In the 1980s, at least 2,000 Canadians acquired HIV from blood transfusions in an event labelled “Canada’s worst-ever preventable public health disaster.” With the unfortunately strong association between HIV/AIDS and gay men at the time, the eligibility criteria was introduced that excluded any man who’d had sex with another man since 1977 from donating blood; this was embedded into Health Canada regulations in 1992.
The eligibility criteria evolved somewhat over the years, but remained a barrier to some gay, bisexual, and other men who have sex with men (gbMSM). In 2013, the criteria were updated so gbMSM had to wait five years after having sex with a man to donate blood, they were updated to a one-year wait in 2016, and updated again to a three-month wait in 2019.
Also in 2019, BMC Public Health published a study on gbMSM’s views on reforming blood donation policy in Canada, co-authored by CTN Investigators Drs. Daniel Grace, David Brennan, and Nathan Lachowsky, alongside Prevention Core Co-Lead Dr. Trevor Hart. Interviewing participants from CTN 300: The Engage Study, the team learned that updating the criteria to a three-month deferral period would not change the issues of fairness and equity in blood donation practices for gbMSM.
“The viewpoints of our participants around policy equity were guided by a general belief that differences in policy rooted in sexuality or identity, or behaviours closely aligned with identity, are inherently unjust and discriminatory,” said Dr. Grace, Associate Professor at the University of Toronto, Dalla Lana School of Public Health, Social and Behavioural Health Sciences.
Further research, published by the same journal in 2022, recommended that donation policy should change to an individual risk-based deferral policy that is applied to all donors regardless of sexual orientation or gender identity.
Another year, another change
Big change is coming. By the end of September 2022, there will no longer be blood donation eligibility criteria specific to gbMSM. Instead, everyone, regardless of their gender identity or sexual preference, will be asked about their sexual activity in the prior three months.
“This is a historic change to blood screening practices that no longer treats any sex between men as risky. This is a change that our communities have advocated on for well over a decade,” said Dr. Lachowsky, Associate Professor in the School of Public Health and Social Policy at the University of Victoria. “This change is also something trans communities have been pushing for. However, there are still many gbMSM (and people) who will not be eligible to donate blood. So, advocacy efforts will continue to ensure that the system does not exclude otherwise safe donors from contributing.”
Such exclusions may include people who have recently taken PrEP or post-exposure prophylaxis (PEP) — both incredibly effective methods of preventing HIV — as criteria will remain in place stating that people who take these medications will not be able to donate for four months following their last use. In addition, anyone who has had anal sex with new or multiple partners in the prior three months will not be able to donate blood for an additional three months. The reason behind these deferral windows is that, if HIV infection has been acquired very recently, the levels of the virus in the donated blood may be too low to be detected by the standard tests.
Finally, people living with HIV will still not be allowed to donate at all, even if they have an undetectable viral load.
Mending broken bonds
“This most recent change to remove the three-month deferment following a man having sex with another man in favour of behaviour-based screening for all donors represents an important milestone, but the work is not done,” explained Dr. Grace. “Considerable repair work is required by Canada’s blood operators to build trust with diverse queer communities and ensure the equitable and scientifically based application of deferent policies.”
Dr. Lachowsky believes this starts with an apology and an earnest centering of members of the 2SLGBTQ+ community within blood donation work.
“It is going to take time and commitment to repair the relationships and establish trust,” he said. “However, it is also important that Canadian Blood Services step up to work with everyone in Canada to reverse and dispel the stereotypes and discrimination that were instilled in the general public through their policies and practices. This is just as important a reparation.”
Interestingly, Héma-Québec — Quebec’s blood donation network — is not yet changing their screening policies to align with Canadian Blood Services. While they will be eliminating the three-month deferral period for gbMSM and trans women who want to donate plasma in 2022, their criteria for blood donation will remain the same until 2023.
“So, we are now going to have two very different systems and processes within Canada and that will undoubtably cause confusion and outrage,” said Dr. Lachowsky.
Looking to the future
It is without a doubt that this latest change to blood donation eligibility is a huge step in the right direction, and will hopefully only encourage more work to be done that could open the doors for even more people to donate around the world.
“It will be important to evaluate these changes in Canada and consider how we can use this evidence to advance changes with Héma-Québec and contribute to conversations with the many other countries who still specifically ban all gbMSM from donating blood,” said Dr. Lachowsky.
Canada Blood Services and other blood operators have also expressed interest in ongoing studies evaluating the impact of PrEP on blood screening assays, so if this is something you are working on, please reach out to them.
If you would like any information about donating blood and to stay up to date with the latest news and criteria, visit the Canadian Blood Services website.
You can also visit the Héma-Québec website for Québec-specific information.