The U.S. gay-rights movement has achieved many victories in recent years - on marriage, military service and other fronts. Yet one vestige of an earlier, more wary era remains firmly in place: the 30-year-old nationwide ban on blood donations by gay and bisexual men.
Dating from the first years of the AIDS epidemic, the ban is a source of frustration to many gay activists, and also to many leading players in the nation's health and blood-supply community who have joined in calling for change.
In June, the American Medical Association voted to oppose the policy. AMA board member William Kobler called it "discriminatory and not based on sound science." Last month, more than 80 members of Congress wrote to the Department of Health and Human Services, criticizing the lifetime ban as an outdated measure that perpetuates inaccurate stereotypes about gay men.
On some college campuses, students have urged boycotts of blood drives until the ban is repealed. Over the summer, activists organized a "National Gay Blood Drive" - asking gay men to visit blood centers, take tests to show their blood was safe, and then try to donate in defiance of the ban.
In the face of such pressure, the Food and Drug Administration - the HHS agency that regulates America's blood supply - has been unwavering. The lifetime ban will be eased, the FDA says, "only if supported by scientific data showing that a change in policy would not present a significant and preventable risk to blood recipients."
Under the auspices of HHS, a few studies are in progress that might lay the groundwork for a review of the policy. Department spokeswoman Diane Gianelli said the studies reflect a commitment to "continuously improving the safety and availability of the nation's blood supply."
However, some activists are impatient at the prospect of a research process that's likely to extend over several years with an uncertain outcome. They argue that the U.S. could move now to emulate Spain and Italy, where blanket bans on gay blood donations have been replaced by policies that ban donations by anyone - gay or straight - who's recently had unsafe sex, while allowing donations from gays and bisexuals whose blood is tested as safe and whose sexual behavior is deemed to pose no risk.
"We do not think HHS is moving fast enough," said Jason Cianciotto of Gay Men's Health Crisis, a New York-based nonprofit engaged in AIDS prevention and care.
Cianciotto said the ban "perpetuates the stigma that gay and bisexual men are dangerous to public health," and thus undercuts efforts to combat HIV.
The FDA says its policy is not intended as a judgment on donors' sexual orientation, and instead is based on the documented risk of blood infections, such as HIV, associated with male-to-male sex.
According to the FDA, men who have had sex with other men represent about 2 percent of the U.S. population, yet accounted for at least 61 percent of all new HIV infections in the U.S. in 2010.
The FDA implemented the ban in 1983, when health officials were first recognizing the risk of contracting AIDS via blood transfusions. Under the policy, blood donations are barred from any man who has had sex with another man at any time since 1977 - the start of the AIDS epidemic in the U.S.
Critics say the policy has been rendered obsolete by advances in testing which can which can detect HIV - the virus that causes AIDS - within days of infection.
Some critics say the lifetime ban could be replaced with a policy barring blood donations on the basis of gay sex within the past 12 months, or the past five years - as Canada recently decided to do. Others say there should be no set time periods, and that the screenings - as in Spain and Italy - should focus on high-risk behaviors of both gay and straight people, while making it easier for gays in monogamous, safe-sex relationships to qualify as donors.
"It's very personal to a lot of people who would like to donate and yet are barred while knowing themselves not to be at risk," said Brian Moulton, legal director of the Human Rights Campaign, a national gay-rights group.
"People perceive of giving blood as a civic duty," Moulton added. "The current policy puts gay and bisexual men who are going to be honest in an awkward position during a blood drive. People ask, `Why aren't you giving blood?'"
The FDA acknowledges that the ban leads to rejection of many healthy donors.
However, it says the policy "minimizes even the small risk of getting infectious diseases such as HIV or hepatitis through a blood transfusion." And it says the blood supply in the U.S. has been stable.
Susan Stramer, executive scientific officer with the American Red Cross, agrees that the magnitude of the blood supply isn't a decisive factor in the debate.
"We have a surplus of blood," she said. "The question is about what's equitable."
The push for changing the policy gained momentum in 2006, when the Red Cross, the American Association of Blood Banks, and America's Blood Centers reported to an FDA-sponsored workshop that the ban "is medically and scientifically unwarranted."
Over the next few years, the California State Assembly and the city councils in New York and Washington, D.C., urged repeal of the ban.
Faced with such appeals, HHS sought input in 2010 from its Advisory Committee for Blood Safety and Availability. The committee concluded that the donor-screening policy is "suboptimal" - permitting some potentially high risk donations while preventing some low risk donations - but recommended that the ban on donations by gay and bisexual men be retained pending further research.
In March 2012, HHS asked for comments on a possible pilot study to assess alternatives that would permit some gay and bisexual men to donate blood while maintaining the current high level of blood safety. That study has yet to begin.
Regardless of the pilot study's fate, Stramer said it's possible federal officials could gather enough data from other ongoing research to make an incremental change, such as emulating Canada by barring donors who've had male-on-male sex during the previous five years.
"We've mounted as much pressure as can be mounted," Stramer said. "Now it's a question of time... The best we can hope for is a gradual change in policy."
Stramer doubts there will be any groundbreaking findings from current studies. Their goals include evaluating the questionnaire presented to potential blood donors to ascertain their risk level, assessing the risk that quarantined blood donations might accidentally be released into the blood supply before being cleared via testing, and examining the phenomenon of some gay and bisexual men thwarting the ban by not acknowledging their sexual activity.
HHS, in a statement provided to members of Congress, said it hoped the studies would yield data sufficient to support a reassessment of the lifetime ban.
"The Department is committed to a full evidence-based evaluation," HHS said. "If the data indicate that a change is possible while protecting the blood supply, we will consider a change to the policy."
Moulton, the Human Rights Campaign official, says he is frustrated that the ban persists and yet acknowledges that scientific data gleaned through deliberative studies could help strengthen the case for change.
"I hope people understand there is a public health aspect to this that isn't there in other aspects of the (gay-rights) movement," he said. "We understand HHS is doing what they have to do."
Dr. Louis Katz of America's Blood Centers, a national network of community-based blood programs, favors replacing the lifetime ban with a ban on donations from men who've had male-on-male sex in the past 12 months. Though he shares the frustrations of more militant advocates, he advises them not to view the FDA as antagonists.
"The FDA is not homophobic - they are risk-averse," said Katz, the network's executive vice president. "We are going to get rational on this only by being patient and dogged."
Katz says activists campaigning for change would be wise to solicit input from groups representing hemophiliacs and other users of blood banks whose overriding goal is to keep the blood supply safe.
The past president of one of those groups, the World Federation of Hemophilia, says he'd be open to changes in current policy if they are based on authoritative research.
"What we support very much is a review of the policy," said Mark Skinner, the federation's president from 2004 to 2012. "We want to move toward a system that reduces discrimination but does not increase risk."