Blood donation restrictions on men who have sex with men

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Many countries have laws, regulations, or recommendations that effectively prohibit donations of blood or tissue for organ and corneal transplants from men who have sex with men (MSM), a classification irrespective of their sexual activities with same-sex partners and of whether they identify themselves as bisexual or gay. Temporary restrictions are sometimes called "deferrals", since blood donors who are found ineligible may be found eligible at a later date. However, many deferrals are indefinite meaning that donations are not accepted at any point in the future, constituting a de facto ban. Even men who have monogamous relations with their same-sex partners are found ineligible.

Contents

Since 1982, the risk for HIV infection transmitted via transfusion has been almost eliminated by the use of questionnaires to exclude donors at higher risk for HIV infection and performing screening tests with highly sensitive equipment to identify infected blood donations. According to the 2015 surveillance report by Canadian Blood Services, the risk of HIV transfusion-transmitted infection was fairly low: in 1 in 21.4 million donations. [1] Contaminated blood put haemophiliacs at massive risk and severe mortality, increasing the risk of common surgical procedures. People who contracted HIV from a contaminated blood transfusion include Isaac Asimov, who received a blood transfusion following cardiac surgery.

HIV/AIDS

In many high-income countries HIV is more prevalent among men who have sex with men (MSM) than among the general population. [2]

In the United States the population most affected by HIV includes gay, bisexual, and other MSM. [3] Of the 38,739 new HIV diagnoses in the US and dependent areas in 2017, 70% consisted of adult and adolescent gay and bisexual men. [3] Although approximately 492,000 sexually active gay and bisexual men are at high risk for HIV, there are more tools to prevent HIV than ever before. [3]

Proponents of the lifetime restriction defend it because of the asserted risk of false negative test results [4] and because the MSM population in developed countries tends to have a higher prevalence of HIV/AIDS infection. [2] The UK government advisory committee, SABTO, stated in 2013 that "the risk of transfusion of HIV infected blood would increase if MSM were allowed to donate blood". [5] In July 2017 however, the UK government reduced the one year deferral window to three months, to take effect in the following months, resulting from SABTO's updated conclusions that "new testing systems were accurate and donors were good at complying with the rules". Furthermore, NHS Blood and Transplant are in the process of investigating how possible it is for MSM, depending on the degree of risk, to donate without even the three-month deferral. [6] NHS has said that there is currently a limited amount of data on effective ways of conducting such risk assessments and that the initial steps of scoping, evidence gathering and testing will potentially take up to two years to complete. [7]

Current situation

Restrictions vary from country to country, and in some countries, the practice of protected sex or periods of abstinence are not considered. The restrictions affect these men and, in some cases, any female sex partners. They do not otherwise affect other women, including women who have sex with women. With regard to blood donation, the United States Food & Drug Administration (FDA) enforces a three-month deferral period for MSM and women who have sex with MSM. [8] In Canada, the deferral period for MSM blood donors was decreased to 3 months in June 2019. [9] Meanwhile, for tissues such as corneas, the MSM deferral period is five years in the United States and 12 months in Canada. [10]

List of countries with their stand on MSM blood donors

This list shows countries that had restrictions on blood donors. [11] [12] Most national standards require direct questioning regarding a man's sexual history, but the length of deferral varies.

CountryDeferral for MSMDeferral for female
sex partners of MSM
Ref.
Albania No deferralNo deferral [13]
Argentina No deferralNo deferral [14] [15] [16] [17]
Australia 3 months3 monthsSince 2021, the deferral period within Australia was reduced from 1 year to 3 months without PrEP. Gay and bi men on PrEP still have a 1-year deferral period – however can donate plasma after 3 months. [18] [19]
Austria No deferralNo deferral [20] A 1-year deferral was implemented following the publication of standardized donor history questionnaire in December 2019. Previously, there was an indefinite ban on donations. In December 2019 this was changed to a 4-month deferral period for blood donors. [21]

Since September 2022, the ban was lifted completely. [22]

