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The Indian Supreme Court on May 14 ordered the central government to consult experts and address policies that label transgender people as “high-risk” blood donors, a designation rooted in assumptions rather than scientific evidence.
“Are we going to brand all transgender individuals as risky and stigmatize them?” said Justices Surya Kant and Nongmeikapam Kotiswar Singh. “You cannot say that all transgender individuals are indulging in sexual activity.”
These restrictions stem from guidelines that the National Blood Transfusion Services, under India’s Health and Family Welfare Ministry, issued on Oct. 11, 2017. The regulations categorize trans people, men who have sex with men, female sex workers, IV drug users, and those with multiple sexual partners as ineligible to donate blood due to presumed risks of HIV, Hepatitis B or C, and require clearance by a medical officer.
The justices considered a petition that contested the constitutional validity of Sections 12 and 51 of the guidelines.
Solicitor General Aishwarya Bhati, representing the central government, stated the rules, which the National Blood Transfusion Council’s panel of medical experts crafted, aimed to prioritize public health and safety without intending to stigmatize any group. The justices during the hearing noted barring trans people from donating blood reinforces their social exclusion, questioning whether these restrictions deepen existing societal biases.
“Just think of something that such feeling does not come, and health standards are not compromised,” they said, granting the government time to address these concerns while maintaining medical safety.
The justices further observed that evolving times and emerging medical technologies offer solutions to screen blood donations for infections without excluding entire groups, allowing broader participation in civic programs.
Bhati said she would relay the court’s recommendations to medical experts for consideration. She explained that donated blood goes directly to blood banks, critical for thalassemia patients and other vulnerable groups who depend entirely on these supplies for their survival.
“As a group, transgenders are considered a high-risk group the world over, with certain exceptions,”Bhati told the justices. “There is a period within which infection has to be identified, and the risk window has to be carefully considered. Nobody can claim to have a fundamental right to donate blood. These guidelines must be seen from the perspective of public health as the idea is not to stigmatize anyone.”
The Washington Blade on Aug. 28, 2024, reported Shariff D. Rangnekar, a gay man from Delhi and director of the Rainbow Literature Festival, challenged the constitutionality of India’s blood donor rules, which bar trans people, MSM, female sex workers, and others from donating blood due to presumed health risks.
The Supreme Court on July 30, 2024, agreed to hear Rangnekar’s petition that Ibad Mushtaq filed and lawyer Rohin Bhatt wrote. It questions the policy’s reliance on outdated stereotypes from the 1980s. Rangnekar notes the U.S., the U.K., Canada, and Israel are among the countries that have updated their blood donor policies. He urged India to adopt individualized risk assessments.
South Asian countries have varying blood donation policies for trans people and gay men, with some avoiding blanket bans and others enforcing them.
Equaldex notes Nepal allows MSM to donate blood without specific restrictions based on sexual orientation or gender identity, suggesting trans people and gay men face no categorical bans. Bangladesh also lacks a specific ban on such donors, although its policies remain ambiguous due to limited documentation.
Pakistan, Sri Lanka, and Malaysia ban MSM and trans people from donating blood, categorizing them as high-risk groups for HIV and other infections.
“It is not just LGBTQIA+ people whose blood can test positive for infections, it could be anybody. All blood that is transfused needs to be tested before transfusion,” said Harish Iyer, a prominent LGBTQ activist in India. “If that is not happening, we have much reason to worry. There is no test on fidelity, regardless of the sex, gender, or sexual orientation. There are open marriages and clandestine affairs that happen in every sexuality. The solution is to speak of safe sex practices and not to take anyone’s word and to test every packet of blood before transfusion.”
Iyer told the Blade that branding and banishing minorities by stereotyping them is an underlying cause of hate crimes. He highlighted that MSM and trans people for years have been seen as simply vectors of HIV, and not as people who lead happy, fulfilling lives. Iyer added the blood donor ban further accentuates this divide and further marginalizes the community.
Iyer said the government should enhance public awareness campaigns around safer sex practices and ensure that all blood undergoes rigorous testing before transfusion. Ankit Bhupatani, a global DEI leader and LGBTQ activist, told the Blade the justices’ directive represents a long-overdue recognition that India’s blood donation guidelines require scientific scrutiny rather than perpetuating stigma.
“By asking the government to seek expert opinion, the bench has opened a path toward evidence-based policy reform. The bench’s observation that labeling all transgender persons as ‘risky’ is troubling, shows judicial wisdom in identifying how these guidelines institutionalize prejudice,” said Bhupatani. “This intervention creates an opportunity to align our healthcare policies with constitutional values of equality and dignity while maintaining necessary medical safeguards.”
He said the 2017 guidelines are a form of structural discrimination.
“Such policies do not merely restrict access to a civic activity; they codify stigma into our healthcare system and reinforce harmful stereotypes about LGBT individuals,” said Bhupatani. “The international trend has indeed moved toward individual risk assessment rather than categorical exclusions. India’s policy remains anachronistic in its approach.”
“The government absolutely should implement individualized medical screening based on specific behaviors rather than identity,” he added. “The current policy creates the paradoxical situation where a heterosexual person engaging in high-risk behaviors faces less scrutiny than a transgender person in a monogamous relationship. The selective application of supposed ‘public health concerns’ reveals that these guidelines are more informed by social prejudice than medical evidence. Rigorous individual screening would better protect our blood supply while eliminating discriminatory practices.”
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