Ahead of a major surgery, one of Dr Gargi’s relatives who was battling cancer needed a blood transfusion. Despite being medically eligible, Gargi couldn’t donate blood solely due to their identity.
The reason is rooted in India’s 2017 blood donor guidelines. Under the policy, “transgender persons, men who have sex with men (MSM), and female sex workers” are subjected to a blanket ban from donating blood, irrespective of their health status or risk profile.
“Fortunately I was able to find another person to donate blood. But not everyone in the queer community has that privilege, and that is exactly why this very ban is discriminatory,” Gargi told TNM.
For many in the nation’s LGBTQIA+ community, such experiences are not new. The blanket ban imposed under the category of “risk behaviour” assumes that transgender persons, gay men (medically referred to as MSM), and female sex workers are at higher risk of HIV or hepatitis B or C infections by default. They are banned from donating blood, regardless of their individual health or medical history.
This reinforces what many activists say is a discriminatory policy based on identity rather than on evidence-based risk assessment.
“Identity-based banning is neither necessary nor sufficient to reduce the risk. Individual risk analysis is ideal. Many countries now assess people based on individual risk rather than identity,” said queer rights activist L Ramakrishnan.
What do the guidelines say?
The ban stems from the 2017 Guidelines for Blood Donor Selection and Blood Donor Referral issued by the National Blood Transfusion Council (NBTC) and the National AIDS Control Organisation (NACO).
Under these guidelines, NACO officially categorises the LGBTQIA+ community, specifically transgender persons and “men who have sex with men”, as inherently “at risk” populations. Clause 12 classifies transgender persons, “men who have sex with men”, female sex workers, drug users who inject substances and people with multiple sexual partners as persons “at risk” for HIV, hepatitis B, and hepatitis C infections.
Clause 51 goes a step further and permanently defers these groups from donating blood or plasma on the ground that they are “at risk for HIV infection”.
Challenge in court
The legal challenge to India’s blood donation policy has been pending in the Supreme Court since 2021, when transgender rights activist Santa Khurai petitioned against the discriminatory guideline.
At the heart of the challenge is a simple question: should a person’s eligibility to donate blood be determined based on their identity or on what risks they have actually undertaken?
Khurai’s petition came at the height of the COVID-19 pandemic, when blood and plasma shortages had become acute. Khurai argued that healthy transgender persons were prevented from donating even to their own family or community members during medical emergencies, solely because they belonged to a category deemed ‘at risk’.
“This provision is just an imagination of social morality. Many non-trans persons have multiple sexual partners or engage in unsafe sexual practices. But the government isn’t concerned with them. They are only targeting the people who are in the margins,” Khurai told TNM.
Invoking Articles 14, 15, and 21 of the Constitution, the petition argues that the exclusion violates the rights to equality, non-discrimination, and dignity. It relies on landmark Supreme Court judgements such as NALSA and Navtej Johar, which recognised the rights of transgender persons and held that discrimination based on sexual orientation and gender identity is constitutionally impermissible.
The plea argues that barring queer and transgender persons from donating blood reinforces stereotypes that these communities are inherently unsafe, while denying them the opportunity for altruism.
“Discriminating queer/LGBTQIA+ people who are loud and proud about their identity from this altruistic and life-saving process is a slap to the face of equality, equity and humanity,” said Arjun, a medico-social activist.
“It reinforces the stereotype that all LGBTQIA+ people are disease carriers or HIV carriers,” he added.
By presuming that transgender persons and gay or bisexual men are inherently ‘high risk’, the guidelines perpetuate outdated stereotypes rooted in the early years of the HIV/AIDS epidemic rather than contemporary scientific evidence, activists argue.
During the HIV/AIDS epidemic in the 1980s, many countries introduced blanket restrictions on gay men and transgender persons, driven by fears and limited scientific understanding. “From the beginning, HIV was associated with gay men. Later the association expanded to transgender persons and sex workers,” Khurai said.
Nearly five years after the petition was filed, the case is still pending in the Supreme Court, with long gaps between hearings. “Nothing has changed. I have lost faith in the government,” Khurai said.
She added that the sole positive moment for the petition was during a hearing in 2025 when a bench including Justice N Kotiswar Singh said that the entire transgender community cannot be branded as ‘risky’ and stigmatised.
Following Khurai’s petition, the challenge has evolved into a broader constitutional battle over LGBTQIA+ equality. Separate petitions filed by writer and LGBTQIA+ activist Sharif D Rangnekar and activist Harish Iyer have been tagged with the original matter.