Belarus No deferralNo deferralNo formal ban on blood donation by men who have sex with men exists in Belarus. However, informal restrictions and refusals have occurred, and it is recommended by the Ministry of Health of Belarus that men who have sex with men do not donate blood. Deceased homosexuals are forbidden from having their blood sampled as of 1993. [23]
Belgium 4 monthsNo deferralIn June 2019, it was explicitly reported by the LGBT media, that the Red Cross banned transgender individuals from donating blood in Belgium. [24] [25] In July 2022, the restrictions changed from 1 year to 4 months. [26] [27]
Bhutan No deferralNo deferral [28]
Bolivia No deferralNo deferralSince July 2019, the ban was lifted completely. [29]
Brazil No deferralNo deferral [30] [31] [32] [33] [34]
Canada No deferralNo deferralSince 11 September 2022, anyone who has had anal sex with a new partner in the last three months, regardless of their gender or their partner's gender, must wait three months before donating. [35] [36] [37] [38] [39] In Quebec the ban on plasma donation has been lifted on 2 October 2022, and the ban on other donations was lifted on 4 December 2022.
Chile No deferralNo deferral [40] [41] [42] [43] [44]
China Indefinite1 year [45] [46]
Colombia No deferralNo deferral [47]
Costa Rica No deferralNo deferral [48]
Croatia Indefinite6 months [49]
Cyprus No deferralNo deferral [50]
Czech Republic No deferralNo deferralBeginning July 1, 2024, anyone who has had anal sex with a new partner or multiple partners is banned from donating blood for 4 months. [51] [52]
Denmark 4 months4 months [53] In March 2020, Denmark implemented a policy that allows gay and bi men to donate blood after a 4-month deferral period. [54] [55] [56]
Estonia No deferralNo deferralUntil 2018, Estonia didn't allow gay and bi men to donate blood. [57] Between 2018 and 11 April 2022, Estonia implemented a policy that allowed gay and bi men to donate blood after a 12-month deferral period. Between 12 April 2022 and 29 February 2024, gay and bi men were allowed to donate after a 4-month deferral period. [58] Since 1 March 2024, there is no deferral period for gay and bi men. [59]
Finland No deferralNo deferralIn December 2023, the deferral period was removed. [60] [61] [62]
France No deferralNo deferral [63] Between 1 February 2020, to 16 March 2022 France implemented a policy that allows gay and bi men to donate blood after a 4-month deferral period. [64] Since 16 March 2022, there is no deferral period for gay and bi men within France to donate blood. [65] [66]
Germany No deferralNo deferral [67] Since September 2021, gay and bisexual men are allowed to donate blood if they live in a permanent monogamous relationship. Sexual contact between men outside of such relationships will lead to exclusion for four months. [68] Effective from 1 April 2023, the German ministry of health removed all remaining discriminatory blood donation policies for gay and bi men throughout Germany. [69]
Greece No deferralNo deferralOn 10 January 2022, Health Minister Thanos Plevris and his deputy, Mina Gaga, signed a ministerial decree, It will come into force upon publication in the Government Gazette. [70] [71]
Greenland 4 months4 monthsThe policy implemented in Denmark proper also applies to Greenland (cf. The Office of the medical director of Health of Greenland). Transfusion Medicine Standards published by the Danish Society for Clinical Immunology applies. [72]
Hong Kong 6 monthsNo deferral [73] [74] [75]
Hungary No deferralNo deferral12-month deferral scrapped in 2020. [76]
Iceland Indefinite1 yearA rule change was proposed in 2021 by the then Minister of Health to have a 4-month deferral. That change has of yet not been enacted. [77] [78]
India IndefiniteNo deferralCourt decision pending [79]
Ireland No deferralNo deferral [80] In January 2017 Ireland lifted the lifetime ban on blood donations from MSM who had ever engaged in oral or anal sex with another man, switching to 12-month deferral. [81] [82] [83] [84] [85] This was further reduced to a 4-month deferral period in March 2022. [86] [87] [88] Since 28 November 2022, all prospective donors, regardless of orientation or gender, are assessed individually and may donate if they have not engaged in anal sex with a new or multiple partners in the 4 months prior to donation. [89]
Israel No deferralNo deferralSince 1 October 2021, Israel completely removed all restrictions on gay and bisexual men donating blood. [90] [91] [92] [93]
Italy No deferralNo deferral [11] [94] High-risk sexual contact is banned irrespective of the partner's sex. Any sexual activity with an occasional partner will result in a 4 months deferral period. [95]
Japan 6 months6 months [96]
Kosovo IndefiniteIndefiniteWomen who have sex with women also barred from donating blood. [97]
Latvia No deferral [lower-alpha 1] No deferral [lower-alpha 1] [99]
Lebanon IndefiniteIndefinite [100]
Lithuania No deferralNo deferralRemoved restrictions on 1 May 2022 [101]
Malaysia IndefiniteIndefinite [102]
Malta No deferralNo deferralIn September 2019, Malta implemented a 1-year deferral period for gay and bi men. [103] [104] [105] [106] Since September 2022, gay and bi men can legally donate blood within Malta under the same conditions as heterosexual people. [107]
Mexico No deferralNo deferral [108]
Netherlands No deferralNo deferralSince 1 September 2021, gay men within monogamous relationships are no longer subjected to the four-month waiting period. [109] [110] From January 2024, gay and bi men are allowed to donate blood under the same conditions as heterosexual people. [111]
New Zealand 3 months3 monthsSince 14 December 2020, New Zealand implemented a 3-month deferral period – down from a 1-year deferral period. [112] [113]
Norway 1 year1 year [114] The deferral period for gay men to donate blood was proposed to be lowered from 1 year to 6 months, but this was not implemented. [115]
Peru No deferralNo deferral [116] [117] [118] [119] [120]
Philippines IndefiniteIndefinite [121]
Poland No deferral [lower-alpha 1] No deferral [lower-alpha 1] [11] [122] [123] [124]
Portugal No deferralNo deferral [125] [126] [127]
Romania No deferralNo deferral [128] [129]
Russia No deferralNo deferral [130] [131]
San Marino No deferralNo deferral
Serbia 6 months6 months [132]
Singapore Indefinite1 year [133] [134]
South Africa No deferralNo deferral [135]
South Korea No deferralNo deferral [136]
Slovakia 1 year1 year [137]
Slovenia No deferralNo deferral [138]
Spain No deferralNo deferral [11]
Sri Lanka IndefiniteIndefinite [139]
Sweden 6 months6 months [140] [141] Since 1 May 2021, Sweden lowered the deferral period from 1 year to 6 months.
Switzerland No deferralNo deferralOn 1 November 2023, a 4-month deferral period for contact with new sexual partners (unified for homo- and heterosexuals) was implemented within Switzerland. [142] [143] [144]
Taiwan IndefiniteNo deferral [145] In 2018, Taiwan proposed new regulations that would have allowed men who have sex with men to donate blood after a 5-year deferral period, starting tentatively in May that year. [146] Those regulations were never fully approved, and in May 2019 the Ministry of Health and Welfare clarified that the rules had not changed. [147]
Thailand IndefiniteIndefinite [148] [149]
Trinidad and Tobago 3 monthsNo deferralAccording to the Ministry of Health's website, prospective donors who have had male-to-male sexual intercourse are deferred for three (3) months after their last intimate encounter. [150]
Turkey Indefinite1 year [151]
Ukraine No deferralNo deferral [152]
United Arab Emirates IndefiniteIndefinite [153]
United Kingdom No deferralNo deferralSince 14 June 2021, Anyone who has had anal sex with a new partner or multiple partners in the last three months, regardless of their gender or their partner's gender, must wait three months before donating. [154]
United States No deferralNo deferralSince August 2023, both the Food and Drug Administration and the American Red Cross implemented and went into effect - the blood donation policy of allowing gay and bi men "who are monogamous" as a condition without any waiting period. [155] [156] Prior to this during the height of the global COVID-19 pandemic, gay and bi men who wanted to donate blood required a 3-month deferred period. [157] [158]
Uruguay No deferralNo deferral [159] [160]
Venezuela Indefinite [lower-alpha 2] No deferral [161]
  1. 1 2 3 4 People of any sexual orientation involved in any kind of sexual activity are welcome to donate blood, if they are confident that their sexual behaviour is safe and does not expose them to sexually transmitted diseases by e.g. unprotected sex with non-trusted partners, regardless of sexual orientation. [98]
  2. Individuals are requested to fill a "Yes/No" questionnaire about their sexual life. Direct questions like "Have you ever had any sexual intercourse with someone from your same sex?" could appear. [ citation needed ]
Blood donation policies for men who have sex with men
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-Men who have sex with men may donate blood; No deferral
-Men who have sex with men may donate blood; Temporary deferral
-Men who have sex with men may not donate blood; Permanent deferral
-No Data Map of blood donation policies for men who have sex with men.svg
Blood donation policies for men who have sex with men
  -Men who have sex with men may donate blood; No deferral
  -Men who have sex with men may donate blood; Temporary deferral
  -Men who have sex with men may not donate blood; Permanent deferral
  -No Data
Blood donation policies for female sex partners of men who have sex with men
-Female sex partners of men who have sex with men may donate blood; No deferral
-Female sex partners of men who have sex with men may donate blood; Temporary deferral
-Female sex partners of men who have sex with men may not donate blood; Permanent deferral
-No Data Map of blood donation policies for female sex partners of men who have sex with men.svg
Blood donation policies for female sex partners of men who have sex with men
  -Female sex partners of men who have sex with men may donate blood; No deferral
  -Female sex partners of men who have sex with men may donate blood; Temporary deferral
  -Female sex partners of men who have sex with men may not donate blood; Permanent deferral
  -No Data

