The information originally on this page is believed to have been correct in January 1997.
The contributors listed at the end of this article have been asked during April 2000 to confirm whether these details are still correct.
This survey of blood exclusion practices in selected countries was begun in March 1996. Since then there has been a tightening of procedures in some countries: with the result that now most of the countries included in the survey claim to have a lifetime ban on donations by men who have ever had sex with another man at any time in their lives.
It is interesting to note that, while there is considerable uniformity in current practices with regard to IV drug users, there is less uniformity with regard to gay men, and still less with regard to prostitutes. This seems to imply that not only medical criteria are being applied when determining who to ban, and that national cultural values are being incorporated.
Canada and the USA ignore sexual contact prior to the advent of AIDS, (which they set at 1977); New Zealand imposes a ten-year exclusion period on gay men; and Australia currently stands out as having the least discriminatory policy, with "just" a one-year ban on donations following gay sex.
This is not the end of the story, however. In Switzerland the Federal Government decreed in June 1996 that there was no need for discriminating against donors on grounds of sexuality; (although the Swiss Red Cross has not yet heeded the ruling). In the Netherlands a Government Commission has been considering since November 1995 whether the current ban there constitutes discrimination. (17-August-1997: The Dutch gay group COC are now pursuing this) In Belgium, discrimination against gay donors was lifted by law in October 1994: although it was reinstituted in summer 1996, despite the recommendation of the physicians in the Belgian Commission. Spanish regional authorities are apparently not discriminating at all. (Greece states that there is a lifetime ban on gay donors: although leaflets given to donors refer explicitly to sexual behaviour since 1977.) -- Thus it would appear that the proportion of countries where official support for a lifetime ban is total is at most ten out of 20.
Some countries refer in donor literature to the use of condoms, safe(r) sex practices, or risk behaviour. Generally, however, there is no definition of what actually constitutes sex. Does this mean just anal (or vaginal) sex? (If so, many gay men would immediately become eligible as donors, as anal sex is, despite misinformed public opinion, by no means universally practised.) Is oral sex included? (This is not usually considered to be an HIV transmission route, unless perhaps semen is swallowed.) Some gay men limit their activity to mutual masturbation, which, in terms of risk of infection, is on a par with celibacy: yet this does not appear to be mentioned in any of the donor literature.
The Council of Europe has published recommendations
|R(95)14||On the Protection of Health of Donors and Recipients in the area of Blood Transfusion,|
|R(95)15||On the Preparation, Use, and Quality Assurance of Blood Components,|
R(95)15 is more explicit, (Part B, Chapter 1, §9), listing 8 pages of criteria and actions relating to various infections. The subsection on AIDS (p.19) states:
"All blood donors should be provided with accurate and updated information on HIV transmission and Aids so that those indulging in unsafe sex practices or other risk behaviour exposing them to potential infectious sources will refrain from donating. All blood donors found to have a confirmed positive marker for HIV should be informed, as part of a full counselling procedure, that they should not give further donations."
[The subsection "Intoxication, alcohol, and drugs" (p.22) unfortunately depends on national law for its interpretation. -
"Persons clearly under the influence of alcohol should be deferred until sober. Illicit drug taking if admitted or suspected (in particular, i.v. drug abuse at any time) must debar."
"Illicit drug taking" in the
UK will preclude users of cannabis, who presumably would not be
debarred from donating in the Netherlands. Additionally: are
donations by alcoholics to be welcomed when they are sober?]
An interesting historical summary of homophobia was sent to me in 1996: an extract from a speech by Lord Russell, speaking in the House of Lords on the Bill to outlaw discrimination against lesbian, gay and bisexual employees. -
"When I look for signs of homophobia (in the 17th century), I find remarkably little.
"In the reign of King James I, one would have expected, with a homosexual on the throne and a côterie of fellow homosexuals around him, that one would find a good deal of it.
"I do not find any homosexual assaults in assize records ... One does not get it coming into depositions about tavern brawls. If I look for cases of homosexual blackmail in the 17th century, I do not believe I can find any.
"I think I am entitled to say that that suggests homophobia in the 17th century was a great deal less deep-seated than it is now ...
