Blood and Bias: The Case for Reforming India’s Outdated Donation Policies | Disha

Abstract

This article explores the ongoing debate over blood donation policies in India, focusing on the restrictions imposed on LGBT+ individuals and transgender people. Originating from global responses to the HIV/AIDS epidemic in the 1980s, these restrictions were initially justified by fears of HIV transmission but have persisted despite advancements in HIV detection technology. In India, the National Blood Transfusion Council and the National AIDS Control Organization’s 2017 guidelines “permanently defer” MSM, transgender individuals, and female sex workers from donating blood. Sharif Rangnekar’s recent Supreme Court petition challenges these discriminatory policies, highlighting their violation of constitutional rights and their impact on the healthcare system. Despite improvements in testing technologies and more progressive policies in other countries, India’s ban remains entrenched, reflecting outdated perceptions of risk. The article also discusses global shifts, such as the removal of similar bans in Greece, France, and Switzerland, and the reduced deferral periods in the U.S. and other nations. The call for reform in India underscores the need for blood donation policies that are inclusive and evidence-based, rather than driven by stigma and prejudice.

Keywords: Blood Donation Policies, HIV/AIDS, LGBT+ Rights, India, Legal Reform

Introduction

The global response to the HIV/AIDS epidemic in the 1980s led many countries to implement blood donation restrictions targeting men who have sex with men (MSM) and LGBT+ individuals, driven by fears of HIV transmission through blood transfusions. The U.S. Food and Drug Administration (FDA) imposed a lifetime ban on MSM blood donations in 1985, reflecting a belief that this group was at higher risk of HIV infection. These policies, while aimed at protecting public health, also entrenched stigma and discrimination against LGBT+ communities.

Despite significant advancements in HIV detection, including nucleic acid testing (NAT), which can identify HIV within 9-11 days post-infection, many countries have maintained these bans. Some nations have moved towards more inclusive policies, allowing MSM and LGBT+ individuals to donate blood after a deferral period or through individual risk assessments. However, others, including India, continue to enforce restrictive rules that exclude these groups from contributing to blood banks.

A Legacy of Discrimination: India’s Blood Donation Policies

India’s blood donation policies reflect a blend of global influences and local discriminatory practices. During the HIV/AIDS crisis of the late 1980s and early 1990s, India adopted policies similar to those of Western countries, reinforcing the belief that MSM and LGBT+ individuals were at higher risk for HIV. This was exacerbated by Section 377 of the Indian Penal Code, a colonial-era law that criminalized same-sex relations and entrenched discriminatory attitudes across various societal aspects, including blood donation.

The National Blood Policy of 2002 formalized a ban on MSM blood donations, further entrenching stigma against the LGBT+ community. Despite the introduction of advanced HIV testing technologies like NAT in the early 2000s, which dramatically reduced the risk of undetected HIV in donated blood, the ban persisted. This exclusion of healthy individuals from donating blood not only perpetuates harmful stereotypes but also limits the nation’s blood supply.

The Ban’s Ongoing Impact

India’s current blood donation regulations continue to discriminate against LGBT+ individuals by classifying them as high-risk donors, a classification that reflects outdated policies from the 1980s. Although Section 377 was partially repealed in 2018 by the Supreme Court’s landmark decision in Navtej Singh Johar v. Union of India, which decriminalized same-sex relations, discriminatory practices in areas like healthcare persist. The continued ban on blood donations from MSM and other LGBT+ individuals reinforces negative stereotypes and excludes a significant portion of the population from contributing to the blood supply.

This exclusion has severe implications for India’s healthcare system, which often faces shortages of donated blood, particularly during emergencies. The restriction of a sizable portion of the population from donating exacerbates this issue, denying the availability of life-saving transfusions. Critics argue that the ban is based more on prejudice than science and that it continues to discriminate while depriving India’s blood banks of crucial donations.

Scientific Advances Challenge the Ban

Recent advancements in HIV testing, including nucleic acid amplification testing (NAT), which detects the virus within a much shorter window than older methods, have increasingly challenged the scientific basis for India’s blood donation ban. Despite these advancements, the National Blood Transfusion Council (NBTC) in India maintains the ban, perpetuating the outdated belief that LGBT+ individuals are inherently at higher risk of HIV.

Other countries have adopted more progressive policies. For example, Greece lifted a decades-old ban on donations by gay and bisexual men in 2022, and France abolished norms that mandated a one-year waiting period for individuals who had engaged in same-sex activity. In Switzerland, the ban on blood donations by gay men was reduced from a lifetime to a one-year deferral period in 2017, and then further to four months last year. The U.S., which had prohibited gay and transgender men from donating blood for decades, introduced a one-year deferral period in 2015, which was later reduced to three months in 2023.

According to ILGA-Europe’s Rainbow Map-2024, which unites over 750 LGBTI organizations from 54 countries across Europe and Central Asia, 24 countries in Europe have no administrative or legislative restrictions or bans on blood donations based on gender identity or sexual orientation.

The Fight for LGBT+ Rights in India

India’s LGBT+ community has made significant strides in the fight for equality, including the decriminalization of homosexuality in 2018. However, challenges remain, particularly in areas like marriage equality and adoption rights. Activists are also pushing for reforms in healthcare practices, such as blood donation policies, to eliminate discriminatory practices and allow LGBT+ individuals to donate blood based on individual risk assessments rather than outdated stereotypes.

Sharif Rangnekar’s Petition: A Push for Change

Sharif Rangnekar, a 55-year-old journalist, author, and activist, has been instrumental in challenging India’s blood donation ban through his petition filed with the Supreme Court. Rangnekar’s petition, submitted last month, specifically challenges clauses 12 and 51 of the National Blood Transfusion Council and the National AIDS Control Organization’s 2017 guidelines, which “permanently defer” transgenders, gay men, and women sex workers from donating blood in India. Rangnekar argues that these restrictions are discriminatory and violate fundamental rights enshrined in the Indian Constitution. Earlier this month, the Supreme Court tagged his petition along with another filed by activist Thangjam Santa Singh, issued notices to the centre, and scheduled a further hearing.

Rangnekar’s case underscores the need for reform of India’s outdated blood donation regulations, which are based more on prejudice than on scientific evidence. The government has defended the ban by citing a 2021 health ministry report claiming that transgender people, gay, and bisexual men are significantly more likely to contract HIV than the general population. However, critics argue that these claims are based on stigma rather than the realities of modern HIV testing and prevention methods.

Conclusion: A Call for Inclusive Blood Donation Policies

The legacy of HIV-related stigma continues to shape blood donation policies in India. However, growing awareness and advancements in scientific understanding challenge the justification for these restrictions. Reforming these policies would not only expand the pool of potential donors but also help dismantle the discrimination faced by the LGBT+ community in healthcare settings. With activists like Sharif Rangnekar drawing attention to the issue, there is hope for a future where blood donation policies in India are guided by evidence and inclusivity, rather than fear and prejudice. The ongoing fight for equality includes ensuring that LGBT+ individuals can contribute to the nation’s blood supply, representing a crucial step towards a more just and equitable society.

(Author: Disha, Ph.D. Scholar & Senior Research Fellow, Dr. K. R. Narayanan Centre for Dalit and Minorities Studies, Jamia Millia Islamia, New Delhi, India)