Europe

Several European countries do not have deferral policies for men who have sex with men (MSM). The donation is allowed if the donor has not had a risky sexual encounter, but not depending on the sexual orientation of the donor. [162] [163] [95] For example, in Italy, the questionnaire item for sexual behaviour is symmetrical with respect to homosexual, heterosexual and bisexual intercourses and mentions them explicitly, as well as all points of sexual contact (oral, genital, anal), and does not mention usage of protection. [95]

The UK since November 2017 has implemented a 3-month deferral policy on all gay/bi men who want to donate their blood. [164] [165] [166] However, this did not apply to Northern Ireland until 2020. [167] The Advisory Committee on the Safety of Blood, Tissues and Organs recommended the policy change after a study concluded that a total ban may breach equality legislation and that the risk of HIV reaching the blood supply would only increase by approximately 2%. [168] In December 2020, it was announced that the UK would move to a personalised sexual behaviour risk assessment and scrap the deferral period specific to MSM. [169]

In Ireland, MSM could historically donate blood if they had not engaged in oral or anal sex with another man at least 12 months prior to a donation. This policy had come into effect on 16 January 2017. On 27 July 2015, Tomás Heneghan, a 23-year-old University of Limerick student, and journalist from Galway began a legal challenge in the High Court against the permanent deferral imposed on MSM donors. [170] [171] He argued that the questionnaire and interview process used by the IBTS does not adequately assess the risk of disease transmission posed by his donation. He claims this is in breach of EU law. He said that both failed to consider the length of time between a donor's last sexual experience and the end of a "window period" in which infections are sometimes not detected. Heneghan's previous sexual activity posed no risk of infection, according to HSE-approved advice and he said the service had no evidence upon which it could legitimately impose a life-long ban on him donating blood. Following several adjournments of the case to allow the blood service and Department of Health to examine and develop the donation policies, in late June 2016 the Irish Blood Transfusion Service recommended that the lifetime ban on MSM be reduced to a 12-month ban. Later that week the Minister for Health Simon Harris agreed to the recommendations and announced the reduction would take place. However, no timeline was reported for the implementation of the new policies. [172]

