Good Public Health Policy, Better Public Health Law: Blood Donation, Individual Risk Assessments, & Lifting the Deferral for Men Who Have Sex with Men
U.S. public health law balances safeguarding public health and respecting individual liberties, and the balance must always be evaluated. The Food and Drug Administration (FDA), having only recently reduced its lifetime deferral for men who have sex with men (MSM) to a 12-month deferral, called for public comment on changing its guidelines once more to consider screening for individual behaviors instead of subpopulation or group identity. The transition from a purely discriminatory and unscientific public health measure to a non-discriminatory and evidence-based public health measure is and should be supported. Prescreening donors for their individual behaviors and post-donation serological testing presents a more accurate means of ensuring blood security while providing opportunity to increase the blood supply. Generalized deferrals may have been justified at a time when human immunodeficiency virus (HIV) and similar viruses were difficult to definitively detect, treat, or prevent from spreading. That time has passed, and under public health law today a generalized MSM deferral is not necessary, proportional, or reasonable to protect the U.S. blood supply while avoiding harm to MSM. FDA should adopt individual risk assessment (IRA) as a sound blood security measure that would restore human dignity to MSM.