As the University Blood Initiative continues to advocate for more accessible, equitable blood donation, we are turning our attention to one of its most infamous, hotly contested barriers. For the next week, we will be discussing the history, impacts, and future of LGBTQ+ blood donor discrimination, from the AIDS epidemic to the COVID-19 pandemic.
Since the 1980s, the United States has upheld intense donation restrictions on potential MSM (men who have sex with men) donors, though the lifetime ban has changed to a shorter-term deferral period. Today, we are discussing how the US policies compare internationally.
American restrictions on MSM blood donors have eased in recent years--from a lifetime ban to a 12-month abstinence deferral period, reduced to 3 months since “most recent sexual contact” in wake of the COVID-19 pandemic--but they remain notoriously, controversially harsh. The blanket ban remained in place for more than 30 years before its 2015 adjustment, a glaring, antiquated, and distinctly American piece of medical guidance.
Public health systems do vary significantly from country to country, but all depend on blood donation, and all have approached this issue differently, perhaps due to their varied socioeconomic and cultural environments. International blood donation does uphold some restrictions on MSM blood donation as well, stemming from similar efforts to quell the spread of HIV/AIDs through the nations’ blood supplies. Though some require similar lifetime bans or extended deferral periods, many are significantly more lenient.
In 2020, after Brazil finally lifted its own lifetime ban, Reuters published a fairly comprehensive breakdown of global blood donation rules for gay and bisexual men. The UK, for instance, has maintained a 3-month deferral period from last sexual contact since 2017 (though not without its own controversies); France lifted its lifelong ban and implemented a 4-month waiting period in 2016; Australia’s 3-month deferral period extends to 12 for donors taking PrEP, an HIV prevention medication. While a number of countries still maintain lifelong bans, there has been a trend in recent towards shorter deferral periods, and, most promisingly, few to no restrictions at all.
According to Reuters, at least 17 countries no longer place any restrictions on MSM blood donors, and instead favor individual risk-based criteria. Italy and Spain are two of the most prominent examples of this method; donors are asked questions based on personal, potentially “risky” lifestyle choices, such as frequent new sexual partners or potential exposure, rather than a blanket yes/no questionnaire. MSM donors are then sorted into “high risk” and “low risk” categories, instead of automatically deferred, which allows for more donors and a more robust blood supply. Studies have shown that HIV transmission in the blood supply has not significantly been impacted since Italy adopted this policy in 2001, indicating that, maybe, it’s time for America to reassess its criteria.
MSM and LGBTQ+ blood donation is a pressing issue worldwide, and approaches to its restriction vary between countries. There may something to be said for an initial basis in temporary emergency prevention, as well as a nation’s healthcare system and its capacity to screen for the risk factors associated with potentially HIV-positive donors, but it is also likely that these restrictions are now more closely linked to the social climates of their respective countries. If Spain and Italy are any indication, the world is beginning to make progress towards equitable blood donation--far too slowly, but progress all the same--and, hopefully, the US may eventually be able to catch up.
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