"That suggests that homophobia is not entirely a deep, instinctive prejudice, that a very large part of it is culturally determined and that it flourishes in a climate of official encouragement ... "
The effects of this discrimination by blood transfusion authorities upon the perception of the general public (and hence on their beliefs and resultant behaviour) serve only to reïnforce existing homophobia. This should not be overlooked by anyone claiming that this discrimination is medically justified. -- Would it be acceptable (medically and politically) to ban donations by Jewish males, say, on the grounds that they might transmit a viral agent for Kaposi's Sarcoma? If not, why should discrimination against gay men be tolerated?
Attempts to justify the ban on gay donors appear to appeal to statistics ("most sexual transmission in western countries is homosexual rather that heterosexual"). Any discrimination based on statistics will unfairly and needlessly reject members of the group; and will simultaneously lull the discriminators into a false sense of security, as threats from other sources are ignored or overlooked.
I am suggesting not that all gay men should be invited to donate blood, but that we should not all be subject to an irrational blanket ban. The goal of protecting recipients of blood products will not be served by blind prejudice.
|Australia||1 year||no ban [e1]||life||1 year||no ban [e1]||1 year||[a1]||nil||no||confirmed |
|Austria||life [a2]||life [a2]||life [a2]||life||6 mth [a3]||life||yes||nil||yes||Reply awaited|
|Belgium -- French-speaking regions only||life [b1]||6 months |
|life||6 months [b3]||6 months [b3]||6 months [b3]||no||nil||[b2]||updated |
|Canada||1977 (*)||1977 (*)||life||1 year||1 year||1 year||no||nil||yes||confirmed |
|Finland||life||1 year||life [fi1]||1 year||1 year||1 year||no||nil||no||confirmed |
|France [fr1]||life||life||life||life||life||life||???||nil||no||Reply awaited|
|Greece||life [gr1]||life [gr1]||life [gr1]||life [gr1]||[gr2]||life [gr1]||no||nil||yes||confirmed |
|Ireland (Eire)||life||life||life||1 year||1 year||1 year||no||nil||no||confirmed |
|Italy||[it1]||[it1]||[it1]||1 year||1 year||1 year||no||nil||no||confirmed |
|Netherlands [n1]||life||1 year||life||life||1 year||life||no||nil||no||Reply awaited|
|New Zealand||10 years||10 years||2 years||2 years||2 years||2 years||no||nil||no||Reply awaited|
|Norway||life||life||life||6 months||6 months||6 months||[nor1]||nil||no||confirmed |
|Portugal||life||life||life||1yr / life||1 year||1 year||no||nil||in some centres||Reply awaited|
|Sweden||life||life||life||6 months||6 months||1 year||no||no||no||updated |
|Switzerland||life||life||life||life||1 year||life||no||nil||yes||updated |
|UK [n/c]||life||life||life||1 year||1 year||1 year||no||nil||no||Reply awaited|
|USA [n/c]||1977 (*)||1977 (*)||life||1 year||1 year||1 year||???||???||???||Confirmation awaited|
|*||Sex prior to the date indicated is considered irrelevant; sex after that date entails a lifetime ban.|
|life||lifetime ban, regardless of when any 'risk behaviour' may have ceased|
|n/c||data originally supplied by national authority (or embassy); but confirmation has not been obtained|
|Columns 2-4||denote any exclusion applicable to: men who have ever had sex with men; to prostitutes; to intravenous drug users.|
|Columns 5-7||denote exclusion criteria applicable to anyone who has knowingly had sex with a member of the above groups.|
|Column 8||are there variations in practice, e.g. between different blood collection authorities?|
|Column 9||what percentage (on average) of donors receive any recompense for their donation?|
|Column 10||do donors have the opportunity to give blood, but to indicate on a form which they themselves seal that the sample should be used for testing only? This avoids answering delicate questions in a situation which could be potentially embarassing or lead to harassment or victimisation.|
|a1 Australia||Centres in some states may have longer deferral periods, if required under local legislation or regulation.|
|a2 Austria||Lifetime ban for "HIV risk behaviour". Most centres give concrete examples (as col.s 2-4): some do not.|
|a3 Austria||Sex with a prostitute may entail a ban of anything from 6 months to life, depending upon the centre.|
|b1||Any donor who has had a change of sexual partner within the last 6 months is temporarily excluded. Discrimination against gay donors ceased in October 1994; but was reinstituted in summer 1996, (despite the opinion of the physicians in the Belgian Commission), following a draft European Recommendation on plasma donation.|
|b2||As from October 1996, donors are able to leave a message on an answering machine, quoting the donation identification no., to have their donation blocked.|
|b3||Permanent exclusion if this is a regular partner.|
|e1||Eligible as a donor, unless the individual is also a member of some other excluded category.|
Have you or your partner ever injected drugs;
in the past 12 months, have you paid or received payment for sex, or been injected with a used needle;
in the past two months, have you had sex with someone other than your regular partner?
