In our latest installment of Evidence for Democracy's Network of Experts Panel, our experts discuss Canada’s deferral on blood from men who have sex with men (MSM), commonly known as the “gay blood ban”.
Over the last month, the Canadian Blood Services (CBS) has widely publicized that the country's blood supply is critically low. However, Health Canada continues to impose a ban on blood donations from sexually active gay men independent of relationship status or other risk factors. Though the previous lifetime ban has been lifted, MSM are currently required to abstain from sex with men for five years before donating. CBS is engaging in public consultations around the highly controversial policy, and examining changing the deferral period to one year.
We asked our experts:
"In your view, is the ban on blood donation by men who have sex with men justified by empirical evidence when considering the current state of HIV research and diagnostics? Do you think the policy should be revised, and if so, how?"
Dr. Stan Houston is the director of the Northern Alberta HIV Program and a Professor of Medicine & Public Health at the University of Alberta.
Current policies around blood donation are still influenced by the circumstances that prevailed early in the HIV epidemic, many of which have changed fundamentally over the past 30 years. The probability of HIV infection is now by no means limited to men who have sex with men, but is distributed to a much greater extent among other "risk groups" and the general population. Testing for HIV has advanced markedly; in particular, nucleic acid testing which is now routine in the Canadian Blood Service (CBS) shortens the "window period” between infection and detectability so that the risk of transmission during this period is almost infinitesimal. Finally, HIV has changed in both reality and perception from a fatal disease to a disease that is easier to manage and with a better prognosis overall than diabetes.
The choice of five years of abstinence required for men who have sex with men to donate is arbitrary and not based on a scientific estimate of transmission risk or the properties of the current screening tests. The extremely high sensitivity of current testing would not be expected to increase further after 3- 6 months have elapsed from the time of a risk exposure (sexual contact). It is my understanding that CBS, having made the reasonable decision to accept blood from men who have sex with men, chose 5 years as a strategic compromise they felt necessary to gain acceptance for this policy change.
Monique Doolittle-Romas is the Chief Executive Officer of the Canadian AIDS Society (CAS), a national coalition of community-based AIDS organizations dedicated to strengthening the response to HIV/AIDS across all sectors of society.
Over the past months, we heard time and time again from Canadian Blood Services (CBS) that Canada’s blood inventory is in danger of running extremely low. As of right now, the blood inventory is at its lowest since 2008. From previous research, we know that over half of Canadians will require blood for themselves or for a family member over the course of their lives. And yet, a mere 4 percent of eligible donors donate their blood. Which leaves us with one important question – how can we grow our current blood supply for our sake and for the sake of future generations?
My belief, shared by the Canadian AIDS Society, is that one of the solutions to the current blood shortage would be to lift the current 5-year deferral period for MSM.
CBS currently uses state-of-the-art nucleic acid testing technology that allows for early detection of HIV infection in blood donations, which means the “window period” is reduced to less than two weeks
. In light of today’s screening approach, it would make the most sense to impose a 6 to 12-months deferral policy dependent on risk assessment, rather than on sexual orientation. This screening system would ensure the focus would remain exclusively on sexual practices and behaviours, not on specific individuals belonging to marginalized groups.
Dr. Mark Wainberg is the director of the McGill University AIDS Centre at the Montreal Jewish General Hospital and a Professor of Medicine and Microbiology. Named to the office of the Order of Canada for his work, his research focuses on HIV eradication and drug resistance.
The so-called “relaxation” of the ban on gay men as blood donors in fact requires that all such individuals become celibate. It is difficult to understand how this policy is anything other than discriminatory, especially given that there are perennial shortages of donated blood. Why, for example, should gay men who are in long-term monogamous relationships not be eligible to be blood donors? If the argument is that some the partners these men may not be monogamous, thereby potentially infecting a would-be donor, should not the extremely effective screening procedures that are now used throughout Canada to screen donated blood rule out any potential danger? These ultrasensitive measures had not yet been developed at the time that the ban on gay men as blood donors was first introduced in the 1980s.
In reality, substantial progress has been made in virtually all areas of HIV treatment and prevention over the past 30 years, and enough information about screening and transmission has long since been available to support a more inclusive policy. Yet, the blood donation policies in Canada seem to be locked in a time warp. There are reports that many monogamous gay men who are motivated to donate blood simply do so, but lie on the donation form about their sexual behavior. Is this really preferable to the implementation of a realistic, evidence-based, non-discriminatory policy?
E4D would like to thank our experts for their contribution, and helping advance informed discussions around public policy. Please direct media inquiries to firstname.lastname@example.org.