Discriminatory blood

Canada may follow U.K. and lift ban on MSM blood donation

On September 8, 2011, health ministers in the United Kingdom resolved to lift the indefinite ban on blood donations from men who have sex with men (MSM). Instead, a one-year deferral period was implemented, in which men who have engaged in same-sex sexual activity within the past 12 months are restricted from donating blood. The U.K. is joining other countries like Australia, Japan, and Sweden with this policy shift.

Canada still has an indefinite ban, which prohibits blood donation by all MSM since the year 1977, citing statistics that claim these men are at greater risk for HIV/AIDS. Canada’s current policy, along with those of other countries that prohibit blood donations from MSM, is mainly based on the fact that HIV infections are more prevalent among MSM relative to the population at large. Moreover, support for the policy has also been bolstered by the tainted blood scandal that affected Canadian blood banks in the 1980s, when numerous transfusion recipients became infected by HIV. There are now many groups that oppose the lifetime ban for MSM, such as the Canadian Federation of Students, the Canadian AIDS Society, and EGALE Canada, on the grounds that such restrictive policy is discriminatory and outdated.

There have been enormous advances in blood testing technologies that have reduced the risk of HIV-infected blood contaminating the blood supply. For instance, Canadian Blood Services and Héma-Québec – non-profit organizations that manage the supply of blood and blood products for Canadians – subject blood from all donors to rigorous testing before it can enter the blood supply. Although there is a “window period” of a few weeks wherein blood from newly-infected donors may give a false negative test result, many experts, such as those in the U.K., have concluded that a one-year deferral would be more than sufficient to account for this period.

Canadian Blood Services and Héma-Québec have been considering a similar move to shift to a definite deferral period for blood donations by MSM. The two organizations are independent of one another, but currently have the same policy in regards to MSM. In order to go through with such a policy change, they would have to be sure that the risk of blood contamination would not increase. Some studies have suggested that moving to a one-year deferral period would slightly increase the risk of infection. However, Dr. Norbert Gilmore, former professor and associate director of the McGill AIDS Centre, maintains that this difference would be too small to be of any significance. “The testing is of very high quality,” he said.

In 2010, Gilmore and three colleagues published a report in the Canadian Medical Association Journal that suggest the removal of the lifetime ban for blood donations from MSM. Their analysis concluded that “a five-year deferral period could maintain the same residual risk as indefinite deferral.” They also outlined that the very marginal increase in risk inherent with a one-year deferral period may be a cost outweighed by other gains. Lifting the ban would promote a less discriminatory image for Canadian Blood Services, and may increase the number of donors – both MSM and from the general population.

Adrian Lomaga, a McGill-educated lawyer who had pursued a case against Héma-Québec, mentioned that one of the effects of the current ban is that it “continues to [perpetuate] the stigma that HIV is a gay man’s disease, and that all gay people are promiscuous and carry disease.” He decided to delay his case, as he judged that there was a reasonable chance of the policy changing soon.

Lomaga and Gilmore both highlighted the double-standard of how Canada’s blood banks treat different risk factors. Whereas heterosexuals can be promiscuous and donate with no deferral if they claim to know the sexual backgrounds of all of their partners, a monogamous man in a same-sex relationship can never donate blood. In addition, blood donors are not asked questions about unprotected sex, and most other risky sexual activities only lead to six or twelve month deferral periods.

While Gilmore and Lomaga were both reluctant to blame discrimination for the longevity of Canada’s ban, Gilmore did say that he doubted such a strict policy would be applied to a heterosexual community.

While change is nearing, it seems unlikely that a monogamous gay man will be able to donate blood in the near future. In an interview with The Daily, Marc Germain, vice president of Medical Affairs for Héma-Québec, said this is partly due to the fact that more detailed and personal questions, about such things as safe sex and fidelity, would have to be added to an already long list of personal questions, thus making it more difficult to gather valid information.

There is, however, reason for opponents of the ban to remain optimistic, as Canadian Blood Services and Héma-Québec have been looking into alternatives to the indefinite deferral period. Germain expressed Héma-Québec’s view that a five-year deferral period would be optimal and safe, as it would not increase the risk of contamination. Héma-Québec does not control the donor restrictions, so they have petitioned the Canadian Standards Association (CSA) to allow for a five-year deferral period, and expect that it will be put to a vote at the CSA’s next meeting. Germain added that “the recent decision in the U.K. is helping.”