Evolving blood donation policies for gay men
Blood donation policies are stuck in the past, critics say
On May 10, the Canadian Blood Services (CBS) issued an apology to 2SLGBTQIA+ communities for the role its former donor eligibility policy played in contributing to “discrimination, homophobia, transphobia, and HIV stigma within society.”
From 1998 until 2013, CBS had a lifetime blood donation ban for any man who had sex with another man, even once.
This ban then became a deferral period of five years, then 12 months, and finally, three months. Under their most recent screening policies updated in late 2022, both CBS and Héma-Québec ask every potential donor if they have had anal sex with a new partner or multiple partners in the last three months. Anyone who answers yes will not be allowed to donate blood at that time.
This new policy represents one of the largest changes in Canadian blood donation since the 90s.
Christopher Karas, a human rights lawyer, argues that despite the inclusive language, the policy’s fixation on anal sex is de facto discrimination.
“We're just not willing to understand that we're actually creating this double standard where we're putting gay men, bi[sexual] men at this higher standard than the general population,” Karas said.
In 2016, Karas filed a complaint with the Canadian Human Rights Commission alleging discrimination on the basis of sexual orientation by Health Canada and CBS.
Notably, CBS and Héma-Quebec were created in response to a public health disaster in which approximately 30,000 people were exposed to blood tainted with HIV and hepatitis C. These exposures occurred between 1980 and 1985, when blood donations were managed by the Canadian Red Cross. Following this, the federal government launched an inquiry into the Canadian blood system, often referred to as the Krever Inquiry, and created new regulations for the testing and management of blood donations. These hearings set the precedent that an abundance of caution should be exercised within the blood system.
At the time of the hearings, blood testing technology and HIV literature were underdeveloped.
“I merely want the same standard to be applied to me as it is someone else,” Karas said. “I don't see how it makes sense to exclude me specifically and not screen for vaginal sex for someone who might be taking much more risk.”
According to the Canadian AIDS Treatment Information Exchange (CATIE), anal sex carries an HIV exposure risk between five and 18 times higher than vaginal sex. However, vaginal sex can still result in transmission. It is estimated that one in every 1,250 exposures to HIV via vaginal sex will lead to the receptive partner contracting the virus. This risk can fluctuate significantly based on factors such as condom use, the presence of STIs during sex, timing of exposure, and tearing during sex, none of which are screened for.
Catherine Thibeault, deputy director of medical affairs for Héma-Québec, states that these factors are not screened for because they are considered to be “risk factors by association.”
“Héma-Quebec avoids surrogate risk factors for infectious disease transmission and asks questions that directly focus on the actual HIV risk behaviours, within the most significant risk of HIV transmission by sexual exposure,” Thibeault said.
As testing technologies have advanced, some wonder why the deferral period has remained at three months. Karas argues that the current deferral length acts as a deterrent for potential donors who are unwilling to abstain for three months.
“[The deferral period] was lowered to three months, but it's having the same effect as all of these previous policies,” Karas said.
HIV expert Dr. Patrick O’Byrne explains that the deferral period corresponds to the “window period” after HIV exposure when the virus cannot reliably be detected by tests.
“We need your viral load to hit a certain level when you acquire the infection for your body to detect that it's present and to produce antibodies,” O’Byrne said. He explains that with fourth-generation technology, HIV tests are now considered reliable 6.5 weeks after exposure. Third-generation tests could take up to 12 weeks.
According to CATIE, fourth-generation screening tests can detect HIV in 99 per cent of patients 44 days after exposure, and confirmatory testing can achieve the same results 58 days after exposure. These tests are standard across labs in Canada, including ones used to test blood donations.
“As a precaution, a slightly longer deferral period has been chosen, compared to the window period of infection,” Thibeault said. “For prospective donors, it is also simpler to consider a time period defined in months, as opposed to a precise number of days.”
This article originally appeared in Volume 45, Issue 4, published October 22, 2024.
