The essential
• The Walloon government is asking the federal government to eliminate discrimination in blood donations, namely the four-month abstinence imposed on homosexual men.
• This rule dates back to the 1990s and Belgium is one of the last six EU countries to impose it.
• The report of the Superior Health Council (CSS) influenced the debate: four experts recommended the end of abstinence, four others favoured maintaining abstinence.
• The Flemish Red Cross estimates that ending abstinence would cost 14 million euros due to a change in the testing process, but this estimate is disputed.
• The CSS’s position could change in December. Political pressure is strong, especially on the French-speaking side.
Why is Belgium still one of the last European countries to impose a period of abstinence on homosexual men who want to donate blood? Health Minister Frank Vandenbroucke is accused of conservatism. But driven by political pressure and new scientific evidence, the Belgian position could change.
It’s a little line in the 105 pages of the General Policy Declaration (DPR) of the new Walloon government: MR and Engagés assure that “the federal government will be asked to eliminate discrimination in blood donations.” Discrimination? Those that continue to affect homosexual (or bisexual) men: four months of abstinence is imposed on them in the event of a blood donation. A rule that also applies to the rest of the population, but only in the event of a new relationship.
“It’s as if we considered that a homosexual was incapable of realizing whether a relationship was risky or not. It’s unbearable,” protests Simon Moutquin. The Ecolo federal deputy tried to have this rule inherited from the 1990s removed, just like the MP Sophie Rohonyi (Challenge). “The majority MPs were telling me behind the scenes that I was right.but that the Minister of Health Franck Vandenbroucke did not want it,” she recalls.
Why Belgium remains one of the last six countries of the European Union to impose this abstinence on “men who have sex with men” (MSM), while many other countries (from France to Brazil, Argentina and the United Kingdom) have abandoned it? Why did the Belgian law, voted on July 1, 2023, only reduce the period of prohibition from twelve to four months?
The answer can be found partly in the report of the Higher Health Council (HSC), commissioned in 2021 by Minister Vandenbroucke (Vooruit). Within the working group tasked with looking into the issue, it was equality: four experts recommended ending MSM abstinence, and four others favored four monthsmotivated in particular by an increase in HIV diagnoses among MSM in 2021 (a rebound that Sciensano will then attribute to the drop in diagnoses carried out during Covid).
The resistance of the Flemish Red Cross to blood donations by homosexual men
This CSS document subsequently had a great influence on the debateseveral deputies confided. It served as a reference at the Royal Academy of Medicinewhich did not recommend ending MSM abstinence. The FAMHP has attempted to gather information abroad on transfusion safety, but did not find much at the time.
“No Belgian study could then affirm that there was no additional risk, so we could not go further,” regrets Hervé Rigot, PS deputy author of a bill on the subject in 2022, himself in favor of its removal.
The Flemish Red Cross also played a role in the debate in claiming that ending MSM abstinence would cost 14 million eurosdue to a need to modify the testing process, opting for individual verification rather than by pooling eight blood samples.
When contacted, the Flemish Red Cross was unable to provide the source of this estimate. Which leaves Michel Moutschen, professor of immunology at ULiège, not convinced. “Changing the technique would mean having a different attitude towards MSM, whereas a heterosexual can also catch anything.”
“Why don’t we trust MSM?”
Another argument from the Flemish Red Cross: Ending MSM abstinence would triple transfusion risk (with individual risk assessment). An estimate based on the number of HIV-positive MSM and potential donors. But countries that have changed their policy have not seen any negative effects.
Unjustified fears? Esther Neijens, medical director of the Red Cross blood service, describes the reports from abroad as “reassuring.” For Claire Sauvage, research officer at Santé publique France, if zero risk does not exist, “The experts’ position is that the risk is extremely low.“The main danger would be if a donor had been infected with HIV in the last ten days, which tests cannot detect. To protect against this, according to Simon Englebert, director of Sida Sol, it would be necessary to screen for risky behavior, regardless of sexual orientation, as other countries do.Why don’t we trust MSM?»
The CSS’s position could change. Roland Hübner, chairman of the working group, says that a Council opinion “going in the direction” of removing the abstinence rule for blood donation by homosexual men could be imaginable following its next meeting in December, “if new contradictory data do not appear” by then.
The political pressure, in any case, is not abating. Especially on the French-speaking side: All the representatives of the parties interviewed described the position of the Ministry of Health as “conservative” and confirmed that their parties wanted to put an end to what they consider to be discrimination. Groen aligns itself with this position, unlike the Open VLD and the N-VA, which remain reluctant, except in the case of new scientific evidence. The CD&V preferred not to take a public position. As for Vooruit, radio silence.