|fr1||Donors who have had a change of partner in the past 6 months are also excluded, unless they have used condoms.|
|gr1||Donors receive a leaflet which enquires about these practices since 1977: but official policy is that activity prior to 1977 also entails a lifetime ban.|
|gr2||This is not an explicit question, but is assumed to be covered by the "sex with people with risk behaviour" category.|
|it1||Donors receive a letter which refers to "temporary or permanent" exclusion for various criteria, including gay sex and sex with strangers. If would-be donors do not decide to exclude themselves, the decision would appear to be at the discretion of the attendant physician. Donation may be permitted one year after the most recent risk behaviour. However, although Italian law sets a precise limit of 12 months for exposure to hepatitis, there is none specifically for potential HIV infection.|
|n1||This information is based on information supplied in July 1996, and relates to a revised guideline, for implementation in January 1997. Additionally, a commission is currently investigating whether the blanket ban on gay men constitutes discrimination.|
|nor1||Regional variations relate not to these issues, but to which nationalities are acceptable as donors.|
|Details have changed since the January 1997 edition.|
Copies of legislation are inconclusive.
No further information from the Ministry has been forthcoming.
However, it is reported that, while donations by gay men were
forbidden by central government until last year, the new regional
governments are not discriminating on grounds of sexuality.
"At the beginning of the AIDS
crisis, around 1984, a Government decree issued by the Ministry
of Health (who was running the blood banks at the time and was
responsible for the blood donation campaigns) forbade gays to
donate their blood. This situation has remained unchanged until
"Meanwhile, as Spain's administrative
structure has shifted from a very centralized structure (something
like France) to a reasonably decentralized one (in line with Germany),
the management of blood banks has been transferred to the regions
(the political / administrative division similar to the German
Länder or the Swiss cantons). It is thus now up to the regions
to have such regulations changed.
"To my knowledge, after the
pressure made by local gay groups, the legislation has already
been changed by the Madrid, Catalonia and Asturias regions (something
quite relevant for Madrid and Catalonia gather 20 % of the population
in Spain). Now, prospective blood donors in Madrid are being
given a leaflet to read before the donation. Its text strongly
encourages people having had promiscuous sex lives to dismiss
the idea of donation. I have the idea that the situation in Catalonia
and Asturias is very similar. Fortunately, the wording of such
info-sheets leaves no way for discrimination based on sexual orientation."
[Quote from Spanish citizen]
The U.K. National Blood Service state that they aim to avoid discrimination against "risk groups", by considering risk behaviour. Sadly, however, this objective is not being met, as traditional British prudishness in refusing to discuss the mechanics of sex means that even gay men who limit their behaviour to well-established safer sex practices are immediately rejected as donors if they admit to being gay.
It is possible that at some point blood
authorities may be forced to reconsider their position simply
on grounds of supply and demand. In the U.K., heterosexual transmission
already accounts for c. 20% of HIV cases. Various reports this
year have suggested that, whilst the rate of HIV prevalence is
levelling off amongst gay men, there is a significant increase
amongst pregnant women in England and Wales; and that HIV-E, reputedly
better adapted to vaginal transmission than other strains, has
already been detected in patients in this country.
Prisoners who have been incarcerated for three days or longer are banned from donating for 12 months. Quite on what grounds is not clear, since this is not consistent with the U.S. exclusion periods for either gay men or I.V. drug users.
Recent figures from the San Francisco
Department of Health indicate that c. 50% of gay men there remain
HIV negative; so that the national incidence of infection amongst
gay men throughout the USA is probably less than 10%, (and even
less in most other countries in the survey).
|Dr. Patrick J. Coghlan, Director of Intellectual Capital,
Australian Red Cross Blood Service, Level 1, 304, Nicholson Street, Fitzroy, Victoria 3065.
|Frau Dr. E. Zach
Bundesministerium für Gesundheit und Konsumentenschutz, A-1031 Wien.
|Dr. Jean Siquet, Médecin-Directeur-Adjoint,
Croix-Rouge de Belgique, rue Dos-Fanchon 41, B-4020 Liège.
