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France has eliminated discrimination in blood donation

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From today, Wednesday 16 March, the men will be in France MSM (men who have sex with other men, from the English “Men who have sex with men”) they will no longer have to prove to have respected a period of abstinence of at least four months to donate blood, and for them the same rules will apply as already valid for all other people. However, there are countries in the world where similar rules are still in force and countries where donation is completely forbidden for men who have sexual relations with other men (this is not the case in Italy).

Among the principles and objectives of blood donation are those of a responsible donation for those who make it and for those who receive it. Therefore, in all countries, there are rules that establish criteria that exclude, for clinical or behavioral reasons, some subjects considered at risk. This exclusion can be temporary or permanent and among the potentially dangerous behaviors there are unprotected sexual relations, with multiple partners, with strangers, which can increase the risk of transmitting infectious diseases.

At the beginning of the Eighties, with the explosion of the HIV epidemic and with the scandal of infected blood (some pharmaceutical companies placed on the market bottles of blood taken from high-risk individuals) various legal systems faced and regulated, in a restrictive sense, the issue of blood donation by men who had sexual relations with other men. The prohibition affected everyone in the same way: those who were not infected at the time of donation, and also those who, despite not having had sexual intercourse or having had them in a protected way, limited themselves to declaring their homosexuality.

The idea on which these restrictions or prohibitions were based – and which were somehow justified by the need for safety – was that an entire category of people had sexually irresponsible behavior or were potentially carriers of a sexually transmitted disease. Over the years, with the improvement of knowledge about HIV-AIDS and how it is infected, these limitations gradually lost their meaning and several countries changed them.

However, in many states the regulation still provides a different discipline for heterosexual donors and for MSM donors. For example, and until yesterday, France.

In 1983, at the beginning of the AIDS epidemic, France banned the donation of blood for any man who had sex with another man. Only in 2016, as part of a reform of the health systemthe MSMs were included among the possible donors, provided that in a preventive interview they justified the sexual abstinence in the twelve months preceding the donation itself.

In fact, during the reform an article was introduced which stated that no one could “be excluded from donating blood because of sexual orientation”. However, the donor selection criteria were set by a separate decree, in which conditions for gay and bisexual men were in fact different from those for heterosexual women and men. Eligibility for donation conditioned by a period of abstinence, then reduced to four months in 2020, therefore excluded men in an exclusive relationship with another man, and effectively established discrimination. For heterosexuals, the ban only concerned the cases of relationships with multiple partners (it therefore had to do with sexual habits and not with sexual orientation), while lesbians were not mentioned.

Libération writes that in 2021 the gays who were refused blood donation for this specific reason were few, about 700 of the 310,000 refused for other reasons (age, recent fever, drugs and so on), but that beyond the quantity they it was about discrimination still in place.

On August 2, 2021, as part of a bioethics law voted by the National Assembly (the French parliament), the amendment was recovered which established that the criteria for donation could not be “based on unequal treatment” and they could not therefore refer to “the sex of the partners with whom the donors had had sexual relations”.

Now the decree implementing the law on that specific issue has also been published and it has been established that from Wednesday 16 March the new questionnaires distributed before the donation will no longer contain “any mention of sexual orientation” or the “sex of partners”, but only about so-called risky sexual habits. The criterion will therefore be the same for everyone and for all. The associations that have been working against homophobia for years have expressed a positive opinion on the measure.

Somewhere else
Three different types of MSM blood donation policies can be distinguished.

The more restrictive ones still include a permanent ban on blood donation by MSM. Equaldex, an association for the rights of LGBT + people, has calculated that, even today, there are 57 countries around the world that prohibit donating to MSMs.

Then there is an intermediate approach which requires a certain period of suspension of sexual intercourse before donation by MSM donors.

The UK, which was in the first category until 2020, changed the legislation in 2021, when the Department of Health and Welfare welcomed the recommendations of the FAIR (For the Assessment of Individualized Risk) committee which had asked that each potential donor be assessed, through various health risk criteria, on an individual basis and not as belonging to a specific category defined by sexual orientation.

From 2021, therefore, homosexual or bisexual men who have a stable relationship, that is, one that has lasted for more than three months, can donate blood in the United Kingdom. Since October 2021, Israel has also lifted the restrictions on blood donation for homosexuals, which came into effect in the 1980s (on the Equaldex website the most recent legislative changes are also reported).

Finally, there are the policies considered less restrictive for MSM donors, adopted among others, also by Italy, Spain and Portugal. Here there are no specific disciplines for the MSM donor category: the principle is that there are no people or categories of people at risk, but risk behaviors. The risk assessment is therefore individual and depends on a specific conduct.

In Italy, discrimination against MSM donors was overcome in 2001, when the then Minister of Health Umberto Veronesi issued a decree that lifted the prohibition for gays to donate blood. Veronesi introduced a questionnaire, which was then updated in the following years, to which still today everyone must submit before each donation: it provides that the questions do not refer to sexual orientation but to sexual habits, with the aim of excluding people who have a sex life deemed inadequate to donate blood regardless of whether they are homosexual, heterosexual, bisexual or otherwise.

Despite the Veronesi decree of 2001, however, even in Italy gay men may have difficulty giving blood. As confirmed some time ago by Giulio Maria Corbelli, vice president of Plus Onlus (an organization that deals with LGBT + HIV-positive people), the donation of blood of gay men is often at the discretion of the transfusion center to which one refers and the doctor with interviewed before the donation.