They argue that the blanket exclusion of queer and transgender persons is discriminatory and rooted in outdated assumptions about HIV risk. They also state that the policy relegates queer persons to “second-class citizenship” by denying them participation in one of society’s most celebrated acts of public service.
The petitions also question the scientific basis of the permanent ban. They point out that every unit of donated blood is already screened for HIV, hepatitis B, and hepatitis C before transfusion. In an era of advanced testing technologies, they argue, permanent exclusion based on identity is neither scientifically justified nor necessary.
Instead, the petitions urge a shift towards behaviour-based screening, where eligibility is determined by factors such as recent high-risk sexual activity or needle sharing, irrespective of a donor’s gender identity or sexual orientation.
Rangnekar’s petition goes a step further by invoking Article 17 of the Constitution, which abolishes untouchability. It argues that branding an entire community as permanently ‘unfit’ to donate blood amounts to a modern form of social exclusion. Drawing on observations from the Sabarimala judgement, the petition contends that Article 17 is not confined to caste but also speaks to discriminatory practices that deny communities equal participation in public life.
By treating LGBTQIA+ persons as presumptively unsafe regardless of their individual medical history, the state, the petition argues, reinforces stigma instead of relying on science.
The petitions also point to the global shift away from identity-based exclusions. Countries such as the United Kingdom and the United States have replaced lifetime bans with shorter deferral periods, while others, including Italy, Canada, and Spain, have adopted behaviour-based screening models that assess individual risk irrespective of sexual orientation.
The petitioners argue that these approaches, coupled with rigorous testing of every donated unit, offer a scientifically sound and less discriminatory alternative to India’s blanket prohibition.
The Union government, however, has fiercely defended the restrictions as a non-negotiable matter of public safety. In recent hearings before a Supreme Court bench headed by Chief Justice Surya Kant, it firmly rejected calls to modify the policy, leaning on epidemiological data to argue that the exclusions are strictly scientific, not social.
The Additional Solicitor General argued that the right of a recipient to receive a safe blood transfusion far outweighs the individual right of a person to donate blood. The state maintained that when dealing with vulnerable patients in a heavily strained public healthcare system, even a marginal increase in the risk of transmitting infections like HIV cannot be constitutionally or medically justified.
Blood safety beyond identity
Medical experts say that blood safety depends on a combination of donor screening, laboratory testing, and post-transfusion monitoring. Before donating blood, every donor is screened through a questionnaire and checked for age, haemoglobin levels, and medical history. The donated blood is then routinely tested for infections such as HIV, hepatitis, and syphilis before it is cleared for transfusion.
However, India’s testing system is not uniform, pointed out Dr Gargi. While some large hospitals use Nucleic Acid Testing (NAT) – a highly sensitive method that can detect HIV and other infections by identifying the virus’s genetic material – many blood banks continue to rely primarily on serological screening tests, including fourth-generation HIV assays that detect both HIV antibodies and p24 antigen.
The problem with serological screening tests is that they have a longer ‘window period’ during which recent infections may go undetected. A ‘window period’ is the time period between the actual infection and the detection of the same.
Larger hospitals that use NAT can detect such cases. “But many smaller blood banks and clinics across the country do not have access to advanced technology,” Gargi said.
They also pointed out that India lacks basic infrastructure and a systemic approach. “In several countries, including the UK and Canada, donors are assessed based on behaviour-based questionnaires that ask about recent high-risk sexual activity.”
In India, however, the questionnaire does include certain risk-related questions, but these are generally less detailed and less behaviour-focused, because of the stigma associated with it.
Describing what an equitable blood donation policy should look like, Ramakrishnan said, “One that is based on the UK model, where each individual is assessed for different kinds of risk – not just one particular kind of sexual activity, but all forms of potential exposure – and based on that, the blood is either accepted or deferred to a later date.”
Gargi also pointed out that the current system can still miss infections if donors do not disclose recent high-risk behaviour. Even a heterosexual person who has had high-risk sex in the past three months but fails to mention it on the questionnaire could test negative on a routine antibody-based screening if the infection is still in its window period.
Queer rights activist and content creator Sanjevi Jayaraman said that it is not just about giving or receiving blood: “It tells people that queer bodies are somehow impure. It becomes another form of untouchability. Today you say we cannot donate blood. Tomorrow it becomes another reason to exclude us from public life.”
“You are just making the closet bigger,” he said, adding that India not only does not provide anti-discrimination protections for queer people but also goes on to create policies that further dehumanise them.
“Being open about your identity only comes with more discrimination that neither the law, families nor society is willing to protect you from. These may seem like isolated incidents, but together they create an environment where queer people cannot exist freely.”