The gay blood ban is unnecessary, ineffective, and poorly targetted, internal documents from Canada’s public health agency suggest.
Documents obtained from Health Canada under the Access to Information Act show that screening is remarkably effective at catching HIV in donated blood, that recent changes to the rules designed to scale-back the blood ban have been largely cosmetic, and that screening based on lifestyle instead of gender and sexuality isn’t seriously being considered.
For nearly 40 years, Canada has banned men who have sex with men, their female partners, and trans people from donating blood, plasma and, often by extension, organs.
Since his electoral win in 2015, Prime Minister Justin Trudeau has called the ban discriminatory, unacceptable, and has promised to do away with it entirely. But he has not.
Pressure is mounting, within every party in Parliament— and some queer members in Trudeau’s own caucus—that the blood ban has to go now, not later.
The blood donation rules were drawn up in the 1980s, after Canada’s blood system infected more than 2,000 people with HIV. An inquiry found that government cost-cutting was to blame: a lack of testing, a lack of treatment, and blood sourced from shady avenues all contributed to the scandal.
Huge effort was taken to improve Canada’s blood system in the fallout of that debacle. Core to that plan was to establish the blood donation bodies: Canadian Blood Services and Héma-Quebec. Both are regulated by Health Canada, but exist independently. They got to work in trying to re-establish trust in the system and, on top of improved testing and screening, they banned gay men from donating blood.
In the last decade, the ban has faced opposition as being ineffective and anachronistic. But the ban hasn’t been dropped, only altered.
In 2013 Canadian Blood Services and Héma-Quebec dropped the outright ban, instead asking potential donors: “In the last five years, have you had sex with a man, even once?” It asked women: “In the last 12 months, have you had sex with a man who had sex with a man, even once in the last five years?” (Internal modelling from Héma-Quebec estimated in 2012 that “a change to a 5-year deferral would result in one additional HIV infection every 6,476 years.”)
That was the status quo when Trudeau took office in 2015, with a pledge to axe the ban entirely.
In office, his government abandoned that promise, instead moving the five-year deferral period down to one year in 2016.
The Health Canada, Canadian Blood Services, and Héma-Quebec documents, which range from 2016 to 2018, reveal that the changes had no substantial effect whatsoever and that Health Canada knew that it would impact only a “small minority” of the ineligible population. Canadian Blood Services reporting that “over 100 previously deferred donors have returned to donate.” Héma-Quebec reports that just 12 donors, who respected the one-year abstinence period, came to donate.
None of those donations tested positive for HIV.
Modelling done around the 2016 change suggested there would be 10 additional donations by HIV-positive people, which didn’t end up happening. “There has been no change in the [transmissible disease] rates...since the change,” the documents note.
From 2011 to mid-2018 the Canadian blood donor agencies caught 24 cases of HIV-positive blood being donated. It followed up with those donors to understand where the screening failed: Of the 11 who responded, one was HIV-positive and clearly ineligible to donate blood. One donor had a single same-sex encounter which he had forgotten, and which may not have been the source of his contracting of the virus; and another donor had an HIV-positive partner. Five of those HIV-positive donors, however, “did not acknowledge any risk” while three heterosexual donors reported “multiple sexual partners” but were not ineligible to donate.
Héma-Quebec reported that seven donations tested positive for HIV from 2008 to 2015.
In every case, screening caught the blood donations from HIV-positive donors. Health Canada acknowledges that it is able to detect the virus if the donor sero-converted at least eight days before donating. That accuracy means the “risk would be more than adequately covered by a one-year deferral.”
The risk of contracting HIV from the blood donor system, they calculate, would be 1 per 21.4 million units transfused—making an accidental transmission about half as likely as Hepatitis C, and nearly three times less likely than Hepatitis B.
The documents also cover how the two agencies handle transgender donors. After a lack of internal policy on the matter, new regulations were drawn up in 2016 that determined trans people who had not undergone gender confirmation surgery would be assessed by their birth gender; whereas donors who had undergone the procedure would be assessed on the gender they identify as. A trans man, then, would be subject to the same ban on men who have sex with men.
Health Canada notes in these internal reports that gay men are the hardest-hit by HIV, comprising about half of all new infections. But, they note, “individuals with diagnosed HIV infection are unlikely to present to donate blood, and prospective donors are asked about having a positive test for HIV.”
What’s more, Health Canada acknowledges that “MSM [men who have sex with men] are more likely to be aware of their diagnosis than other risk groups. (18% of MSM with HIV are unaware, compared with 20% with IDU (injection drug use) exposure and 28% with heterosexual exposure).”
