Drained away: When giving is moulded into privilege

The first attempts at blood transfusion date back to the Seventeenth century, a time when blood circulation attracted research and experimental interest. Since the 1930s, the Australian Red Cross has focussed on a commitment to safely storing donated blood and providing blood transfusions. More than ninety years have passed since these pioneering endeavours, so bear with me while I take you on a hypothetical journey through a (paradoxical) scenario set in today’s world.

M. is a blood donor in their home country and has been invited by a friend — while both of them are in Australia — to donate blood on a Tuesday night. M. happily carries out all the procedures required to register as an Aussie first-time donor. Since donating blood is such a fulfilling experience for them, they have been doing so for years. They answer the basic questions — what countries they have visited in the previous years, the vaccinations they’ve received, etc. Then, the question is asked: “In the last 3 months have you had male to male sex (that is, oral or anal sex) with or without condom?”

Walking into the donation centre wearing their wristband from the WorldPride March, this very question seems to be an anachronism. M. is in utter confusion: is this a sort of moral dilemma? An ethical issue arises as they ponder the lesser evil: do they lie about their sexual experience and end up donating blood which could save lives, or do they be honest, and deprive someone of those invaluable life-saving 470 millilitres? 

The bitter aspect of this story is that it is not uncommon. The paradox is that it pushes certain categories to the boundaries of discrimination, in a context where you wouldn’t expect it to happen.

A study from 2019 pointed out how fair policies in blood donors’ screening must be the ‘same for everyone’, stressing how ‘gender blind’ and HIV testing-related strategies should be the way to go so as to avoid discrimination altogether. Drawing upon bans instituted in the 1980s, framed within broader endeavours to halt the HIV/AIDS epidemic, the current deferral period subtly hints at the association of a specific sexual identity with an increased risk of infection. Discrimination is even stronger towards ‘zero risk’ monogamous relationships with tested partners. These policies contribute to reinforcing the stigma around HIV being a ‘gay disease’, when it actually affects all sexualities. Heterosexual people are not facing lower risks of being infected by HIV, and they tend to have lower HIV-testing rates with respect to homosexual people.

We have come a long way — have we now? — from the 1980s fatal toll taken on lives by HIV, but these policies seem to base their logic on stereotypes coming from that time. While it is true that anal sex is associated with a higher likelihood of the virus’ transmission, are we able to crush the taboo and say that it does not just happen in male-to-male intercourses? Yes, we are and the best preventive policy remains adopting safe sexual behaviours.

However, is there hope on the horizon? A blood donation policy similar to the Australian one has been adopted by the USA. Nonetheless, recent news suggested that a new FDA “proposed policy would eliminate the time-based restrictions on men who have sex with men […]”, screening potential donors’ eligibility based on a series of questions to assess their HIV risk, regardless of gender. This possibility has been envisaged by the Australian Red Cross as well: defined as individual risk assessment procedure, “the risk assessment would include questions about anal sex”, excluding from the pool of donors those who had anal sex in the three months previous to the donation “with a new […] or more than one sexual partner.”

A report by the organisation Let Us Give has shown how a “policy of assessing every individual donor for the safety of their sexual activity, regardless of their gender or the gender of their sexual partner”, would not compromise blood safety. Australia should seize this opportunity to review their rules — especially those deemed by many as prejudiced. 

In Europe, an increasing number of countries have lifted or are planning on lifting this ban on blood donation, focusing on an individual risk assessment to exclude donors based on risky sexual practices independent of gender. Italy has been doing this since 2001.

Italian journalist and author Oriana Fallaci once said that “You’re not supposed to donate your soul to someone who’s not willing to donate theirs.” [“Non si regala l’anima a chi non è disposto a regalare la sua”]. When considering this idea in the context of blood donation, it is clear that we must change the current situation. When you start giving blood, without needing to be conscious of how what you are donating is going to be accepted, it really becomes an unfettering and fulfilling experience.

In a world (allegedly) striving for equality, this whole story represents just another example of a huge setback. Article 29 of the Universal Declaration of Human Rights states how ‘in the exercise of […] rights and freedoms, everyone shall be subject only to such limitations […] solely for the purpose of securing due recognition and respect for the rights […] of others and of meeting the just requirements of morality, public order and the general welfare […]’. 

Building upon one of the founding documents of the realm of formal human rights, much is up for debate: whose rights matter more? Which morality are we talking about? General welfare of whom? I, unfortunately, do not possess any clear solution to these dilemmas, but I surely can lend you some bitterness, disappointment and (sanguinely) information to be used when facing a reality which is clearly not made for everyone to enjoy and which strikingly reinforces boundaries by hiding huge walls behind rainbow flags.