The ability to conceive and bear children is an important aspect of life for many
Thanks to modern medical treatment, people with HIV can now live healthy lives without serious health complications or symptoms. Antiretroviral therapy (ART) can even reduce the virus to such a low level that standard blood tests cannot detect it. So, what does that mean for blood donation?
Can a person with undetectable HIV donate blood? The short answer is no.
The Food and Drug Administration (FDA) bans people from donating blood or blood products if they have tested positive for HIV. It makes no difference whether their viral load is detectable or undetectable for donation purposes. However, a growing debate has emerged about whether people with undetectable HIV could potentially safely donate certain blood products, such as plasma.
Learn about the risks of HIV transmission in blood transfusions, current blood donation policies, and the debate around allowing people with HIV to donate blood. If you're looking for an HIV test, Rapid STD Testing can help with rapid STD tests to help you determine if you are eligible to donate blood.
Understanding Undetectable HIV and Blood Donation Eligibility
ART involves the use of a combination of medicines (called an HIV regimen) to treat HIV infection. They work by interfering with the replication of the virus. While these drugs never fully eliminate HIV from the body, they can reduce it to a level that is undetectable via standard blood tests.
People with undetectable HIV have less than 200 copies of the virus per milliliter of blood. Having an undetectable level of HIV means the virus is less able to attack immune system cells, causing less damage. This allows people to stay healthier and live longer.
But can a person with undetectable HIV donate blood? No, even people with undetectable HIV viral loads cannot donate blood. Let's go over HIV-related blood donor assessment criteria for different groups.
Individuals with HIV
Current guidelines from the FDA and the American Red Cross prohibit individuals who have tested positive for HIV from donating blood or blood components like plasma. Similarly, the rules ban those who have ever taken ART from donating, since the virus may still be circulating in their blood.
Individuals on HIV Preventative Medications (PrEP/PEP)
Different rules apply to HIV-negative people who have taken newer, preventative forms of ART known as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). These medications can prevent HIV transmission if taken before or after a potential exposure.
However, PrEP and PEP may also delay the detection of HIV by current tests for blood donations. For that reason, the American Red Cross and FDA ask donors taking these medications to wait three months from their last oral dose (two years if taken by injection) to donate blood.
Men Who Have Sex with Men (MSM)
For decades, the FDA had a lifetime ban on blood donations from MSM to reduce the risk of transfusion-transmitted HIV. However, in 2023 the rules changed dramatically to eliminate screening questions based on sexual orientation.
Now, all prospective blood donors must answer a series of individual questions about their HIV risks to determine their eligibility. As a result, many more people are potentially eligible to donate blood.
The Science Behind HIV Transmission Risks in Blood Transfusion
When people with HIV have undetectable viral loads due to ART, they do not transmit the virus through sexual contact. This concept has become known as “undetectable equals untransmittable.”
However, even if individuals with undetectable HIV loads do not transmit the virus through sex, they can potentially still transmit it through blood donations. The reason mostly comes down to volume: a transfusion involves exposure to a large amount of blood compared to the exposure to bodily fluid that occurs during sexual contact.
Blood Donation Safety Precautions
The FDA specifies most donor eligibility rules for blood collection centers in the U.S. Other regulatory bodies and the medical professionals at each center may specify other blood donation policies. To ensure blood transfusion safety, the donation process involves multiple steps before any donated blood can reach a transfusion patient.
Before you donate blood, you will have to answer some basic eligibility questions (such as minimum age and weight requirements) and fill out a health history questionnaire. The screening process typically asks about the following:
- Any health conditions (such as HIV)
- Medication use (including PrEP or PEP)
- Your sexual history (including sex with multiple partners and anal sex)
- Travel outside the United States
- Low iron levels
The answers to some of these questions may prevent you from donating blood permanently (such as HIV infection), while others may require a deferral (waiting) period. This is due to the difficulty tests may have in detecting HIV during the narrow window between infection and test positivity.
For example, you may have to wait for three months if you have done any of the following in the past three months:
- Taken PrEP or Truvada to prevent HIV
- Had anal sex with new or multiple sexual partners
- Injected recreational drugs or had sex with someone who injected drugs not prescribed by a doctor
- Worked as a sex worker
- Had sex with someone with HIV, Hepatitis B or C, or Human T-lymphotropic viruses (HTLV)
Blood donation testing has improved significantly, but it is not 100% effective at detecting all infectious diseases in the early stages. This is why many organizations may require a deferral based on your answers to specific questions.
Regardless of how donors answer screening questions, organizations screen all donated blood for infectious diseases according to national guidelines. Blood screening tests look for the following infections:
- Hepatitis B virus (HBV)
- Hepatitis C virus (HCV)
- Zika virus (ZIKV)
- West Nile virus (WNV)
While HIV prevents you from donating blood, not all sexually transmitted diseases (STDs) do. For example, some facilities may allow you to donate blood if you have herpes, chlamydia, or HPV.