Belgian Ministry of Health
Dr. Graham D. Sher, Vice President,
Canadian Blood Services, 1800, Alta Vista Drive, Ottawa. K1G 4J5
|Torben Haerslev, MD, Ph.D.,
Sundhedsstyrelsen, Postboks 2020, 1012 København K.
Fax +45-33 93 16 36
Sonja Mikkelsen, sundhedsminister, Junivej 35, 8210 Århus V.
Danish Ministry of Health
|Dr. Tom Krusius, Director, Laboratory Services,
Veripalvelu (Finnish Red Cross Blood Transfusion Service), Kivihaantie 7, 00310 Helsinki.
|Mme. Agnès Jeannet,
Agence Française du Sang, 6, rue Alexandre Cabanel, F-75015 Paris.
Mme. Dominique Gillot, Secrétaire d'Etat à la santé et aux handicapés
French Ministry of Health
|Herr Dr. E. Werner,
Bundesministerium für Gesundheit, Hauptgebäude, Am Propsthof 78-a, Bonn.
Fax +49-22.89.41 49.27
|1) Minister of Health,
Aristotelous Str. 17, 101 87 Athens.
2) Prof. Constantina Politis, President Blood Transfusion Cttee
Dracopoulion Blood Transfusion Centre, 4, Alkiviadou Str., 104 39 Athens.
|K. H. du Plessis, FRCPath., Consultant Hæmatologist,
Blood Transfusion Service Board, Pelican House, P.O. Box 97, 40, Mespil Road, Dublin 4.
|Prof. S. M. Aloj, Scientific Attaché,
Italian Embassy, 14, Three Kings' Yard, London. W1Y 2EH
Italian Ministry of Health
|C. M. de Vos, MD, Ph.D., Executive Director of Pharmaceutical Affairs,
Ministerie van Volksgezondheid, Welzijn en Sport, Postbus 5406, 2280 HK Rijswijk.
Equal Treatment Commission, Postbus 16001, 3500 DA Utrecht
COC Statement about the rôle of the Equal Treatment Commission
Minister mevrouw dr. E. Borst-Eilers
Ministerie van Volksgezondheid, Welzijn en Sport
Mw. Borst-Eilers was voorts voorzitter van het College voor de Bloedtransfusie en voorzitter van de Kerncommissie Ethiek Medisch Onderzoek.
|Hon. Annette King, Minister of Health
Peter Hunter, Acting Mgr, Personal Health Services,
Ministry of Health, 133, Molesworth Street, P.O. Box 5013, Wellington.
|Inger Brusel, Consul,
Norwegian Embassy, 25, Belgrave Square, London. SW1X 8QD
|1) Dr. Maria de Belem, Minister of Health,
Gabinete da Ministério da Saúde, Av. João Crisostomo, 9; 1000 Lisboa.
2) Sr. José d'Almeida Gonçalves, Director,
Insituto Português do Sangue, Parque da Saúde, Av. do Brasil, 53; 1700 Lisboa.
|Minister of Health,
Ministerio de Sanidad y Consumo, Paseo del Prado, 18-20; 28071 Madrid.
|1) Lars Engqvist, Minister of Health,
SE-103 33 Stockholm.
2) Bengt Wadman, MD, Ph.D., Head of Division,
Socialsstyrelsen Örebro, P.O. Box 423, S-701 48 Örebro.
Swedish Dept. of Public Health Sciences
|1) Dr. Ch. Schärer, Inspektorat,
Bundesamt für Gesundheitswesen, Bollwerk 27, Postfach, CH-3001 Bern.
2) Blutspendedienst SRK, Gutenbergstr. 14, CH-3000 Bern.
|1) Minister of Health,
Dept. of Health, Richmond House, 79, Whitehall, London. SW1A 2NS
2) Dr. E. A. Robinson, Medical Director,
National Blood Authority, Oak House, Reeds Crescent, Watford. WD1 1RH
3) Dr. V. James, Consultant Hæmatologist, National Blood Service.
Trent Centre, Longley Lane, Sheffield. S5 7JN
Fax 0114-203 4911
Leaflet distributed to donors since Dec. 1995
|1) Dr. Allen Holt,
National Institute of Health, Bethesda, MD 20892.
2) Dr. Joan W. Blair,
Centre for Biologics Evaluation & Research.
|Peter Carolan, Blood Dept.
International Federation of Red Cross and Red Crescent Societies
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