On 26 July 2016, Tomás Heneghan dropped his High Court challenge against the service as an end to the lifetime deferral on MSM blood donors had been announced in the interim. [173] Heneghan then wrote about his experiences of challenging the ban in a number of national media outlets. [174] [175] On 2 October 2016, it was reported that Minister Harris would implement the new policy from 16 January 2017, almost seven months after he announced the policy change. [82] On 16 January 2017, Heneghan (now 25) attended a blood donation clinic in D'Olier Street, Dublin, and became the first man who has had sex with another man to donate blood openly in the Republic of Ireland since the lifetime deferral policy was first introduced in the 1980s. However, he also criticized the new 12-month deferral policy on MSM and called on Ireland's Health Minister to initiate a review of the IBTS and replace the 12-month deferral period for MSM with no deferral or a 3-month deferral on all donors following sexual intercourse. [176] [177] [178] [179]

On 20 May 2019, Heneghan (27) initiated a fresh legal challenge in the High Court against the blanket deferral on men who had had oral or anal sex with another man in the previous 12-month period. [180] [181] [182] [183]

Heneghan claims he cannot understand the reasoning behind the IBTS policy and argues that the questionnaire does not enable the IBTS to make a full evaluation of the level of risk presented by an individual donor due to their sexual behaviour. He also states that according to the IBTS's own website, there is a window period following infection during which HIV and hepatitis may not be detected in the blood and that this window is seven days for HIV and 16 days for hepatitis. He claims that a far less onerous restriction could be imposed rather than the 12-month deferral, which would protect blood recipients. He claims the decision to place an "automatic deferral" on him is unlawful and in breach of EU law and European communities regulations on the quality and safety of human blood products and that the policy is disproportionate, discriminates against homosexual and bisexual men, and breaches his constitutional rights and rights under the European Convention on Human Rights. The case is due to return to the court in July 2019.

In July 2019, a gay man in Ireland filed two formal complaints with the European Commission against the Department of Health and the Irish Blood Transfusion Service, and the Northern Ireland Blood Transfusion Service (the only part of the United Kingdom to maintain a 12-month deferral policy for MSM) over the MSM one-year deferral policy. The man, who has chosen to have his complaints examined by the Commission anonymously, is alleging the ban in both jurisdictions violates a number of European Union laws, including two European Union Directives covering the standards of quality and safety for the collection of blood by EU member states, as well as provisions contained in both the EU Charter of Fundamental Rights and the European Convention on Human Rights. The commission has informed the man his complaints will now be considered in light of EU law. [184]

A similar policy exists in the rest of the European Union and is the prevailing interpretation of the European Union Directive 2004–33/EC article 2.1 on donor deferrals. [185] The policy, however, is not very specific and refers to "high-risk sexual contact". The UK interprets the directive to include all forms of homosexual sex as falling within 2.2.2 of Annex III to the directive "Persons whose behaviour or activity places them at risk of acquiring infectious diseases that may be transmitted by blood", requiring a deferral based on the window period for the diseases involved, and sets this at 12 months, despite the Annex suggesting 6 months for risk of exposure to hepatitis B. Hélder Trindade, President of the Portuguese Institute of Blood and Transplantation (IPST), stated in 2015 that sexually abstinent homosexuals may give blood, but that MSM is definitely seen as a risk factor. [186] On the 28th of November 2022, the Irish Blood Transfusion Service introduced Individual Donor Risk Assessments and removed sexuality from the eligibility criteria. All potential donors including MSM are now asked about new sexual partners, of any gender, and are eligible to donate if they have had no new partners in the previous 4 months.

In Finland, the parliamentary ombudsman launched an investigation on the possible unconstitutionality of the lifetime ban in January 2006. In June 2008, it was concluded that the ban was not unlawful in Finland as it is based on "appropriately reasoned epidemiological information" and because it is related to sexual behaviour rather than sexual orientation. The ombudsman added that people over the age of 65 and people who lived in Britain during the bovine spongiform encephalopathy (mad cow disease) outbreak are also screened out during blood donor interviews. In December 2013, the Finnish Red Cross blood service announced it was lifting the ban and introducing a one-year deferral instead. In 2021, the deferral period in Finland was reduced to 4 months.

In July 2016, France implemented a 1-year deferral period policy on all gay and bisexual men donating blood. [187] Then the blood MSM deferral policy implemented in France was lowered to 4 months effective on 1 February 2020.[ citation needed ]

New Zealand

At the formation of the New Zealand Blood Service (NZBS) in 1998, the deferral period had been 10 years but was reduced to 5 years in 2009. This was following an independent review of blood donation criteria in 2007–2008 which found no significant difference in risk of the blood supply for a deferral period of 5 years compared to 10 years. [188]

In 2014, the NZBS dropped the ban period from 5 years to 1 year following the recommendation of Medsafe. [189] Their decision was mainly caused by new information about HIV transmission in Australia [190] which already had a one-year deferral period. The 1-year deferral commenced 15 December 2014. [191] On 14 December 2020 the NZBS reduced the deferral to 3 months. [192]

The 3 month deferral period for MSM is on par with the 3-month deferral period for several other behavioural categories carrying a higher probability of unrecognized HIV infection, such as persons engaging in sex work and people who have resided in a country that has a high (1% or more) HIV prevalence. [193]

United States

Current recommendations

In the United States, the Food and Drug Administration (FDA) issues non-binding guidance for deferral of blood donations, though they are universally followed. [194]

In May 2023, the restrictions were updated to focus on behavior rather than sexual orientation or gender. People are ineligible to donate blood if they have: [195]

