Blanket ban on blood donation by trans people, sex workers: Ensuring blood safety is non-negotiable. But stigmatising policies is the wrong way to ensure it
India faces a massive shortfall of blood. In this context, excluding willing, healthy donors based on outdated, unscientific reasons defies logic. Blood donation should save lives, not exclude some people or add to the stigma around a few communities
While these prohibitory guidelines against trans and MSM groups were adopted by many countries when HIV hit in the ’80s, they have been updated with time and new evidence to ensure that safe blood is delivered without senseless stigmatisation. (File Photo/Canva) “Imagine you are a transgender person battling dengue fever and urgently need a blood transfusion. Naturally, you turn to your friends and chosen family, many of whom are also transgender. Now, here’s the shocking part: They are legally barred from donating blood.” When I said this at a recent dengue conference, the hall fell silent. The audience stared in disbelief. Unfortunately, it is true: In India, under the guidelines issued by the National Blood Transfusion Council (NBTC), transgender individuals, along with men who have sex with men (MSM) and female sex workers, are permanently deferred from donating blood. The reason cited? A supposedly higher risk of transmitting infections such as HIV, Hepatitis B, and Hepatitis C.
While “MSM” and “female sex workers” are behavioural categories, transgender is a gender identity. It does not inherently indicate high-risk sexual behaviour. Yes, a portion of transgender individuals may engage in sex work — often due to systemic marginalisation — but labelling the entire community as “high-risk” is not only inaccurate, it’s discriminatory.
No one wants to contract a life-threatening illness like HIV from a blood transfusion. Ensuring blood safety is non-negotiable. However, safety should be ensured through individual risk assessments, not blanket bans that profile entire communities. This kind of policy plays into the dangerous trope of transgender people as “AIDS spreaders” — a harmful stereotype rooted in stigma, not science. The transgender community has long been marginalised and was disproportionately impacted by the HIV/AIDS crisis, fighting both a public health emergency and relentless discrimination.
While these prohibitory guidelines against trans and MSM groups were adopted by many countries when HIV hit in the ’80s, they have been updated with time and new evidence to ensure that safe blood is delivered without senseless stigmatisation. In the UK, these guidelines were revised in 2021; in Canada, in 2022. The US FDA came up with its revised guidelines in 2023, which include a new inclusive screening process that expands blood donor eligibility and eliminates questions based on sexual orientation. The new gender-neutral guidelines have abolished deferral of blood donation from MSM and other communities based on their sexual orientation or gender identity. They now use individual risk-based questions to identify the potential donors with a higher risk of HIV transmission.
In contrast, India’s NBTC guidelines were last updated in 2017 and still uphold these outdated exclusions. Not only does this perpetuate stigma, but it also ignores the current, medically informed view of HIV transmission. The revised US guidelines highlight important concerns. For example, people on Pre-Exposure Prophylaxis (PrEP) or Post-Exposure Prophylaxis (PEP) may have undetectable levels of HIV in their blood but could still transmit the virus. Similarly, those on antiretroviral therapy (ART) may have suppressed viral loads but are not risk-free donors. These nuances demand in-depth donor histories, not judgemental community-wide bans. Stigmatising policies force people into silence. Individuals from banned communities may feel compelled to lie about their identity to save a loved one’s life. That alone is an indictment of the policy’s failure.
These guidelines have been challenged in the Supreme Court by Nupi Maanbi, a transgender woman, and Santa Khurai from Manipur. Khurai has argued that these guidelines are arbitrary, discriminatory, and unscientific. But the government’s lack of seriousness is evident. The case, filed in 2021, languished for years because no lawyer was appointed to represent the government. This apathy on the part of the government, the Ministry of Health and Family Welfare, the National Blood Transfusion Council, and the National AIDS Control Organisation is furthering stigmatisation of marginalised communities while missing out on creating updated guidelines that would allow for more blood donations in India.
The Supreme Court has taken a stern view of the matter and asked, “Are we branding all transgender persons as high-risk? Are we then indirectly stigmatising these communities?” The hypocrisy of labelling an entire community as high risk in the name of “public safety” was questioned by the Court when it stated, referring to normal vs high risk groups, “Even so-called ‘normal’ individuals engage in high-risk behaviour. Why single out entire communities?”
It is important to understand that these guidelines are not just about blood donation but about our societal perceptions of a community. Large sections of the medical community have long viewed transgender people as abnormal, mentally ill, perverted, and/or criminal. The transgender community has poor access to healthcare thanks to the systemic barriers of our infrastructure, policies, training, and, most importantly, provider mindsets. However, post the NALSA vs Union of India (2014) judgment, which recognised transgender people and Transgender Persons Act, 2019, there is no room for discrimination against trans people — medically or otherwise. These words by the Supreme Court in the case should guide us: “Aren’t we creating a segregated group? This only deepens stigma, biases, and societal prejudices.”
India faces a massive shortfall of blood. An estimated one million units are needed annually to meet the demand. In this context, excluding willing, healthy donors based on outdated, unscientific reasons defies logic and lacks compassion. June 14 was World Blood Donor Day. On this occasion, let’s ask our government to revise blood donation guidelines in a way that they are scientific, updated, and aligned with global guidelines without unnecessarily excluding any group of donors or further stigmatising them. After all, blood donation should save lives, not exclude some people or add to the stigma around a few communities.
The writer is professor, community medicine, Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard
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