A Year Into Serbia's Gender-Neutral Blood Donation Rule, Here's What Changed

For most of its existence, Serbia’s blood donation questionnaire asked one version or another of the same question: have you ever had sex with another man? A “yes” meant an automatic, permanent ban from donating — no exceptions for monogamy, testing, or time elapsed. It was one of the more blunt instruments left over from the early-AIDS-era donor policies that much of Western Europe had already spent the 2020s dismantling.

That changed on July 14, 2025, when Serbia’s National Blood Transfusion Institute (ITKS) replaced the blanket lifetime deferral with a gender-neutral, behavior-based risk assessment. A year on, it’s worth checking what that actually looks like in practice — and whether it’s held up.

What the policy says

Under the current rules, deferral periods are tied to specific behaviors rather than a donor’s sexual orientation. Anyone — regardless of gender or the gender of their partner — who has had a new sexual partner or engaged in higher-risk sexual activity within the past three months faces a three-month deferral. Anal sex, specifically, carries a separate six-month deferral window regardless of who’s involved. Gay and bisexual men in stable, monogamous relationships, who would previously have been turned away at the door without exception, can now donate with no deferral at all.

It’s the same basic model the UK adopted in 2021 and that France, the Netherlands, and Greece have implemented in various forms since — individualized risk assessment rather than a category-wide exclusion. ITKS’s stated rationale mirrored the evidence those countries cited: donor screening built around specific behaviors catches actual transmission risk more accurately than screening built around identity, and it does so without needlessly shrinking the donor pool.

The numbers, a year in

Serbian LGBTQ+ health advocates who pushed for the change for years describe the first twelve months as quietly successful — more a non-event than a controversy, which is more or less what advocates were hoping for. ITKS has not published a full public breakdown of donor numbers by the new screening categories, a gap that groups including Belgrade’s Da Se Zna and regional health-rights organizations have flagged as something the institute should address if it wants to demonstrate the policy is working as intended, rather than just describe it in a press release.

What’s easier to measure is the absence of the fallout that critics predicted. There’s no evidence the change affected the safety of Serbia’s blood supply, and no reported spike in screening failures at the point of donation. Serbia’s public hospitals, which rely heavily on volunteer donation drives to keep supply stable, have not reported disruptions tied to the new questionnaire.

Where Serbia sits regionally

The policy puts Serbia ahead of several of its neighbors. Bosnia and Herzegovina, North Macedonia, and Kosovo all still operate blanket or near-blanket deferrals for men who have sex with men, with no public timeline for review. Croatia, an EU member since 2013, moved to a shorter deferral model years ago but has faced periodic criticism from advocates for keeping the window longer than current WHO guidance supports.

For a country whose EU accession file gets marked down every year for LGBTQ+ rights gaps — no partnership recognition, no gender-recognition law, and a Pride parade that still needs a heavy police presence — the blood donation reform stands out as a case where Serbia moved on the medical evidence without waiting for Brussels to make it a formal benchmark. It’s a narrow policy, and it doesn’t touch the bigger fights over partnership rights or protection from discrimination that dominate LGBTQ+ advocacy in Serbia. But narrow, evidence-based wins are still wins, and this one appears, a year in, to have stuck.