As early as 1983, in many countries, men who have sex with men were permanently barred from donating blood because they were considered to be at high risk of HIV infection. Since the introduction of HIV screening for blood donations in 1985, significant progress has been made in the viral safety of blood products thanks to improved donor selection and the development of effective screening tools, including viral genomic testing. Despite these improvements and strong pressure from certain civil society organizations, only a few countries have limited the duration of exclusion for men who have sex with men. Impact studies on the effect of modifying the exclusion policy on HIV risk have shown that reducing the duration of exclusion creates an additional risk. Admittedly, this risk is very low, but is it acceptable to expose recipients of blood products to even an infinitesimally small additional risk? These studies, however, do not take into account an important factor: the potential improvement in compliance among men who have sex with men under a temporary exclusion policy. The most recent studies agree that an alternative to permanent deferral could be to allow donations from men who have been abstinent for the past 12 months, as some countries have already done. This measure would largely cover the silent window period for men who have recently engaged in risky behavior or for those whose partners have engaged in risky behavior, provided that donor compliance improves. (R.A.)