Current Food and Drug Administration (FDA) policy recommends that men who have had sex with another man (MSM) even one time since 1977 should be deferred indefinitely from donating blood, a position that has become increasingly controversial as detractors point to alternative policies in other countries. This program will review the international experience with MSM deferral policies in countries with lifetime or limited-period deferrals or no MSM deferral at all, and the use of behavioral criteria to identify high risk. The prospect of utilizing behavioral risk criteria not based on sexual persuasion, such as number of partners, new or casual partners, protected, and anal sex, has been proposed and implemented in a limited number of countries. The difficulties in implementing such policies to achieve meaningful risk reduction will be discussed.