HIV,” explains Dr. Julia Marcus, an assistant professor of population medicine at Harvard Medical School, where she studies the epidemiology of HIV. Such risk-based screening systems have been successfully implemented in Spain, Chile, Argentina, and South Africa. As written, the FDA rules aren’t supported by science. They simply discriminate against gay and bisexual men.
America desperately needs more blood donations, and lifting this ban could save lives
Plasma donations are critical. If the experimental treatment works, countless deaths from Covid-19 could be prevented. But in addition to plasma, the US also has a dire shortage of whole blood.
Due to social distancing, there have been 150,000 fewer blood donations since the pandemic began. More blood is leaving the blood banks than is coming in. This blood is desperately needed for trauma victims who are bleeding out, cancer patients undergoing chemotherapy, and children with sickle cell disease, to name a few in-need groups.
Federal officials have been begging the public to donate blood. They should know that gay men like me are ready to roll up our sleeves and help.
America is in the midst of a public health crisis. Old homophobic policies are making it worse: leaving trauma victims without donor blood and withholding plasma donations that could potentially save people dying from the coronavirus. It’s time for the FDA to lift the ban and save lives. When they do, I’ll be the first in line.
Jack Turban MD (@jack_turban) is a resident physician in psychiatry at the Massachusetts General Hospital.
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Author: Jack Turban
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