A Reflection on Blood Donation Policy in Canada
24 Aug 2017Published on Impact Ethics on August 24th, 2017.
Landon J. Getz reflects on the current sexual abstention period within Canada for blood donations by men who have sex with men.
Driving through Halifax during pride week, I noticed a Pride advertisement on the back of a city bus. It noted a headline from a Global News article titled: Canada’s limitations on gay blood donations ‘ridiculous’: HIV researchers. Currently, in Canada, men who have sex with men are prohibited from donating blood if they have had sex with a man in the year prior to their donation. Even though many LGBTQ advocates and HIV researchers are saying this deferral period on blood donation by men who have had sex with men is ‘ridiculous,’ Canadian Blood Services and Health Canada do not seem to agree. Approximately one year ago, the current 1-year deferral period policy replaced a 5-year deferral period. The anniversary of this policy change marks an opportunity to reflect on Canada’s blood donation policy and what it means for the LGBTQ community.
Historically, bans, deferral periods, and restrictions on blood donation by gay/bisexual men have been rooted in fear of harming patients by exposing them to contaminated blood. HIV was discovered in 1983, and from there new methods of diagnosis were discovered. Unfortunately, this did not stop HIV-infected blood from entering the blood supply, leading to what is known today as the “Tainted Blood Scandal.” Consequently, roughly 2000 Canadians were exposed to HIV via blood products in the early 1980s. However, a lack of policy and proper diagnostic testing procedures played important roles in this problem. While previously, diagnostic tests took months to diagnose HIV, modern tests can identify the virus in blood two weeks after exposure.
This two-week window gets right at the root of why a 1-year deferral period for gay/bisexual men is no longer necessary from an infectious diseases perspective. Selecting this duration seems arbitrary when we have confidence that we can detect HIV infection within two weeks. So, the question here is why Canadian Blood Services continue to impose lengthy donation restrictions for men in this group when the risk of HIV contaminated blood entering the blood supply exists only for two weeks after sexual contact. Canadian Blood Services states that their reason for maintaining the 1-year deferral period is that gay/bisexual men make up the largest proportion of individuals newly infected with HIV. However, sexual behaviours among gay/bisexual men vary greatly, and certain behaviours can significantly reduce an individual’s risk of exposure to HIV. Examples include having protected sex (using condoms), being in a monogamous relationship where both partners are HIV negative, and avoiding sexual encounters with anonymous individuals. While the statistics tell us that gay/bisexual men are the most likely to become infected with HIV, it does not mean that all men who have sex with men are at a high risk for HIV exposure. As well, Canadian Blood Services tests all donated blood samples via modern diagnostic tests for infectious disease contamination. If contamination does occur, the screening process prevents it from entering the blood supply.
For an organization whose slogans focus on how we can each give life, it is worrisome that a portion of the population is restricted from doing so by policy that, at best, seems no longer necessary. Especially considering the current blood shortage issues in Canada, we need to ensure that any prohibition on donation is for reasons that are worthy. The current policy seems to fail here because diagnostic testing has improved, such that HIV can be detected in the blood within two weeks of infection. Also, the risk of contaminating the blood supply with HIV can be reduced by screening for certain sexual behaviours, rather than simply screening on the basis of sexual orientation. Replacement of the 1-year deferral period is necessary because gay/bisexual men are interested in donating blood and not all are at increased risk for HIV infection. Further, gay/bisexual men are already stigmatized and policy that does not accurately reflect risks acts to further this stigma. The facts tell us a shorter abstention period from risky sexual practices would be sufficiently long to ensure a safe blood supply. Even further, for individuals who are taking appropriate precautions when it comes to protected sex, or who have been in long-term, HIV-negative, monogamous relationships, it hardly seems appropriate to have a deferral period at all. For a future of blood donation that is more based on facts, Canadian Blood Services must understand that current policy is not a worthwhile solution to infection control. As well, future statistics collected on HIV infections should be focused on sexual practices and behaviours rather than simply on sexual orientation. Finally, blood donation for men who have sex with men is already changing in places around the world. Canada's blood donation policy has changed before, and it is time for it to change again.
Landon J. Getz is a gay man and an MSc Candidate with Dalhousie University’s Department of Microbiology and Immunology. @landongetz