us, the food and drug administration (fda) issues donor deferral recommendations to blood establishments. the guidance as of 2020 is to "defer for 3 months from the most recent sexual contact, a man who has had sex with another man during the past 3 months." this policy replaces a previous one-year deferral that was approved by the fda on 21 december 2015, which itself replaced a previous lifetime ban on blood donations from msm. the recommendations are nonbinding and generally do not establish legally enforceable responsibilities. although the technically nonbinding recommendations may not be law, in practice they are regarded as if they are law. for example, the american red cross refers to the recommendation as a "federal requirement" that must be followed. females are also prohibited from donating for three months after having sex with an msm. prior to april 2020, this 3-month ban was the same 12-month period placed on msms. the argument used to follow these policies is that blood should be collected from a population that is at low risk for the disease since the tests are not perfect and human error may lead to infected units not being properly discarded, and these population groups would be considered high risk. the policy was first put in place in 1983 by the fda, which regulates blood donations to profit and non-profit organizations. donors of human cells and tissues other than organs, such as corneas or reproductive tissue like semen, are ineligible for five years after the most recent contact. with regard to corneal donations, the five-year deferral policy in the united states and the similar 12-month deferral policy in canada have the effect of preventing thousands of corneal donations annually. unos policies for organ donation allow for solid organs from msm donors such as hearts, lungs, and kidneys to be used in transplant surgeries, though they require the hospital receiving the organ to be notified if the donor was an msm within the past 5 years. the organs are generally used unless there is a clear positive test for a disease. history of calls to change the policy in 2006, the aabb, american red cross, and america's blood centers all supported a change from the current us policy of a lifetime deferral of msm to one year since most recent contact. one model suggested that this change would result in one additional case of hiv transmitted by transfusion every 32.8 years. the aabb has suggested making this change since 1997. the fda did not accept the proposal and had concerns about the data used to produce the model, citing that additional risk to recipients was not justified. on 19 august 2009, the assembly judiciary committee in california passed ajr13, the u.s. blood donor nondiscrimination resolution, calling upon the fda to end the msm blood ban. in april 2010, the new york city council passed a resolution calling on the u.s. food and drug administration (fda) to eliminate the ban stating "this ban was based on prejudice, a knee-jerk reaction, and misunderstandings about the hiv/aids disease. given the constant need for blood, it does not make common sense to prohibit donations from an entire population." on 1 june 2010, the council of the district of columbia passed a resolution calling on the fda to "reverse the lifetime deferment of blood donations by men who have had sex with men since 1977 in favor of a policy that protects the safety and integrity of the blood supply that is based on up-to-date scientific criteria." in june 2013, the american medical association issued a statement calling on the fda to change the policy, stating that "the lifetime ban on blood donation for men who have sex with men is discriminatory and not based on sound science." in july 2013, the american osteopathic association approved a policy calling on the fda to "end the indefinite deferment period for men who have sex with men (msm)", and to "modify the exclusion criteria for msm to be consistent with deferrals for those judged to be at an increased risk of infection." on 14 december 2015, jordan moll-vigrass, congressmen brian higgins and the pride center of western new york held a community rally in buffalo, new york, to rally against the fda policy that bans blood donations by gay and bisexual men. moll-vigrass, who is openly gay and had been in a committed relationship for four years, was refused as a blood donor after disclosing his sexual orientation during the questionnaire screening process. outraged by the federal policy and disappointed by being refused as a blood donor, moll-vigrass started to advocate for change. "the government's unfounded policy is hurtful to the people being turned away solely based on sexual orientation and the millions of others who will be in need of a lifesaving blood donation," said higgins. "eligibility should be based on risk-based science rather than outdated, fear-based speculation." on 21 december 2015, the u.s. food and drug administration changed the policy by replacing the indefinite deferral with a 1-year deferral. the change was proposed the previous july. on 27 may 2016, the u.s. food and drug administration approved of a new blood donor history questionnaire for general use by blood establishments, which is compatible with the deferral for 12 months. before this update, the approved questionnaires were compatible only with an indefinite deferral of blood donations from msm. as of december 2016, the american red cross reports that msm may be eligible to donate blood if they did not have sex with another man in more than 12 months. the american red cross reports that, in january 2017, the organization began donor reinstatement of msm who were previously deferred from donating, and who later became qualified to donate blood in accordance with the new donation deferral period of 12 months. the american red cross website specifies that this 12-month deferral does also apply to transgender men who have sex with men, but does not apply to transgender women who have sex with men. australia australia implemented a 12-month deferral in 1999; a comparison of confirmed hiv positive blood donations before and after the change did not see a statistically significant difference. the australian red cross blood service pushed to have the deferral period