Hundreds of miles from Orlando's Pulse Nightclub massacre, where more than 100 people lay dead or wounded, Tim Hewitt and his friends in Kansas City wanted to do something, anything, to help.
They thought donating blood would address a pressing need for the victims at the LGBTQ bar. But these perfectly healthy young men were federally prohibited from giving because they are gay.
"Donating blood was one of the easiest things we could have done, but we had to sit on the sidelines. All we could do was be in shock and mourning," Hewitt recalled recently, two years after the tragedy.
"We felt helpless."
In 1983, the Food and Drug Administration — in the midst of the HIV/AIDS epidemic — told blood banks to prohibit men who have sex with men from donating blood, blood components or plasma. The ban also included women who have sex with those men, as well as intravenous drug users and sex workers.
The medical and scientific communities said the policy was necessary to stem the spread of disease, but it has been a point of contention for many in the LGBT community who viewed it as archaic and stigmatizing in a time when HIV is less of a threat.
In 2015, the FDA amended its ban to a "12 month deferment" policy, allowing men to donate blood as long as they haven't had sex with other men for the past year.
The change, while seen by some as a step in the right direction, has been derided by others.
"It's a Band-Aid to fix a bigger problem," Hewitt says. "It's completely unreasonable." Even men married to men must abstain from sex for a year if they wish to donate blood.
The issue is particularly prickly considering the United States' nearly ubiquitous shortage of blood.
Last September, the American Red Cross reported a nationwide blood shortage of nearly 40,000 units. The shortage was so dire that the organization advised hospitals in cities including Philadelphia, Los Angeles and Atlanta to postpone elective surgeries.
Earlier this year Chicago reported a "critically low" blood supply.
And on June 6, the Community Blood Center, Kansas City's largest blood bank, declared a citywide "emergency blood shortage," due largely to low donor turnout.
In 2014, the Williams Institute at the University of California, Los Angeles concluded in a study that lifting the ban on men who have sex with men could add 2 to 4 percent more blood to the national supply each year — or 345,400 to 615,300 pints — with no increased health risk.
The United Kingdom, Japan and Serbia have shortened their deferment periods to just a couple months. Others, including Russia, South Africa and Italy, have eliminated the ban altogether and instead use an "individual risk assessment" — an interview with a potential blood donor to screen for disease.
So why doesn't the U.S. do the same?
"It's very complicated," says Louis Katz, chief medical officer of America's Blood Centers in Washington, D.C. "To make the change right away is just not easy."
Katz ran an AIDS clinic for over 30 years and was one of the earliest and most prominent voices criticizing the lifetime ban. Still, he says, it will take years before the one-year deferment is shortened or eradicated.
"The FDA will not move forward without high quality data and a strong assurance that there won't be an increase in the HIV blood supply," Katz says.
Katz points out that he began advocating against the lifetime ban in 2002 but did not see policy change until 2015. "People underestimate the complexity of getting those answers."
Today, the likelihood of contracting HIV during a blood transfusion is 1 in 1.47 million donations, according to the FDA; you're more likely to get struck by lightning. When the ban was lifted in 2015 in favor of the 12 month deferment, a director with the FDA's Center for Biologics Evaluation and Research told the New York Times that any shorter deferment would make the infection rate "unacceptably high" at 1 infection per every 347,000 donations.
The fact is, men who have sex with men are at higher risk for HIV and other sexually transmitted diseases such as gonorrhea, syphilis and Hepatitis C than heterosexual men and women. In 2016, HIV.gov found that those men accounted for nearly 70 percent of new HIV cases.
Katz says the research necessary to prove the blood is safe is "incredibly difficult." It's hard to obtain large amounts of blood for testing when the nation is already in a perennial shortage. Then, he says, there's the issue of funding the research. "It's slow," he says.
Though other countries have researched the issue, their data doesn't necessarily translate to the U.S.
There's also the challenge of what is feasible at the typical American blood center, where blood screeners are mostly entry-level workers with little or no higher education or medical background. Conversely, in Italy, blood banks are staffed almost entirely by licensed medical professionals .
The good news is that antiretroviral drugs like PrEP, a daily pill, have reduced the risk of HIV by more than 90 percent. But a new ease of mind has led to a simultaneous increase in unprotected sex between men and a rise of new strains of syphilis and Hepatitis A, both viruses that can be transmitted through blood.
FDA spokeswoman Megan McSeveney told The Star that the agency is "fully committed in its actions to facilitate change" and is looking into new ways to evaluate blood donors.
Since lifting the ban, the FDA has given the public the chance to weigh in on what questions should be asked during blood screenings. It now monitors more than half of collected U.S. blood to provide data that may spur policy changes.
"Developing the scientific information that is needed to further change blood donor policies will take time and effort," McSeveney said.
Most blood detection technology can recognize HIV within nine to 11 days of contraction, Katz says. So he thinks the deferment could be shortened from a year to three months. "But should we trust the safety of potentially millions of Americans to 'probably'?" Katz asks.
Craig Dietz, the chief medical officer at the Kansas City Care Clinic, a hub for health care in the KC LGBTQ community, speaks similarly.
"Based on the testing we have now, close to three or four months would probably be more sufficient and more reasonable," Dietz says.
In the meantime, Dietz says, the FDA could simply do better in spreading the news of the 12-month deferral.
"If I asked the majority of my patients, they would say they aren't allowed to give blood at all," Dietz says. "I'm a doctor involved in these issues and even I didn't know until several weeks after the fact."
Hewitt says the slow pace of change — and lack of publicity about those changes — is yet another instance of stigmatization against the LGBTQ community. "It feels like animosity or indifference," he says.
Katz, however, cautions against the pessimism.
"The work is being done, " he says. "But everybody's got to be patient."