“We need to identify those people who are at high risk of being in that
window period and prevent them from donating,” Walker said. “Up until
now, it’s been very stigmatizing in that we’ve only delved deeply into
risk factors for men who have sex with men.”

Canada’s federal health agency authorized a similar change last April.

Aditi Khandelwal, a hematologist and medical officer at Canadian Blood
Services, a nonprofit based in Ottawa that provides blood products, said
restriction based on sexual identity is “not ideal and does not get to
the risk factors of how HIV is transmitted.”

Howard Forman, a 57-year-old Yale School of Medicine professor, started
donating blood when he turned 18 in 1983, proudly carrying his donor
card. But a few years after the FDA banned donations by men who have sex
with men, Forman became ineligible and felt a sense of loss.

“They took away something that many people found meaningful,” Forman said.

Similar stories of disappointment and rejection would play out over the following decades.

Eric Kutscher, 32, wasn’t out to his classmates at Columbia University
when he joined them to donate blood at the campus gym in 2011.

When he came to the question: “Have you ever had sexual contact with
another man since 1977?” Kutscher answered “Yes.” And that’s when he was
told he wouldn’t be allowed to donate.

Kutscher left the gym feeling ashamed and embarrassed. But after a few
days, he started organizing a student effort to review the FDA’s policy
on blood donors. That led to volunteer work as an HIV testing counselor,
then medical school and a career in public health. Kutscher, an
addiction medicine fellow at NYU Grossman School of Medicine, said he
looks forward to being able to donate his O positive, the most common
blood type.

“I understand how lifesaving this is and I’m excited to be a young,
healthy adult man who is able to provide blood to the patients who need
it,” he said. “As soon as I am eligible to donate blood, I will be the
first in line.”

The FDA funded a study conducted
between December 2020 and September 2022 by three of the nation’s
largest nonprofit blood centers — Vitalant, OneBlood and the American
Red Cross — to examine whether there are questions providers could ask
sexually active gay and bisexual men to determine a person’s risk in donating blood.

Brian Custer, director of the Vitalant Research Institute and the
study’s principal investigator, declined to share the results without
FDA approval but characterized them as promising.

“Clearly, if there is a consideration of moving to an individual
risk-based approach, then the FDA must believe they have sufficient
data,” Custer said.

Some of the strongest advocacy for relaxing restrictions came from blood banks themselves.

Kate Fry, chief executive of America’s Blood Centers, an organization of
independent blood banks that provide 60 percent of the nation’s supply,
said lingering effects of the coronavirus pandemic continue to disrupt
the supply. At least half of the blood centers have less than two days’
worth of blood rather than the recommended three to five days.

“We are in a very challenging time for the blood supply,” Fry said.

It’s unclear how much the new rules would expand the blood supply, which
would require a concerted outreach campaign to inform gay and bisexual
men accustomed to be being banned that they might now be eligible to
donate.

Some critics say a three-month waiting period, mirroring other Western
countries, is still overly stringent because of advancements in testing
that allow for HIV to be detected sooner.

Brad Hoylman-Sigal, an openly gay Democratic senator in the New York
legislature, said any deferral “continues to foster stigma around men
who have sex with men.”

“They need to completely get rid of any semblance of restrictions on gay men donating blood,” Hoylman-Sigal said.

The reason for the three-month deferral period, according to Khandelwal
in Canada, is that testing for blood-borne viruses, which include
hepatitis B and C as well as HIV, “is not perfect.” While viruses may be
detected in a few weeks, the three-month period provides a generous
“buffer” for detecting harmful viruses, she said.

Every unit of blood donated to a blood bank in the United States is
tested for HIV using what’s called a nucleic acid test, which can detect
the virus in a sample of blood “within 10 to 33 days of infection,”
said Sean Cahill, director of health policy research at the Fenway
Institute, a Boston-based group that serves the LGBT community. “The
three-month deferral is taking that 33 days and tripling it to be extra
sure, extra cautious about this period in the nucleic acid test.”

Stefan Baral, a professor in the department of epidemiology at Johns
Hopkins University, said the problem with the U.S. blood supply is not
HIV-tainted blood but rather the dearth of donors.

“Nobody has been infected through blood transfusion for more than 20
years,” Baral said. “The U.S. has a safe blood supply and the major
issue with all of it is that there’s not enough of it.”