An 18-year-old young girl or a boy who is fully eligible to donate blood in India may technically be denied if self-identified as a transgender, says Public Health Specialist Dr. Praveen G Pai, who argues for rectifying the anomaly on the occasion of World Blood Donors Day which falls on June 14

According to the Census 2011, 4.88 Lakh transgender were enumerated in India for the first time along with their literacy, employment, and caste. Here, the data was clubbed inside “males” in the primary data and for research and policy purpose, a separate data-set was curved out. It is logical to understand that only a miniscule number of transgender have been classified while a large number of those who could not open up their status remain hidden and so are their issues.

Sex of an individual is assigned at birth in most cases except in rare intersex category and as the child grows up, gender gets determined and is a social construct. A gender focussed discussion and data collection is what is required as stated in a report by the International Development Research Centre (2020). As per the report, nearly two third of the surveyed persons were school drop-outs due to severe gender-related bad experiences. Another report by Sangama, a human rights organisation found that only 12% of the transgender were employed.

In Kerala too, the ground reality is bleak where acceptance of a transgender by family and society is poor. Youth who already had a poor scholastic performance due to negative environmental factors and stressors during their crucial years are left un-employable and without adequate social support. The multiple jeopardy that a transgender has to go through in their early life results in indulgence in high risk behaviours and being noted as the “not-so-good-people” in society.

It is a vicious cycle that persistently pull down the social position of the transgender community where parents, family, teachers, societal norms and government policies all play a significant role. Regardless, they get excluded and marginalized in every walks of life due to the stigma, to the extent that they are banned from contributing to social service or altruistic activities such as voluntary blood donation.

The Guideline on Blood Donor Selection and Blood Donor Referral (2017) by the National Aids Control Organisation and the National Blood Transfusion Council, classifies transgender persons as a “high-risk category” vulnerable to HIV/AIDS and a reason for the ban. Taking gender identity and sexual orientation as a criterion for risk classification and permanently excluding from blood donation is un-scientific, discriminatory, unreasonable and violative of their right to equality to other blood donors.

Though it is evidence-based that the guideline excludes men having sex with men (MSM), female sex workers, injecting drug users and people with multiple sex partners from donating blood, there is no base that particular gender to be labelled as high-risk. Just as men and women with high-risk practices are excluded, a transgender has to be excluded if they are found to be high-risk in their behaviour. Labelling transgender community as “high-risk-sex practicing individuals” will further bring down the social position of transgender community and hinder the development of future generation.

It is ludicrous that eligibility to donate blood is based on how a person identifies himself and to whom they are attracted to. In the US, based on research, the FDA clarified their related guidelines by adding a deferral for 12 months from last MSM activity lifting the total ban on transgender and gays. During the COVID19 pandemic, FDA relaxed the period to three months owing to increased demand of blood and blood products.

A similar clarification on who among gays and transgender to be excluded has to be made clear in the guidelines we have. In reality, it is the skill and genuineness of the blood bank medical officer or the counsellor to evaluate and accept safe-blood. It should be understood that behavior is what that puts someone in high-risk category. Ensuring voluntary blood donation and abolishing the practice of replacement blood donation could be one major policy that can ensure safe blood than maintaining discriminatory and stigmatizing practices.