Thicker Than Water - Slow Movement on Blood Policy
26 Oct 2018Published on Impact Ethics on October 26th, 2018.
Landon J. Getz provides an update on Canadian Blood Services’ progress in updating outmoded policies on gay blood donation.
In the past year Canadian Blood Services, and Health Canada, have made little progress on their blood donation policies for gay men. The Liberal Party of Canada made significant promises to the LGBTQ+ community in terms of the gay blood ban and have yet to deliver on these promises. As an update to the previous article here on Impact Ethics, I will begin by covering a quick history on the blood ban in Canada, move into what changes we have seen on this issue in the past year, and end on what needs to be done to improve the state of Canadian policy.
Currently, Canadian Blood Services requires a one-year sexual abstention period for gay and bisexual men (men who have sex with other men) prior to donating blood. Importantly, this policy has been updated from the five-year gay blood-ban and the previous lifetime ban. Largely, these policies stem from the AIDS crisis, and the Tainted Blood Scandal that occurred around the world and in Canada, respectively. The public was worried about contracting HIV from the blood donations of gay men, and Health Canada responded.
Image description: red blood cells
It has been a bit over two years since Canada moved from the five-year blanket ban to the one-year deferral period. Since that time, many advocacy groups and an E-petition have argued that the 1-year ban is still not backed by science. Largely, this is because they argue, and I agree, that a blanket ban on gay blood does not accurately reflect who is a “high-risk” HIV donor. Further, this can perpetuate the idea that gay men are sick/carry disease, which leads to further stigmatization and “othering” of this group. Canadian Blood Services has noted that they are reviewing research in order to safely lower the one-year ban to a three-month ban (in line with the current UK policy), and have conducted focus groups in considering a behavioural-based approach to screening. Behavioural-based approaches are those which screen blood donors not on their sexuality, but on the behaviours which put them at risk for HIV infection.
Here’s what the science says. Many of the tests available for HIV detection have sensitivities and specificities that approach 100%, meaning that missing a contaminated sample is very unlikely after the window of detection (two-weeks from infection). Further, previous reductions in blood-bans have not resulted in significant increases in blood contamination. In fact, a study in 2013 showed that when the UK changed their policy from a five-year to a one-year deferral in 2011, the number of blood contamination increased only marginally – to one contaminated sample every 455 years – while it made 46% of men who have sex with men eligible for blood donation. More importantly, reduction to the three-month deferral period is working well for the UK.
Italy and Spain have implemented behavioural-based screening approaches, which have been supported by the American Red Cross and American Association of Blood Banks, and screen all individuals (including gay men) into “low-risk” and “high-risk” groups based on their sexual behaviours. For example, individuals who are in long-term monogamous relationships, or practice regular safe sex, are unlikely to have contracted HIV that would be undetectable at the time of donation and are therefore labelled “low-risk”. On the other hand, individuals who have unprotected sex, or are engaged in anonymous sexual encounters, are more likely to have contracted HIV and are labelled “high-risk”. Currently, this approach is working in Italy and Spain and increases the number of eligible donors while preventing the further stigmatization of gay men.
A behavioural-based approach is the ideal option for reducing the stigmatization of gay blood, as well as increasing the number of potential donors, while still protecting the blood supply from HIV contamination. Canadian advocates, including BloodWatch, support a decrease in the deferral period to three-months, but agree that a behavioural-based approach is preferable. Importantly, the diagnostic tests which currently screen for HIV are incredibly robust tools, and with proper donor screening and blood testing, Canadian Blood Services can ensure that supplies remain safe.
Most importantly, as I have argued before, Canadian Blood Services needs to work quickly to implement better policy as blood shortages continue to be a problem. It is my, and others, hope that this policy can change soon, and Canada can become a world-leader in blood donation policy for gay men. Gay blood ban policies are based in an outdated and unsupported fear of blood donation from gay men. Therefore, we must work faster to update our policies to ensure our blood donation policies so as to prevent stigmatization, as well as ensure that our blood supply remains safe, and our policies are backed by science.
Landon J. Getz is a gay man and a Ph.D. Candidate in the Microbiology and Immunology Department at Dalhousie University @landongetz