Explained: Why Can't Gay, Trans People Donate Blood? Is It Really 'Scientific'?

The Centre recently justified the ban on blood donation by gay and trans people, citing 'scientific evidence'.

"About 10 years ago, my mother had a terrible fall and hit her head. She had excessive bleeding, and she needed blood. Both of us were of the same blood group, but when I offered to donate blood at the hospital, the authorities were reluctant to take it," said Vyjayanti Vasanta Mogli, a transgender activist based in Hyderabad.

What was worse was that the hospital didn't give her a clear reason as to why they were rejecting her blood.

There has been a blanket ban on blood donation by transgender people, gay men, and sex workers in several parts of the world since the 1980s over the lack of information about HIV AIDS.

In India, the National Blood Transfusion Council (NBTC) and the National AIDS Control Organisation issued the 'Guidelines for Blood Donor Selection & Blood Donor Referral' in October 2017 – a few years after Vyjayanti's ordeal.

Clauses 12 and 51 of these guidelines permanently defer transgender persons, female sex workers, and men having sex with men from being blood donors in India, citing they belong to the 'at-risk' category for HIV and Hepatitis B and C.

Four years later, in 2021, Thangjam Santa Singh, a Manipuri transgender activist, challenged these guidelines in a plea in the Supreme Court, stating they are "unconstitutional" and "violative of Articles 14, 15 and 21…"

The Centre responded to her plea and justified the ban, stating that the "exclusions [for blood donation] are based on due consideration of scientific evidence."

But how "scientific" is the basis for such an exclusion? Should entire communities be prevented from donating blood based on their gender identity and sexual orientation?

Why Are Gay, Trans People Excluded?

As a trans woman who performs her gender whenever she goes out, Vyjayanti said that the hospital authorities were visibly uncomfortable with her appearance.

"They kept asking me and my father to get someone else to donate blood. I insisted that they take mine, but they never did. Later, they called my father to the side and convinced him that I shouldn't donate."

Vyjayanti Vasanta Mogli

She, however, added that she managed to donate blood about 12 years ago when she went to a donation drive wearing pants and a shirt.

"Recently, too, when I went to a donation drive at my friend's insistence, they refused to take my blood. They didn't outrightly say no, but they said that they were out of equipment. It was obvious," Vyjayanti said.

Speaking to The Quint, Dr Pitchi Reddy, the director of the Indian Red Cross Society Blood Bank in Hyderabad, explained that hospitals and blood banks shouldn't have such reservations against donors.

"The only thing we look for is whether the donors are over 18 years of age, more than 45 kg in weight, and if their haemoglobin level is 12.5. If they meet these three criteria, we collect blood from them," he added.

Once the blood is collected, it is tested based on five mandatory parameters – for HIV, HbsAg (Hepatitis B), HCV (Hepatitis C), syphilis, and malaria.

"If the donor's blood clears these tests, then it is safe for use," he explained.

Singh's plea had asked why there was a need to exclude donors based on their gender identity and sexual preference if the blood is screened for infectious diseases. It is "completely arbitrary, unreasonable, and discriminatory and also unscientific," the plea added.

The Centre's response to the petition is reflective of its queer and transphobia, added Vyjayanti.

"The guidelines should forbid people with communicable diseases, infectious diseases. That is understandable. But how can they ban a whole community of people regardless of their medical status? It should be based on pathological status – not based on some social identity," she said.

What About the Incubation Period?

"It is possible that people are rejecting blood from trans persons, gay men, and sex workers because they are worried about the incubation period for HIV or Hepatitis," said Dr Pitchi Reddy.

It takes 6-12 weeks for normal HIV blood tests to detect the presence of antibodies in the human body. This period is called the incubation period. During this period, the HIV status of a person does not show in the test, but they can infect others.

"So, what happens if the person's blood is collected during this period? There is a possibility of transmission," he added. "But this is applicable to anyone with this infection – not just members of the LGBT community."

In the United Kingdom, for example, all donors, irrespective of their gender or sexual orientation, can donate blood. But they would be asked a few self-deferral questions – "if they have had a new sexual partner, or multiple partners, in the last three months," according to the NHS website.

"Anyone who has had anal sex with a new partner or multiple partners in the last three months will not be able to give blood at that time," the website adds.

Jayant Iyer, a queer activist based in Hyderabad, told The Quint that he was also prevented from donating blood to his uncle, who had met with an accident, at a hospital in Bengaluru in 2016.

"The hospital's blood donation form clearly stated that one could not donate the blood if they have had multiple partners or have engaged in male-to-male sexual activity at any given point in their lives. No time period was mentioned," said Jayant.

"I was shocked. So, when I questioned the hospital, they not only refused to let me donate but also suggested I take my uncle to another hospital."

Jayant Iyer

The System Is Also at Fault – Here's Why

This brings us to why the system of blood donation is also at fault for the exclusion of gender minorities.

In its response to Singh's plea, the Centre stated:

"There is substantial evidence to show that transgender persons, men having sex with men and female sex workers are at risk for HIV, Hepatitis B or C infections."

It also cited "reputed" local and scientific journals to back its claim.

Speaking to The Quint, Dr Ishwar Gilada, an infectious diseases expert who specialises in HIV AIDS, said, "There is no data that calls for trans and gay people to be excluded from blood donation. The only difference is that if you compare heterosexual and trans/gay people, the latter may have had multiple sexual partners."

"But when you stop someone from donating blood, it means the system is not robust. This amounts to discrimination," he says.

Is There a Solution?

"The solution definitely does not lie in excluding an entire community. What needs to be done is to improve the system of checking for infectious diseases," said Dr Gilada.

"The incubation period for various sexually transmitted diseases ranges from 9-90 days. But this incubation period can be reduced by using better quality kits, like the PCR technology, which we have seen during COVID. The prices of such kits came down during COVID. Similarly, the cost of early detection kits for STIs can also come down and become negligible if the need arises."

And secondly, he added, hospitals and blood banks can always pool samples and test them together.

"Say, 10 samples are tested together for HIV or any other STIs. If that test is negative, then all 10 are negative. If the test is positive, then you need to check again to see which of them is positive. In a batch of 100 donors, you would have only done 10 tests. You spend only 20 percent of the cost," Dr Gilada explained.

He further said that the government should work towards developing testing kits that perform all the necessary tests in one go, instead of individually checking for each disease. "If it's positive, then you know you can't use that blood," he added.