  • Had anal sex within the past 3 months and have a new or multiple sexual partners
  • Ever tested positive for HIV or been treated for HIV with anti-retroviral therapy
  • Taken any HIV prevention medication (PEP or PrEP; these can affect test results) by mouth within the past 3 months or by injection within the past 2 years
  • Ever exchanged sex for payment or barter
  • Used non-prescription injection drugs within the past 3 months
  • Had sex within the past 3 months with someone who has ever tested positive for HIV
  • Received an allogeneic blood transfusion or been exposed to blood of another individual (e.g. through a wound) within the past 3 months
  • Gotten a tattoo or body piercing within the last 3 months, unless pierced with single-use equipment or tattooed in a state-approved shop with sterile needles and non-reused ink
  • Been infected with or treated for syphilis or gonorrhea within the past 3 months
  • Hemophilia or other clotting factor deficiency

UNOS policies for organ donation allow for solid organs from MSM donors such as hearts, lungs, and kidneys to be used in transplant surgeries, though they require the hospital receiving the organ to be notified if the donor was an MSM within the past 5 years. [196] The organs are generally used unless there is a clear positive test for a disease.

Donors of human cells and tissues other than organs, such as corneas or reproductive tissue like semen, are ineligible for five years after the most recent contact. [197] With regard to corneal donations, the five-year deferral policy in the United States and the similar 12-month deferral policy in Canada have the effect of preventing thousands of corneal donations annually. [10]

History of FDA policy

  • In 1983, two years after the discovery of HIV/AIDS in the United States, the FDA guidelines were changed to lifetime donation ban for men having had sex with a man since 1977. The argument used to follow these policies is that blood should be collected from a population that is at low risk for the disease since the tests are not perfect and human error may lead to infected units not being properly discarded, and these population groups would be considered high risk. [198]
  • In 2006, the AABB, American Red Cross, and America's Blood Centers all supported a change from the current US policy of a lifetime deferral of MSM to one year since most recent contact. [199] One model suggested that this change would result in one additional case of HIV transmitted by transfusion every 32.8 years. The AABB has suggested making this change since 1997. The FDA did not accept the proposal and had concerns about the data used to produce the model, citing that additional risk to recipients was not justified.
  • On 19 August 2009, the Assembly Judiciary Committee in California passed AJR13, the U.S. Blood Donor Nondiscrimination Resolution, calling upon the FDA to end the MSM blood ban. [200]
  • In April 2010, the New York City Council passed a resolution calling on the U.S. Food and Drug Administration (FDA) to eliminate the ban stating "This ban was based on prejudice, a knee-jerk reaction, and misunderstandings about the HIV/AIDS disease. Given the constant need for blood, it does not make common sense to prohibit donations from an entire population." [201]
  • On 1 June 2010, the Council of the District of Columbia passed a resolution calling on the FDA to "reverse the lifetime deferment of blood donations by men who have had sex with men since 1977 in favor of a policy that protects the safety and integrity of the blood supply that is based on up-to-date scientific criteria." [202]
  • In June 2013, the American Medical Association issued a statement calling on the FDA to change the policy, stating that "The lifetime ban on blood donation for men who have sex with men is discriminatory and not based on sound science." [203] [204]
  • In July 2013, the American Osteopathic Association approved a policy calling on the FDA to "end the indefinite deferment period for Men who have sex with Men (MSM)", and to "modify the exclusion criteria for MSM to be consistent with deferrals for those judged to be at an increased risk of infection." [205]
  • On 14 December 2015, Jordan Moll-Vigrass, Congressmen Brian Higgins and the Pride Center of Western New York held a community rally in Buffalo, New York, to rally against the FDA policy that bans blood donations by gay and bisexual men. Moll-Vigrass, who is openly gay and had been in a committed relationship for four years, was refused as a blood donor after disclosing his sexual orientation during the questionnaire screening process. Outraged by the federal policy and disappointed by being refused as a blood donor, Moll-Vigrass started to advocate for change. [206] "The government's unfounded policy is hurtful to the people being turned away solely based on sexual orientation and the millions of others who will be in need of a lifesaving blood donation," said Higgins. "Eligibility should be based on risk-based science rather than outdated, fear-based speculation." [207]
  • On 21 December 2015, the U.S. Food and Drug Administration changed the policy by replacing the indefinite deferral with a 1-year deferral for MSM and women who have sex with MSM. [204] [8] [208] The change was proposed the previous July. [209] [210]
  • On 27 May 2016, the U.S. Food and Drug Administration approved of a new blood donor history questionnaire for general use by blood establishments, which is compatible with the deferral for 12 months. [211] Before this update, the approved questionnaires were compatible only with an indefinite deferral of blood donations from MSM.
  • As of December 2016, the American Red Cross reports that MSM may be eligible to donate blood if they did not have sex with another man in more than 12 months. The American Red Cross reports that, in January 2017, the organization began donor reinstatement of MSM who were previously deferred from donating, and who later became qualified to donate blood in accordance with the new donation deferral period of 12 months. [212] The American Red Cross website specifies that this 12-month deferral does also apply to transgender men who have sex with men, but does not apply to transgender women who have sex with men. [213]
  • The COVID-19 pandemic, a drop in blood donations prompted changing the 1-year deferral to 3 months after the most recent sexual contact for MSM. [8] [214]
  • Current guidance was issued in May 2023

Australia

Australia implemented a 12-month deferral in 1999; a comparison of confirmed HIV positive blood donations before and after the change did not see a statistically significant difference. [11] The Australian Red Cross Blood Service pushed to have the deferral period lowered from twelve to six months, however it was rejected by the Therapeutic Goods Administration (TGA) in 2014. In April 2020 the TGA revised the deferral period for MSM down to three months. The revision requires approval of the federal, state and territory governments before it can go into effect. [215] [216]

Lifeblood's new 3-month deferral period rules went into effect on 31 January 2021. [217] The spokesperson said they empathise with those who cannot give blood. [218]

Reasoning for the restrictions

Blood services first and foremost must ensure that all blood received for donation is safe for transfusion purposes. This is achieved by screening potential donors for high risk behaviours through questionnaires and interviews before blood is taken, and subsequent laboratory testing on samples of donated blood.

