Guillaume Souvant, AFP | A nurse prepare tubes during an EFS (Etablissement Francais du Sang) blood donation campaign on December 21, 2017 in Tours, central France.

The French government has banned gay and bisexual men from donating blood within a year of sexual activity since 2016. On Wednesday it said it would lower this “deferral” period – long been criticised as discriminatory – to four months.

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Homosexual men will be able to give blood four months after sexual intercourse instead of 12 months, France’s health ministry announced, in a policy shift that owes more to medical progress than to changing attitudes towards homosexuality.

Under current rules, men who have sex with men are barred from donating blood for a year following their last sexual encounter in order to reduce the risk of transmitting HIV, the virus that causes AIDS.

The health ministry, which will implement the changes on February 1, 2020, said the decision to relax the abstinence period was based on the latest scientific evidence and medical advances.

It said the change marked a “first step” in plans to bring donor conditions for gay men in line with those for heterosexuals by 2022, pending a “transparent” evaluation of the potential risks involved.

The announcement comes a month after gay rights groups filed a complaint with the European Commission alleging discrimination by France, pointing out that the 12-month abstinence rule “effectively excludes 93.8% of gay men from donating blood”.

‘Deferrals’

The issue is particularly sensitive in France, where hundreds of people died in the 1980s after HIV-tainted blood was distributed by the national blood transfusion centre.

France instituted a total ban on gay men giving blood in 1983 as part of efforts to halt the spread of AIDS, mirroring steps taken in a majority of Western countries.

After years of campaigning by LGBT rights activists, the ban was finally lifted in 2016 – but replaced with a 12-month “deferral” period, during which would-be donors had to abstain from sexual activity.

>> After 30-year ban, gay men in France allowed to donate blood

Many other countries that have lifted bans on gay men giving blood have also introduced 12-month waiting periods, including the United States, Australia, Japan and Sweden. Italy, Spain and Russia are among only a handful of European countries that don't have a deferral policy.

In justifying the restrictions, health authorities noted that men who have unprotected sex with men are at a significantly higher risk of infection and that the virus’s long dormancy period made it hard to detect.

In 2016, the Luxembourg-based European Court of Justice (ECJ) ruled that governments were allowed to ban – or restrict – homosexual blood donors if they could prove it was the best way to limit the risk of HIV infection.

Evolving evidence

However, scientific innovation has steadily chipped away at the rationale for restrictions on gay donors, while critics have questioned the wisdom of excluding healthy donors when blood shortages are common.

Back in 2010, when gay men were still barred from giving blood in the United States, the country’s Food and Drug Administration (FDA) conceded that the ban was "suboptimal" in that it allowed "some potentially high risk donations while preventing some potentially low risk donations".

Announcing its decision to partially lift the ban five years later, the agency said “the 12-month deferral window is supported by the best available scientific evidence, at this point in time, relevant to the US population".

Since then, the evidence has moved on again.

In July 2017, the UK government announced it would lower the deferral period to three months, based on the recommendations of the country’s Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO), which concluded that new testing systems were sufficiently quick and accurate.

Later that year, a team of Australian researchers concluded in a report published by scientific journal Transfusion that a 12-month deferral “exceeds what is required to maintain blood safety”.

“[W]ith current testing technologies the window period during which infection may be present but not detected is now less than 1 week,” the authors wrote. “While there is a moral imperative to maintain blood safety, there is also a moral imperative to ensure that differential treatment of population groups with regard to donation eligibility is scientifically justified.”

In place of the year-long abstinence period, the authors recommended reducing the timeframe to three months, noting that such a move “will not increase health risks to recipients and may have the social benefit of increasing inclusiveness”.

‘Not a human right’

Scientific progress has also informed France’s decision to ease blood donation rules.

Studies carried out by Santé publique France (SpF), the French public health authority, have shown that the decision to lift the ban on gay donors in 2016 did not increase the risk of HIV infection. They also revealed that the vast majority of donors complied with the rules.

However, the health ministry resisted calls to give homosexuals and heterosexuals equal treatment when it comes to blood donations.

“Being able to donate blood is not a right, it’s a civic gesture that is subject to safety rules,” France’s health ministry told AFP news agency on Wednesday, noting that heterosexual men who have had more than one partner over the last four months are also barred from giving blood.

Late last year, lawmakers in the French National Assembly also rejected a bill that would have placed equal conditions on heterosexual and homosexual men. One of the bill’s sponsors, centrist lawmaker Jean-Luc Lagleize, had called for “the criteria of exclusion [from blood donations] to be high-risk behaviour – and not a person’s sexual orientation”.

Even with a shorter “deferral” period, restrictions on gay blood donors continue to reflect discriminatory attitudes toward gay and bisexual men, writes Jennifer Power, a research fellow at La Trobe University’s Australian Research Centre in Sex, Health and Society.

“A gay man who has been having safe sex, including within a monogamous relationship, is not necessarily at higher risk of acquiring HIV than a woman who has had multiple sexual partners and possibly unsafe sex,” says Power.

“Yet a heterosexual woman is not banned from blood donation because she has had sex. Instead, heterosexual women are trusted to make their own assessment and accurate disclosure of their likely HIV risk. Gay and bisexual men are not.”

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