In other words, the donor criteria makes a class-based distinction for gay men and their partners, who are more likely to know their HIV status; but makes no attempt to screen for heterosexual donors, who also represent a significant number of new HIV infections and are less likely to know their status.
The documents note that both Italy and Spain use lifestyle-based questionnaires, instead of banning an entire sexuality, to screen for potentially-infectious diseases.
On Monday, the United Kingdom announced it was moving towards a lifestyle-based screening, allowing gay men in long-term relationships to donate blood.
Canadian Blood Services and Héma-Quebec have long ignored question as to why they could not switch from a ban on queer people to a lifestyle-based questionnaire—one that interrogates the number of sexual partners of donors, or the frequency of unprotected sex they have. The documents reveal that the agencies have resisted such a questionnaire because it would reveal that their current donor base actually has a high risk profile.
“Gender neutral, behaviour-based screening criteria would result in excessive loss of currently donating safe donors, if all donors were subjected to the same set of questions and criteria,” the documents note. “For example, approximately 10% of first time and 5% of repeat donors have had more than one sexual partner in the last year.”
At the same time, the internal memos detail that “a larger impact on supply may be related to how CBS is perceived by potential blood donors, particularly by younger people, such as university students, who are most concerned about issues of social justice.” Outreach campaigns, they report, have been frustrated by the protests.
Student groups across the country have led boycotts of Canadian Blood Services and Héma-Quebec due to the blood ban. “They may be contributing to the small percentage of new, young donors recruited overall,” the documents note.
A 2014 survey done by the Canadian Blood Services suggests that roughly one-in-five Canadians are less likely to donate blood due to the ban.
Héma-Quebec was more optimistic, writing in one report that a one-year ban “is a more acceptable option for groups which represent the interests of men who have sex with men. As a result, we can expect at least less protests coming from these groups.”
That, largely, hasn’t happened. Opposition has still been stark.
“However,” the Quebec agency added, “a more important advantage comes from the fact that the new criteria will be much more easily justifiable with the general population, especially with those who abstain from donating blood because they consider the existing criteria to be unjustifiably discriminatory.”
That hasn’t happened either.
There is already a desperate demand for new donors. Meeting the demand for blood donations, they acknowledge, “will require substantial expansion of the donor pool.”
The consensus in the House of Commons is that the blood ban has to go immediately—Trudeau’s Liberals are the lone holdouts. As VICE World News reported in 2016, Ottawa has the power to remove the ban, under section 13 of the Blood Regulations, but chooses not to.
Last Wednesday, Conservative Member of Parliament Eric Duncan, the first openly gay MP from the party, castigated the prime minister. “All parties are united in ending this outdated stigma now, not in months or years,” Duncan told the House, noting that even the Canadian Medical Association opposes the current policy. “Will the prime minister finally keep his promise and put an immediate end to this discrimination?” he asked.
The prime minister lauded his own work, and pointed blame at the previous Conservative government—which left office five-and-a-half years ago—for not funding research on the matter. “When we got elected in 2015, we made the commitment to end the MSM blood ban, and we are working towards that,” he told the House.
Conservative Leader Erin O’Toole followed up on Duncan’s question. “There is science, and there are several other countries following this procedure and ending discriminatory bans now,” O’Toole noted. “Will the prime minister answer the serious question with a timeline to live up to the promise he made five years ago?”
Trudeau, again, sidestepped the question, stating only that his government has funded a dozen studies “to find the evidence necessary to eliminate it altogether.”
The New Democratic Party first began raising problems with the blood ban in 2008, and have consistently campaigned against it. In October, their health critic Don Davies put the question to Rob Oliphant, a Liberal MP who is, himself, gay and therefore banned from donating.
The ban, “is not based on science but on stereotype,” Davies argued. “We allow a sexually promiscuous heterosexual man who engages in dangerous activities to donate blood, but two gay men in a loving, stable, monogamous relationship are not allowed.” He called that the “most base stigmatization.”
Oliphant admitted he agreed “100%” with Davies. “It is not scientific. It is not right. It is wrong, and it is part of the legacy of discrimination,” Oliphant told the House. “I am really glad the member asked me that question because I wanted to get that out.”
The NDP also highlighted that the ban is particularly frustrating amid the COVID-19 pandemic. As MP Randall Garrison pointed out earlier in the outbreak, the ban “will also result in rejecting plasma donors, when plasma is so critical in emerging COVID-19 research and treatment.”
The Green Party and Bloc Quebecois have also come out against the blood ban.
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