Blood services commonly justify their bans against MSM due to the marginal increase in the risk for transfusion-transmitted HIV. [219] Other groups with similar restrictions, or complete prohibition to donate blood, due to increased or possible risk for certain infectious diseases include intravenous drug users, recipients of animal organs or tissues, and those who have traveled or lived abroad in certain countries. [220]

In the 1980s, when the HIV/AIDS epidemic outbreak occurred, there was a high prevalence of the disease in MSM and no reliable tests for the virus, which justified blanket bans on blood donations from high-risk groups. [221]

These restrictions are similar to current restrictions on people with certain residence in the United Kingdom, France, or Saudi Arabia during the height of the BSE ("mad cow disease") epidemic of 1980 through 1996, due to the absence of a test for its human form, variant Creutzfeldt–Jakob disease (vCJD). [222]

In 1985, early tests using the ELISA method looked for antibodies, which are the immune system's response to the virus. [223] However, there is a window period when using this method in which a person who has been infected with HIV is able to spread the disease but may test negative for the virus. [224] [225] This window period can be as long as three to six months, [226] with an average of 22 days. [227] Tests using the ELISA methods are often still used in developed countries because of their ease-of-use, as well as their fairly high sensitivity, which boasts 100% sensitivity. [228] [229] To cover the window period resultant from the use of these tests, donors are also screened for high risk behaviours, one of which is a history of same-sex sexual activity among male potential donors. [230] Newer tests look for the virus itself, such as the p24 antigen test, which looks for a part of the virus on the surface of infected cells, and nucleic acid tests (NAT), which look for the genetic material of the virus in HIV-infected cells. [231] With these tests, the window period is shorter, with an average duration of 12 days. [227] Fourth generation, or combination, HIV tests can detect HIV infection in 99% of individuals by one and a half months after infection. [232]

Risks are also associated with a non-MSM donors testing positive for HIV, which can have major implications as the donor's last donation could have been given within the window period for testing and could have entered the blood supply, potentially infecting blood product recipients. An incident in 2003 in New Zealand saw a non-MSM donor testing positive for HIV and subsequently all blood products made with the donor's last blood donation had to be recalled. This included NZ$4 million worth of Factor VIII, a blood clotting factor used to treat hemophiliacs which is manufactured from large pools of donated plasma, and subsequently led to a nationwide shortage of Factor VIII and the deferral of non-emergency surgery on hemophiliac patients, costing the health sector millions of dollars more. [188] Screening out those at high risk of blood borne diseases, including MSM, reduces the potential frequency and impact of such incidents.

Criticism of the restrictions

Need for blood

Objections to the restrictions, including those from the American Medical Association [233] and the American Red Cross, are generally based on the idea that improvements in testing and other safeguards have reduced the risk from transfusion transmitted HIV to an acceptable level. Blood shortages are common, and advocates for change to the policies point out that excluding healthy donors only makes the problem worse. In 2018, approximately 10,000 donations were still urgently needed by 10 March to continue to meet patients' needs. However, Canadian Blood Services noted that the national inventory and days on hand of several blood groups remain at critically low levels. Less than four per cent of eligible donors give blood each year. [234]

Need for corneas

Corneal transplant surgery can cure blindness caused by corneal disease. However, there is a global shortage of corneal donations, severely limiting the availability of corneal transplants across most of the world. A 2016 study found that 12.7 million visually impaired people were in need of a corneal transplant, with only 1 cornea available for every 70 needed. [235] Many countries have years-long waitlists for corneal transplant surgery due to the shortage of donated corneas. [236] [237] Even though there has never been a reported case of HIV transmission through corneal transplant surgery, and even though all donated corneas are screened for the presence of HIV through antibody or nucleic acid testing, many countries continue to ban MSM corneal donors. [10]

Risk of STD transmission

In some European countries, high-risk sexual intercourses lead to a temporary ban, regardless of the sex of the partner. In fact, advocates for change in other countries note that the ban encompasses all same-sex sexual contact, even if the partner's HIV status is shown beyond doubt to be negative. Advocates for change point out that a promiscuous straight male is a higher-risk donor than a gay or bisexual man in a monogamous relationship, but the former will usually be allowed to donate blood. Furthermore, in some countries, other high-risk activities determine a temporary ban, such as sexual contact with anyone who has used needles to take drugs not prescribed by their doctor, whereas MSM donors are deferred indefinitely. [36]

Roots in discrimination

Many LGBTQ organizations view the restrictions on donation as based on homophobia and not based on valid medical concern since donations are rigorously tested to rule out donors that are infected with known viruses such as HIV, hepatitis B, and hepatitis C. They state the deferrals are based on stereotypes. [238]

