This is a decision at the heart of ethical and health debates for nearly forty years. As of March 16, homosexual men will be able to donate blood, under the same conditions as other donors; they had previously to justify a period of sexual abstinence of four months. A decree, published on January 11, 2021, had put an end to this condition, removing the reference to the gender of sexual partners in the selection of candidates for donation.
A symbolic decision
Number of LGBT associations (lesbian, gay, bisexual, transgender movement), mobilized for several years on the subject, do not hide their satisfaction. “This is clearly the end of discrimination. When I was a gay student at the University of Assas, I went to donate blood and was told I was not allowed to. It was very violent”relates Étienne Deshoulières, a Parisian lawyer, who defends several LGBT associations.
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An observation shared by Terrence Khatchadourian, secretary general of the Stop Homophobia association, who reports recurring testimonies from men who have experienced these restrictions as a humiliation and is pleased that ” science finally overcomes prejudice ». “In truth, it is a mostly symbolic story. Behind the donation of blood, there is the idea of national community. Someone who is excluded from blood donation experiences being excluded from the national community. That is why this decision is a step forward”explains Étienne Deshoulières.
A steadily declining incidence
Decided in the wake of the bioethics law of August 2021, the measure reverses another decision of 1983. At the start of the AIDS years, men who had relations with other men had been permanently excluded from the donation of blood, due to the very high incidence of HIV in this population at the time.
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If it remains today higher than the national average (of the order of 84.5 per 10,000 in 2018, against 1.6 per 10,000 in the general population, according to the French Blood Establishment), it does not stopped falling, justifying a first opening. In 2016, plasma donation was thus authorized, provided that homosexual men did not have sexual relations during the twelve months preceding the blood donation; a period reduced to four months from April 2020.
Progress in the performance of biological tests
“These developments have been made possible by advances in the performance of serology tests and pathogen inactivation techniques,” explains Pascale Richard, medical director of the EFS. It also underlines the arrival, in 2001, of viral genomic diagnosis for HIV and hepatitis C.
These advances make it possible to reduce the “silent window”, this period between the moment when a person becomes infected and when biological tests can detect the infection: from 45 days in 1990, it is now 9 days. In addition to these new scientific tools, there are questionnaires designed to assess the risks according to the sexual practices of candidates for donation.
Despite everything, some associations remain reserved on this lifting of restrictions, like Fabrice Pilorgé. “There is a residual risk, certainly low, but which leaves a margin of uncertainty, all the more so after the health crisis which caused the number of screenings to drop», believes the advocacy director at Aides, an association fighting against HIV. The residual risk would increase from 1 for 6 million donations to 1 for 4.3 million with the extension of the conditions of access to donation for homosexuals, according to a study carried out by Public Health France between 2016 and 2017. A risk considered very low by EFS.
But for Fabrice Pilorgé, this lifting of restrictions has another bias. “One of the problems posed by this decision, more political than healthhe warns, is that it can lead people to believe, wrongly, that homosexuals are no longer infected with AIDS. »