When social distancing orders intended to restrict the spread of the coronavirus resulted in a drastic decline in blood donations, the Food and Drug Administration intervened to expand the pool of donors in an effort to keep the nation’s blood supply stable.

In early April, the FDA changed guidelines so that men who have had sex with men or women who have had sex with a man who has had sex with another man could give blood three months after their last sexual encounter instead of waiting 12 months.

Since then, hospitals have begun to resume elective surgeries, putting renewed pressure on the blood supply, according to the Red Cross.

And some critics are arguing that the three-month wait should be eliminated as well, saying that the guidelines reflect homophobia rather than science.

Restrictions on blood donations, described as an effort to protect the blood supply, began when the AIDS epidemic was raging and there was little understanding of HIV, the virus that causes it. From September 1985 to December 2015, the FDA guidelines prohibited donations from men who had had sex with another man even once since 1977.

As it became easier to detect HIV quickly, the rule was reconsidered. In 2015, the lifetime ban was modified to 12 months.

“Based on recently completed studies and epidemiologic data,” the agency said in April, “the FDA has concluded that current policies regarding certain donor eligibility criteria can be modified without compromising the safety of the blood supply.”

The FDA noted that three-month waiting periods had been successful in the United Kingdom and Canada.

But Amfar, the Foundation for AIDS Research, (originally known as the American Foundation for AIDS Research), contends the science already supports elimination of the three-month waiting period.

They and others point out that blood donors are screened for risk and blood donations are screened for a variety of pathogens, including HIV.

A 2010 study by the Centers for Disease Control and Prevention found that men who sleep with men and who are also likely to give blood are not likely to have engaged in any risky behaviors, Amfar’s Public Policy Director Gregorio Millett said. “So to have that type of policy where you can tell people explicitly ‘we don’t want you here because of who you are’ is incredibly heartbreaking,” he said.

“It’s easy to explain away these types of issues based on what people might believe is science, but when you are part of that community, it looks just like homophobia,” Millett said. “As laudable as it is for the U.S. to go from one year to three months, it is still discriminatory.”

In addition to keeping blood available for non-pandemic requirements such as accidents, burns and surgeries, the coronavirus has created a need for donations of what is called convalescent plasma from patients who have recovered from covid-19. Doctors are investigating whether antibodies developed by those who have recovered might help treat others threatened by the disease.

Russ Plato, an attorney in the Boston area, recovered from covid-19 early in the crisis and wanted to donate his plasma, the liquid part of the blood, in case it could be used to help others. He was turned away because he and his spouse were not abstinent for three months before he tried to donate.

“I thought that would be a way to have something potentially good come out of being sick,” Plato said. “So, I tried multiple avenues for donating plasma. All of those avenues lead back to the Red Cross, and the Red Cross won’t have me as a donor because I fall in the category of men who have sex with men.”

Plato has been married for years, and both he and his spouse are monogamous, which puts him in a lower risk category for contracting HIV.

“I think the rules send a signal that people like me are dirty or dangerous in a way that seems inconsistent with my understanding of the risks posed by men who have sex with men as opposed to other demographics who are not subjected to the same restrictions,” he said. “We are living in the age of preparation, of much more sophisticated testing for HIV, so this feels targeted.”

Since 2001, Italy has used what’s called a risk assessment system for blood donations in which possible blood donors fill out individual questionnaires on their health and behaviors that could put them at risk for carrying HIV or other transfusion-transmissible illnesses. Then candidate donors are interviewed face-to-face by a medical professional, who then determines whether the candidate will be able to give blood. Analysis of data from Italy did not find an increased risk of contaminated blood.

In an email, a spokesperson for the FDA said that moving to individual risk assessment could lead to “decreased safety of the blood supply” but said that the agency is committed to “considering alternatives to the time-based deferral for men who have sex with men.”

In its latest guidance, the FDA says a history of man-to-man sexual contact increases the likelihood of being HIV positive 62-fold, but only 0.25 percent of gay blood donors who self-reported both having sex with a man recently and donating blood after that were HIV positive. This means, the document says, that self-selection is already occurring in those who wish to give blood.

Activists, AIDS fighting organizations and gay men say that it shouldn’t take a health emergency and low blood supplies to open up lines of donation. They say the FDA changed its recommendation in April without the customary public comment period because it already knew a three-month period was safe after examining the experience of other countries.

“What most people, including health professionals, are recommending is ‘assess and test.’ This is what Spain and Italy do,” Millett said. “It’s a risk-based recommendation that entails finding out if people were involved in risky behavior recently, particularly in groups where we have a higher HIV prevalence like gay men.”

Antibody tests can detect HIV from three to 12 weeks after having contracted the virus, and the CDC recommends testing for everyone once a year or if they get a new partner. Advocates say this wide access to quick testing bolsters the argument against a 90-day waiting period.

The Red Cross “remains committed to building an inclusive environment that embraces diversity for all those who engage with [its] lifesaving mission and does not believe blood donation eligibility should be determined by methods that are based upon sexual orientation,” Stephanie Rendon, media relations manager, said in an email.

She said the Red Cross goal was to ensure a safe, sufficient blood supply while treating all donors with respect.

Plato tried to sidestep the restriction through the Red Cross directed donations option when a friend of a friend needed help. Plato said his blood was a match.

“I thought perhaps the rule might be different for a specific patient, so I asked in terms of that one specific person. The rules still prohibit me from donating,” Plato said.

“It’s hard to keep pushing for permission to help. It’s awkward to be in a spot where you have to beg to help someone else. And I think it’s unrealistic to think that people are just going to keep doing that. At some point, that message will come through: We don’t want you, ever.”