Activism regarding reform of MSM donor policies

Advocates worldwide for change to MSM prohibitions point out that screening of donors should focus on sexual behaviour as well as safe sex practices since many MSM may always have protected sex, be monogamous, or be in other low risk categories. [238] [5] Some groups in favor of lifting the restrictions support a waiting period after the blood is donated when the donor is considered to have had behaviour considered higher risk, and before it is used, to match the blood bank's window of testing methods. [238] While HIV is reliably detected in 10 to 14 days with RNA testing, older testing methods provide accuracy for only up to 98% of positive cases after three months. [239]

Student and faculty activism on campuses

In Canada

In the United States [198]

In the United Kingdom

United Kingdom

In 2015, Welsh writer and poet RJ Arkhipov exhibited a poetry series written with his own blood as ink in protest of the MSM blood donor restrictions. His poem Inkwell discusses the shame and stigma surrounding "gay blood". An abecedarian poem, each line of Inkwell's five quatrains begins with letters from each of the blood groups, alternating between A, B, AB and O. [264] [265] [266]

Court cases

In 2018, the European Court of Human Rights took up a case of a French citizen who was prevented from donating blood. [267]

See also

Related Research Articles

<span class="mw-page-title-main">Blood donation</span> Blood withdrawal for use by another person via transfusion

A blood donation occurs when a person voluntarily has blood drawn and used for transfusions and/or made into biopharmaceutical medications by a process called fractionation. A donation may be of whole blood, or of specific components directly (apheresis). Blood banks often participate in the collection process as well as the procedures that follow it.

Men who have sex with men (MSM) are men who engage in sexual activity with other men, regardless of their sexual orientation or sexual identity. The term was created by epidemiologists in the 1990s, to better study and communicate the spread of sexually transmitted infections such as HIV/AIDS between all sexually active males, not strictly those identifying as gay, bisexual, pansexual or various other sexualities, but also for example male prostitutes. The term is often used in medical literature and social research to describe such men as a group. It does not describe any specific kind of sexual activity, and which activities are covered by the term depends on context. The alternative term "males who have sex with males" is sometimes considered more accurate in cases where those described may not be legal adults.

<span class="mw-page-title-main">Canadian Blood Services</span> Canadian health non-profit

Canadian Blood Services is a non-profit charitable organization that is independent from the Canadian government. The Canadian Blood Services was established as Canada's blood authority in all provinces and territories except for Quebec in 1998. The federal, provincial and territorial governments created the Canadian Blood Services through a memorandum of understanding. Canadian Blood Services is funded mainly through the provincial and territorial governments.

<span class="mw-page-title-main">LGBTQ rights in the Republic of Ireland</span>

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights in the Republic of Ireland are regarded as some of the most progressive in Europe and the world. Ireland is notable for its transformation from a country holding overwhelmingly conservative attitudes toward LGBTQ issues, in part due to the opposition by the Roman Catholic Church, to one holding overwhelmingly liberal views in the space of a generation. In May 2015, Ireland became the first country to legalise same-sex marriage on a national level by popular vote. The New York Times declared that the result put Ireland at the "vanguard of social change". Since July 2015, transgender people in Ireland can self-declare their gender for the purpose of updating passports, driving licences, obtaining new birth certificates, and getting married. Both male and female expressions of homosexuality were decriminalised in 1993, and most forms of discrimination based on sexual orientation are now outlawed. Ireland also forbids incitement to hatred based on sexual orientation. Article 41 of the Constitution of Ireland explicitly protects the right to marriage irrespective of sex.

<span class="mw-page-title-main">Blood donation in England</span>

In England, blood and other tissues are collected by NHS Blood and Transplant (NHSBT). NHSBT Blood Donation was previously known as the National Blood Service until it merged with UK Transplant in 2005 to form a NHS special health authority. Other official blood services in the United Kingdom include the Northern Ireland Blood Transfusion Service, the Scottish National Blood Transfusion Service and the Welsh Blood Service.

Australian Red Cross Lifeblood, simply known as Lifeblood, is a branch of the Australian Red Cross responsible for the collection and distribution of blood and biological products in Australia. Lifeblood employs around 3,700 employees across scientific, clinical and support services, processing over one and a half a million blood donations each year. Lifeblood is primarily funded by the Australian Government and state and territory governments.

The Irish Blood Transfusion Service (IBTS), or Seirbhís Fuilaistriúcháin na hÉireann in Irish, was established in Ireland as the Blood Transfusion Service Board (BTSB) by the Blood Transfusion Service Board (Establishment) Order, 1965. It took its current name in April 2000 by Statutory Instrument issued by the Minister for Health and Children to whom it is responsible. The Service provides blood and blood products for humans.

<span class="mw-page-title-main">LGBTQ rights in the Netherlands</span>

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights in the Netherlands are among the most advanced in the world. Same-sex sexual activity was legalized in 1811 after France invaded the country and installed the Napoleonic Code, erasing any remaining sodomy laws. No more sodomy laws were enacted after the country received independence. An age of consent equal with that of heterosexual activity was put in place in 1971. During the late 20th century, awareness surrounding homosexuality grew and society became more tolerant of gay and bisexual people. The changes eventually led to homosexuality's declassification as a mental illness in 1973 and a ban on discrimination based on sexual orientation in the military. The Equal Treatment Act 1994 bans discrimination on account of sexual orientation in employment, housing, public accommodations, and other areas. This was extended in 2019 to include discrimination based on gender identity, gender expression and sex characteristics. After the country began granting same-sex couples registered partnerships benefits in 1998, the Netherlands became the first country in the world to legalize same-sex marriage in 2001. Same-sex joint and stepchild adoption are also permitted, and lesbian couples can access IVF as well.

