Last week we suffered a terrible tragedy when almost 50 people were killed at a gay nightclub in Orlando. But as the wise man once said, "Only in the darkness can you see the stars." 'Cause volunteers lined up around the block to donate blood, but it was feared that some might still be denied the chance to give and help save lives. That's because its still FDA policy that men who've had sex with other men in the last year are not allowed to give blood. That policy is the topic of this week's Healthcare Triage.

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Back in 1983, the FDA put a ban on all blood donations from men who had ever had sex with other men. This was the beginning of the AIDS epidemic, many were afraid that such blood had a high likelihood of being tainted, putting recipients at risk. We weren't good at testing for HIV yet and stories like those of Ryan White had many in a panic.

But we got better at testing for HIV, this should have allowed us to start believing our tests would pick up the virus better in blood. And the FDA finally did get around to revising its recommendations. And even then, the new recommendations allowed gay men to donate blood if they hadn't had any sex with any other men in the last year. In other words, only gay men who are abstinent are allowed to donate blood. The rationale for this is straightforward - People are worried that you can be infected with HIV without the test being positive. In other words, if you were infected very recently, and had the HIV virus in your bloodstream, then the test might still be negative even though the blood is infected.

For this reason, the one-year ban also applies to people who've had syphilis or gonorrhea, and those who got tattoos from an unregulated tattoo parlor in the last year.

There are a few things still off here though. The first is that nucleic acid amplification testing (NAT) has gotten so good that the risk of HIV or Hepatitis infection from a blood transfusion has been lowered to about 1 in 1.5-2 million blood units. That's very low! They're even working on new protocols to lower the risk even further.

While there’s a window between exposure to HIV and a chance of becoming infected and showing up on a test, that can now be as short as 9 to 11 days with the latest tests. So, there's no good rationale for making gay men be abstinent for a year before they can donate blood.

The bigger issue though is the discrepancy between the thinking for gay men and other men or women for that matter. A gay man in a monogamous relationship who doesn't share needles or engage in any other risky behavior has pretty much no chance of becoming infected with HIV, especially if that man also engages in safe sex. But the FDA says no to their blood. They seem to have no such concerns about heterosexual men or women. They can be as promiscuous as they like, have had many partners over the last year, and there's no bans on taking their blood. Why don't the same concerns apply to them? If your standard is 'being as safe as possible' then any sex in the last 9-11 days would make you suspect.

Ironically the FDA policies are just guidance and local and private blood banks aren't required to follow them. This doesn't mean that local institutions are accepting blood from gay men though. Since the rules aren't mandatory many blood banks, including some in Orlando according to reports, are still operating under the old guidance of turning away all gay men who are trying to donate if they've ever had sex with a man.

The one year policy is aligned with those in other countries, such as England, Japan, and Australia. But some countries, like Italy, have moved to an individual assessment which cares more about history of unprotected sex than with whom that sex was with. Since making that change in 2001, Italy has not seen a major increase in HIV infections. Argentina also lifted it's ban on gay men entirely in September of 2015.

I imagine that all of this, in the minds of those that make the polices, is to play it very very very safe. No one wants to see an HIV infection from a blood donation but when people's lives are on the line because of a shortage of blood, it might be time to realize that turning away potentially lifesaving blood for an infinitesimal risk might be short-sighted.

UCLA's Williams Institute has estimated that if we lifted this ban entirely, more than 2 million more men would be eligible to donate blood in the US, about 175,000 of whom might be likely to donate. This might mean an additional 300,000 pints of blood. And since the American Red Cross suggests that a pint of blood might be used in lifesaving procedures for up to 3 people, that's upwards of a million lives that could be saved.

Don't even get me started on how policy might affect transgender people. Many of whom are just outright denied. Some have sued, saying this is discrimination and when reporters asked the FDA whether this was a correct interpretation of policy the FDA evidently refused to answer, 5 times.

I haven't yet heard a good argument for why, when there's no crisis, we make gay men wait a year to give blood when our tests can pick up the virus much sooner. Or why safe sex and monogamous relationships wouldn't clear hurdles for all.

Might also be time for us to recognize that polices that send the message that unprotected heterosexual sex with multiple partners is safer than monogamous safe sex between homosexual men aren’t just non-scientific, they seem sort of bigoted too.

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