lowered from twelve to six months, however it was rejected by the therapeutic goods administration (tga) in 2014. in april 2020 the tga revised the deferral period for msm down to three months. the revision requires approval of the federal, state and territory governments before it can go into effect. lifeblood's new 3-month deferral period rules went into effect on 31 january 2021. the spokesperson said they empathise with those who cannot give blood. reasoning for the restrictions blood services first and foremost must ensure that all blood received for donation is safe for transfusion purposes. this is achieved by screening potential donors for high risk behaviours through questionnaires and interviews before blood is taken, and subsequent laboratory testing on samples of donated blood. blood services commonly justify their bans against msm due to the marginal increase in the risk for transfusion-transmitted hiv. other groups with similar restrictions, or complete prohibition to donate blood, due to increased or possible risk for certain infectious diseases include intravenous drug users, recipients of animal organs or tissues, and those who have traveled or lived abroad in certain countries. in the 1980s, when the hiv/aids epidemic outbreak occurred, there was a high prevalence of the disease in msm and no reliable tests for the virus, which justified blanket bans on blood donations from high-risk groups. these restrictions are similar to current restrictions on people with certain residence in the united kingdom, france, or saudi-arabia during the height of the bse ("mad cow disease") epidemic of 1980 through 1996, due to the absence of a test for its human form, variant creutzfeldt–jakob disease (vcjd). in 1985, early tests using the elisa method looked for antibodies, which are the immune system's response to the virus. however, there is a window period when using this method in which a person who has been infected with hiv is able to spread the disease but may test negative for the virus. this window period can be as long as three to six months, with an average of 22 days. tests using the elisa methods are often still used in developed countries because of their ease-of-use, as well as their fairly high sensitivity, which boasts 100% sensitivity. to cover the window period resultant from the use of these tests, donors are also screened for high risk behaviours, one of which is a history of same-sex sexual activity among male potential donors. newer tests look for the virus itself, such as the p24 antigen test, which looks for a part of the virus on the surface of infected cells, and nucleic acid tests (nat), which look for the genetic material of the virus in hiv-infected cells. with these tests, the window period is shorter, with an average duration of 12 days. fourth generation, or combination, hiv tests can detect hiv infection in 99% of individuals by one and a half months after infection. risks are also associated with a non-msm donors testing positive for hiv, which can have major implications as the donor's last donation could have been given within the window period for testing and could have entered the blood supply, potentially infecting blood product recipients. an incident in 2003 in new zealand saw a non-msm donor testing positive for hiv and subsequently all blood products made with the donor's last blood donation had to be recalled. this included nz$4 million worth of factor viii, a blood clotting factor used to treat hemophiliacs which is manufactured from large pools of donated plasma, and subsequently led to a nationwide shortage of factor viii and the deferral of non-emergency surgery on hemophiliac patients, costing the health sector millions of dollars more. screening out those at high risk of blood borne diseases, including msm, reduces the potential frequency and impact of such incidents. criticism of the restrictions need for blood objections to the restrictions, including those from the american medical association and the american red cross, are generally based on the idea that improvements in testing and other safeguards have reduced the risk from transfusion transmitted hiv to an acceptable level. blood shortages are common, and advocates for change to the policies point out that excluding healthy donors only makes the problem worse. in 2018, approximately 10,000 donations were still urgently needed by 10 march to continue to meet patients' needs. however, canadian blood services noted that the national inventory and days on hand of several blood groups remain at critically low levels. less than four per cent of eligible donors give blood each year. need for corneas corneal transplant surgery can cure blindness caused by corneal disease. however, there is a global shortage of corneal donations, severely limiting the availability of corneal transplants across most of the world. a 2016 study found that 12.7 million visually impaired people were in need of a corneal transplant, with only 1 cornea available for every 70 needed. many countries have years-long waitlists for corneal transplant surgery due to the shortage of donated corneas. even though there has never been a reported case of hiv transmission through corneal transplant surgery, and even though all donated corneas are screened for the presence of hiv through antibody or nucleic acid testing, many countries continue to ban msm corneal donors. risk of std transmission in some european countries, high-risk sexual intercourses lead to a temporary ban, regardless of the sex of the partner. in fact, advocates for change in other countries note that the ban encompasses all same-sex sexual contact, even if the partner's hiv status is shown beyond doubt to be negative. advocates for change point out that a promiscuous straight male is a higher-risk donor than a gay or bisexual man in a monogamous relationship, but the former will usually be allowed to donate blood. furthermore, in some countries, other high-risk activities determine a temporary ban, such as sexual contact with anyone who has used needles to take drugs not prescribed by their doctor, whereas msm donors are deferred indefinitely. roots in discrimination many lgbt organizations view the restrictions on donation as based on homophobia