The Caribbean is the second-most affected region in the world in terms of HIV prevalence rates. Based on 2009 data, about 1.0 percent of the adult population is living with the disease, which is higher than any other region except Sub-Saharan Africa. Several factors influence this epidemic, including poverty, gender, sex tourism, and stigma. HIV incidence in the Caribbean declined 49% between 2001 and 2012. Different countries have employed a variety of responses to the disease, with a range of challenges and successes.

Numerous governmental and non-governmental organizations have criticized the U. S. Food and Drug Administration for alleged excessive and/or insufficient regulation. The U.S. Food and Drug Administration (FDA) is an agency of the United States Department of Health and Human Services and is responsible for the safety regulation of most types of foods, dietary supplements, drugs, vaccines, biological medical products, blood products, medical devices, radiation-emitting devices, veterinary products, and cosmetics. The FDA also enforces section 361 of the Public Health Service Act and the associated regulations, including sanitation requirements on interstate travel as well as specific rules for control of disease on products ranging from animals sold as pets to donations of human blood and tissue.

The history of HIV/AIDS in Australia is distinctive, as Australian government bodies recognised and responded to the AIDS pandemic relatively swiftly, with the implementation of effective disease prevention and public health programs, such as needle and syringe programs (NSPs). As a result, despite significant numbers of at-risk group members contracting the virus in the early period following its discovery, Australia achieved and has maintained a low rate of HIV infection in comparison to the rest of the world.

The New Zealand Blood Service is the provider of blood services for New Zealand. The service is a Crown entity responsible to New Zealand's Parliament and is governed by a Board appointed by the Minister of Health.

A transfusion transmitted infection (TTI) is a virus, parasite, or other potential pathogen that can be transmitted in donated blood through a transfusion to a recipient. The term is usually limited to known pathogens, but also sometimes includes agents such as simian foamy virus which are not known to cause disease.

Discrimination against people with HIV/AIDS or serophobia is the prejudice, fear, rejection, and stigmatization of people with HIV/AIDS. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world. Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.

<span class="mw-page-title-main">LGBTQ rights in the District of Columbia</span>

In the District of Columbia, lesbian, gay, bisexual, and transgender (LGBTQ) people enjoy the same rights as non-LGBTQ people. Along with the rest of the country, the District of Columbia recognizes and allows same-sex marriages. The percentage of same-sex households in the District of Columbia in 2008 was at 1.8%, the highest in the nation. This number had grown to 4.2% by early 2015.

<span class="mw-page-title-main">South African National Blood Service</span>

The South African National Blood Service (SANBS) is a non-profit organisation that provides human blood for transfusion that operates in South Africa, with the exception of the Western Cape, which has its own blood service. The head office of the SANBS is in Constantia Kloof, Gauteng, near Johannesburg, but there are blood collection operations in eight of the nine provinces. Western Cape has a separate blood centre, the Western Cape Blood Service. SANBS was founded in 2001 from a merger of seven blood centres, and was embroiled in controversy in 2004 over a policy of racial profiling for blood safety.

<span class="mw-page-title-main">Men who have sex with men blood donor controversy in the United Kingdom</span> Gay male blood donation policy

The MSM blood donor controversy in the United Kingdom refers to the former deferral policy of men who have had sex with men (MSM) in the United Kingdom who wish to donate their blood to UK blood donation services. Since June 2021, there is no deferral period in all four home nations. This followed an announcement in December 2020 that blood donation policies specific to MSM would be scrapped in favour of personalised risk assessment based on sexual behaviour.

Since reports of emergence and spread of the human immunodeficiency virus (HIV) in the United States between the 1970s and 1980s, the HIV/AIDS epidemic has frequently been linked to gay, bisexual, and other men who have sex with men (MSM) by epidemiologists and medical professionals. It was first noticed after doctors discovered clusters of Kaposi's sarcoma and pneumocystis pneumonia in homosexual men in Los Angeles, New York City, and San Francisco in 1981. The first official report on the virus was published by the Center for Disease Control (CDC) on June 5, 1981, and detailed the cases of five young gay men who were hospitalized with serious infections. A month later, The New York Times reported that 41 homosexuals had been diagnosed with Kaposi's sarcoma, and eight had died less than 24 months after the diagnosis was made.

This is a list of notable events in the history of LGBT rights that took place in the year 2016.

Blood donations in India are conducted by organisations and hospitals through blood donation camps. Donors can also visit blood banks in hospitals to donate blood. Efforts by the government and advocacy groups over the years have helped bridge the gap between demand and supply. The regulatory framework for blood donation and blood bank management rests with the Central Drugs Standard Control Organisation, while technical bodies like the National Blood Transfusion Council and National AIDS Control Organisation formulate guidelines and recommendations for transfusion medicine and blood bank management. Challenges persist with regards to regulation of blood banks and transfusion practices as the sector is largely fragmented with uneven distribution of blood banks and supply of blood in parts of the country. Donors are usually provided with refreshments after the procedure, which include glucose drinks, biscuits and fruits. Some organisations offer transportation facilities, as well as certificates or badges as gratitude.

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