On August 7, the Red Cross implemented a new blood donor eligibility assessment that doesn’t discriminate against men who have sex with men (MSM). By its own estimate, the organization facilitates about 40 percent of the donated blood supply in the United States.
The change is based on Food and Drug Administration guidance published in May. Beginning in 1985, blood drives gave an “indefinite deferment” to a number of demographics, including MSM—at least if they disclosed that sexual activity on the forms. In 2015, this lifetime ban was downgraded to a deferment of 12 months after last reported sexual encounter with MSM; then down to a three-month ban in 2020, due to a blood shortage during the COVID-19 pandemic. Now, prospective donors at Red Cross-operated blood drives will all be assessed with the same set of questions.
The estimated chance of acquiring HIV through a blood transfusion is less than one in 1.5 million, largely thanks to the advent of screening processes for blood-borne disease markers. But because these aren’t 100-percent effective, donor eligibility has long been determined by a risk questionnaire. Which has definitely not been 100-percent effective.
“Wait, you’re straight?” The nurse looked at my clothes, then back at the form I’d filled out. It also said I was 22, but apparently that wasn’t in question.
In the late 1980s, pop-up blood drives were a good hustle for a lot of street kids doing sex work in Hollywood. Every couple of months some big organization would set up in a parking lot or outside a hospital and pay out around $20 per pint, and you’d stay until they kicked you out. Then you’d drink some orange juice, change clothes if you could, and go right back under a different name.
Almost everyone in our crew was underage—I was around 13 at the time—but they never checked ID if it was obvious that you didn’t have any. They didn’t discriminate against people who injected drugs or engaged in sex work. They didn’t care whether you looked your age. The only thing that ever seemed to matter to them was whether or not you were gay.
If you did sex work, which most of us did, you showed up in the same clothes you wore on the Boulevard; there wasn’t anything else to change into. The flamboyantly gay boys would be intercepted at the door and told not to bother filling out the paperwork. The cis girls were always allowed in. I’d usually get as far as someone reading the form I’d filled out, specifically the question about sexual preference.
“Wait, this says you’re straight?” a nurse at one of the bigger drives asked me. She looked at the tight jeans I was wearing, then back at the form. The form also said I was 22, but apparently that wasn’t in question.
She told me she’d be right back and went over to a man wearing scrubs. He looked over at me while the nurse gestured in my direction saying things I couldn’t hear, and I recognized him; he was a regular. He had a Band-Aid on his arm and a sticker saying he’d donated blood. When the nurse came back she said they couldn’t take my blood, since I might have AIDS.
I never did manage to sell any blood at that age, not even once. I kept trying whenever my friends did; it was easy money compared to just about anything else. Safer, too.
I did later manage to sell blood, three times in the weeks before I learned I had HIV.
In April 1992, the FDA issued a memo outlining more robust screening processes for blood donation, which became mandated that June. As it happens, that same time period was when I did finally manage to sell some blood. I was no longer doing sex work; once my clothes and appearance changed, no one ever questioned what I wrote on the forms. I sold blood three times between April, when I turned 18, and June, when I learned I’d contracted HIV.
In 2020, when COVID pushed the FDA to shorten the deferment period from 12 months, it settled on a three-month-period because that’s about how long it takes for exposure to HIV to show up on an antibody test.
This three-month ban wasn’t just for MSM. It also applied to women who have sex with MSM—a restriction that was lifted in early 2023 alongside the one for MSM themselves. And it also applied to sex workers and injection drug users; for them, it remains in place. Over the years, blood screening processes have gotten even more thorough, but the processes of determining which people represent which risk factors still leave something to be desired.
Injection drug use isn’t even subject to the 12-month deferment anymore, but for injection drug use by association it still applies.
The only risk category that hasn’t been updated at all since 1992 is for people currently or recently incarcerated. That year, an FDA memo recommended a 12-month deferment period for anyone incarcerated in a correctional institution for more than 72 consecutive hours.
The rationale was that “incarceration in a correctional institution is associated with behaviors, such as intravenous drug abuse that indicate an increased risk of transfusion transmitted disease,” according to the Association for the Advancement of Blood & Biotherapies, the nonprofit that provides accreditation to blood banks.
Injection drug use isn’t even subject to the 12-month deferment anymore, but for injection drug use by association—for instance, getting thrown in county jail for a couple of days—it still applies.
The FDA even doubled down in 2015, codifying it as a legally binding regulation.
“We have rejected the suggestion that we leave this deferral to guidance [rather than regulation] because we concluded that this deferral is readily described and unlikely to change due to technological developments,” the agency wrote in its 2015 ruling, a few months before easing the lifetime ban on MSM that it had upheld for 30 years.