Blood Transfusion Safety Protocols
Donated blood makes its way to hospitals, where staff use it as they see fit. Before performing transfusions, healthcare facilities carry out additional safety checks, such as the following:
- Ensuring that the donor blood type is a match for the patient
- Making sure that the supplied blood is the correct product and labeled with the patient's name
As a result of blood bank testing, the chances of passing on an infection during blood transfusions are extremely low. For HIV, only 1 in 1.5 million donations results in a transmitted infection.
Debating the Blood Donation Policies for People with HIV
Due to frequent blood shortages and increasing medical advances, many advocates are calling for more inclusive blood donation practices. Some organizations are advocating for new guidelines that take into account ART's effectiveness in suppressing HIV viral loads to undetectable levels.
However, any change to donor eligibility involves carefully balancing the desire for more inclusivity with the need for safety in the blood supply.
Eligibility Based on Sexual Orientation
Starting in the 1980s, the FDA implemented a lifetime ban on blood donation from gay and bisexual men. In 2015, the administration moved to a 12-month deferral period since their last sexual contact with another man. In 2023, the deferral period for MSM dropped from 12 months to three months.
In addition, donation screening forms no longer require questions specific to MSM. Instead, questions focus on individual HIV risk factors for people of all genders and sexual orientations.
Calling it a “significant milestone for the LGBTQI+ community,” the updated policy was based on the FDA's careful review of data from countries with similar HIV epidemiology. The current guidelines are in line with policies already in place in Canada and the United Kingdom.
Advocates and the research community have called for more studies in the following areas:
HIV Transmission with PrEP and PEP
Today's FDA recommendations state that those taking medications to treat or prevent HIV infection must defer blood donation. Because of the increased availability of these medications, there is growing concern about whether they can mask the presence of HIV during blood donation screening tests.
While scientists believe that this risk is real, there is no direct evidence of such transmission under these circumstances. Thanks also to the extremely accurate current generations of HIV screening tests, the risk of acquiring HIV from donated blood has almost been eliminated.
Blood Donation with Undetectable HIV
When it comes to sexual transmission of undetectable levels of HIV, the science is solid: people on ART who have a fully suppressed viral load cannot transmit HIV sexually.
However, because of the higher volume of exposed blood, it remains theoretically possible that HIV-positive blood donors with undetectable viral loads could transmit the virus through transfusions. So, can a person with undetectable HIV donate blood? The short answer is no.
Plasma Donation with Undetectable HIV
Current guidelines also prevent people with HIV from donating blood products like platelets or plasma. Plasma is a clear component of blood that helps create life-saving therapies for individuals with a range of medical conditions.
Some evidence indicates that plasma donated by people with undetectable HIV may be just as safe for transfusion as plasma from people without HIV. However, the research community has not yet universally accepted this finding.
A Balancing Act
In any debate surrounding the topic of blood donation and HIV, it's important to understand the science, the risks, and the benefits. Just as new research ended the lifetime ban on blood donation for gay men, more studies are needed to quantify other HIV-related risks.
For example, if science shows that people with undetectable HIV can safely donate plasma, it could increase the overall supply available for transfusions in the United States.
The Impact of Blood Donation Restrictions on the HIV Community
People donate blood and blood products for a variety of reasons: to provide life-saving support to others, to get a free health screening, or to earn a little extra income. A prohibition on blood donation prevents those living with HIV from experiencing these benefits. It may also contribute to HIV community stigmatization and discrimination.
For example, revising plasma donation policies to include those with HIV safely could have the following benefits:
- Expanding the pool of eligible donors, contributing to more available therapies for people in need
- Providing the psychological boost that comes from altruistically helping others
- Helping maintain healthy blood counts and reduce the risk of certain health conditions, such as heart disease and stroke
- Allowing those with HIV to help their own community, since their plasma may contribute to therapies for others with HIV
- Increase understanding and acceptance of those living with HIV
- Earning monetary compensation, which may be particularly important to HIV-positive individuals facing additional medical costs or other financial burdens related to their condition
Debates and discussions surrounding blood and plasma donation by those with undetectable HIV will no doubt continue into the foreseeable future. If the research proves that HIV-positive individuals may safely donate blood or blood products in certain circumstances, it may open up a host of benefits to both transfusion patients and the HIV community.
The first step in donating blood is to know whether you meet the criteria, including having any sexually transmitted infections. Not all hospitals perform STD testing when drawing blood, so a recent blood draw won't necessarily show the presence of STDs.
Know Your HIV Status With Affordable, Private STD Testing
Can a person with undetectable HIV donate blood? A person with undetectable HIV cannot donate blood under current guidelines, but an STD like chlamydia may not stop you from donating. To know whether you have any of these infections, you will need a test.
Contact Rapid STD Testing to order at-home tests or find one of our STD testing centers today.