Despite Canadian blood banks being chronically short on supply, as recently as 2013 men who have sex with men (MSM) were banned from donating blood, and up until a month ago faced having to prove abstinence for one year prior to being approved as a donor. While Prime Minister Justin Trudeau’s 2015 election platform pledged to end the ban, echoing advocates that label the ban as discriminatory against gay and bisexual men, it is yet to be completely repealed.
As part of our commitment to support equitable policy-making at local, provincial and federal levels, UMSU talked to both UMSU’s LGBTTQ* Community Representative, Trevor Smith (TS), and Canadian Blood Services (CBS) to bring clarity to some of the simplistic narratives popularized to keep the ban in place, and what is being done about it.
Narrative 1: “No countries allow donations from sexually active gay men.”
TS: This is untrue. Many countries around the world allow donations from sexually active gay men, but depending on the country, there may be a deferral window where abstinence from sexual activity is required. In Canada, the deferral window was recently changed from 1 year to 3 months.
CBS: Because the patterns, causes and effects of HIV differ by country, there is no international scientific consensus on an optimal eligibility criteria for men who have sex with men. Some European countries have instituted lifetime bans on blood donations from MSM, while the United States and Australia have reduced their waiting periods to one year.
Some blood centres in Spain and Italy have taken the approach of asking about safe sex practices or monogamy, but those countries have different blood systems than Canada’s. In those countries, physicians interview individual donors and may be able to perform individual health assessments. It should be noted, however, that the rate of donors with HIV-positive test results in those countries is more than 10 times higher than in Canada.
Narrative 2: “Statistically higher prevalence of HIV and hepatitis of MSM in population studies justifies the ban.”
TS: The ban is typically universal against all MSM and does not take into account factors like committed monogamy and safe sex practices, which is a problem. As well, testing methods have improved since the time these bans were put in place, so it is quite stigmatizing, and while MSM do have a high prevalence, any person of any gender or sexual orientation can get HIV and hepatitis.
CBS: Men who have sex with men account for the largest proportion of new HIV infections reported in Canada according to data from the Public Health Agency of Canada.
Canada decided on the waiting period based on several factors, such as the lack of international consensus, as discussed above; and Canada’s history of tainted blood is very different from other countries. Any policy change related to donor eligibility criteria requires special prudence to maintain public trust and confidence in the safety of the system.
An indefinite deferral for men who have had sex with a man even once since 1977 was instituted in the United States in the early 1980s, before the virus that causes AIDS was identified and when men who have sex with men were noted to be a particularly high-risk group. Being solely responsible for Canada’s blood supply at that time, the Canadian Red Cross Society followed suit. This criterion was in place until July 2013, when both Canadian Blood Services and Héma-Québec [a non-profit organization that handles blood supply in Quebec] reduced the eligibility criteria from an indefinite deferral to a five–year waiting period following sexual contact with another man. While this change allowed only a small percentage of MSM to donate blood, it was still significant as it was the first update to Canada’s donor eligibility criteria for MSM since the criteria was implemented more than 35 years ago. All changes to screening practices were made after an extensive review of scientific and epidemiologic evidence.
The five-year waiting period was implemented in 2013, and a minimum of two years of data was required for re-submission to Health Canada to support a further reduction to the waiting period. Canadian Blood Services then submitted an application to reduce the MSM eligibility criteria from five years to one year in March 2016. In 2016, Health Canada approved our request to reduce the waiting period for MSM from five years to the one year and the change was implemented nationally. This change was based on scientific evidence and supported by input from stakeholders. In December 2018, Canadian Blood Services and Héma-Québec both submitted applications to Health Canada to change the eligibility criteria of donors to reduce the waiting period from one year to three months. Health Canada approved the request in May, and the change took effect on June 3.
These incremental changes are important steps towards being as minimally restrictive as possible while also maintaining the safety of the blood supply.
Narrative 3: “There is inadequate data to support individual risk-based assessment for MSM blood donors as an unviable approach to risk reduction.”
TS: Some clinics in Europe use individual risk-based assessment via physician interviews prior to blood donation. These policies are not a blanket ban on MSM or any particular donor’s sexual orientation, but instead are based on a donor’s specific sex behaviors and the associated HIV risk, regardless of gender or orientation. I don’t believe this practice is widespread, and it is important to thoroughly analyze whether or not there is an increased risk in advance of more widespread adoption of these systems. More data is never a bad thing, and Canadian Blood Services is currently researching the feasibility of this approach with a grant from Health Canada.
CBS: New research must be done to generate the evidence required for low risk groups to be identified and included as eligible donors while maintaining the safety of the blood supply for patients.
That’s why Canadian Blood Services, in partnership with Héma-Québec and with funding from Health Canada, is supporting 15 research projects investigating various aspects of blood and plasma donors’ eligibility criteria and screening process.
The goal of this unique research funding program is to generate adequate evidence to inform alternative screening approaches for blood and plasma donors, which could evolve the current eligibility criteria for men who have sex with men.
Narrative 4: “The reason for the ban is due to systems providing false negatives when testing blood – and thus the ban is valid.”
TS: The systems are incredibly advanced, and the risk of a false negative is quite low. With current tests, the window period for bloodborne infections to become detectable is way shorter than would justify a lifetime or yearlong ban. The true primary reason for the ban is stigma, and I am excited that Canadian Blood Services is collecting the data necessary to convince Health Canada to move toward a less discriminatory policy.
CBS: We test every donation for several infectious diseases, including HIV, hepatitis B and hepatitis C. While our technology is sophisticated, there is a brief period shortly after infection when HIV is not detectable. If an individual were to donate blood during this “window period” in the early stages of infection, our testing process would not detect the virus and that donation would be infectious to a patient.
Despite its sophistication, no test is 100 per cent perfect. Tests can fail for technical reasons or because the pathogen has mutated. In addition to testing every donation, we rely on our donors to be honest about their exposure risks when completing the donor eligibility screening criteria, which is part of a multi-tiered safety system designed to protect patients.
Additional information about false reactive test results is available on our website.
For more information on this topic, including FAQs on blood donation for MSM persons and suggestions for other ways for MSM persons to help patients in need, please see the Canadian Blood Services website here.