While much of the hysteria that surrounded HIV/AIDS in the 1980s and ’90s has dissipated over the years, there still remains pockets of paranoia and fear in certain segments of society, especially when it comes to gay/bisexual men – and other men who have sex with men –donating blood.
In the late 1990s the Canadian Red Cross – then the principal agency responsible for the collection of blood to be used in transfusions – was hit with a huge tainted blood scandal in which thousands of Canadians, hemophiliacs and trauma patients were infected with HIV and Hepatitis C as a result of infected blood and plasma entering the system. As a result, the Red Cross was removed from being the agency responsible for blood donations and the Canada Blood Services (CBS) was established in 1988 to fill the void.
From the outset (since 1977), CBS had a policy that barred ‘high risk’ individuals, which included men who had had sex with men, from ever donating blood. Various agencies, such as the Canadian AIDS Society and Egale Canada, lobbied to have this lifelong ban rescinded, citing evidence that with the proper post-donation treatment any pathogens that might be present in the blood supply would be neutralized, rendering the supply safe. These organizations also maintained that any blanket policy prohibiting gay men, and men who had sex with men, from donating blood was discriminatory, and does not take into account actual behaviours but relies solely on orientation. It did not matter to CBS if a potential donor had consistently practiced safer sex, or whose sexual practices were low risk for HIV transmission; the mere fact that an individual had had sex with another man at some point was grounds for denying that individual the ability to donate blood.
Of course technology has changed in the last 26 years. It is now wholly possible to ‘screen out’ infected blood and/or to have systems in place through which all donations pass that would assure the supply is safe. CBS, for whatever reasons, has consistently refused to rely on this proven technology despite several other countries doing so, although it, along with Hema Quebec, did ease the lifelong ban in 2013, allowing gay men to donate five years after their last sexual contact.
In the U.S., the federal Food and Drug Administration (FDA) recently recommended that restrictions be reduced to allow men who have had sex with men to donate one year after their last same-sex sexual contact. Australia and Germany, and other Western countries, have had similar policies in place for some time.
The FDA referenced various scientific studies that indicate the move to the one-year deferral will not create risks to the blood supply. It has been projected that the new FDA policy will increase the blood supply by hundreds of thousands pints per year.
In a statement released in December 2014, CBS said it was closely following the American developments and would "continue to learn about the process" before any decision to further update its donation criteria was made.
CBS went on to say "[a]t this time, Canadian Blood Services is collecting scientific data and undertaking additional stakeholder consultations to inform [the] next steps for Canada’s policy."
The science is clear that HIV and hepatitis pathogens can be effectively eliminated from the supply through relatively simple means, including the process of rendering whole blood into the plasma used in transfusions. It is not as if the blood taken from Person A is directly injected into Person B. Following donation, the various blood donations obtained go through a whole screening and, one could say, cleansing process before being placed into our country’s blood reserves.
Of course, every precaution to ensure our blood supply is safe should be taken. This goes without saying, I would think. But the ban against gay/bisexual men, and other men who have had sex with men since 1977 – be it lifelong or five years – is draconian, an over-reaction. It is a textbook example of discrimination based on sexual orientation. Because you have had sex with another male, regardless of what form that sexual contact may have taken, and are therefore automatically denied the privilege of donating much needed blood, cannot be described as anything less than discriminatory.
Clearly there are specific high-risk activities, when it comes to the transmission of the human immunodeficiency virus (HIV), which can lead to AIDS. Amongst them is sharing needles and even crack pipes, unprotected sex with an infected person (male or female), and specific sexual behaviours, such as unprotected anal intercourse (or barebacking). We all know this. In an ideal world (well, in an ideal world we wouldn’t have HIV/AIDS or other sexually-transmitted infection in general) those who know they have engaged in high-risk behaviours, be they sexual or drug-related, would voluntarily opt out of donating blood. You would think that be the ethical, one might even say moral, thing to do. But people don’t. That reality is something which the CBS, Hema Quebec and Health Canada are acutely aware.
While I understand the reaction to ban (to the best of my knowledge, female sex-trade workers do not face the same, although I believe intravenous drug users do), it still comes back to the policy being discriminatory against men who have sex with men, whether we self-identify as gay or not.
As it is, the current policy is imperfect. People lie. They will lie about their sexual orientation. They will lie about their sexual history. How does the current Canadian – or any other country’s – policy protect against that sad reality? The fact of the matter is some gay men who engage in risky sexual behaviour (but not all), and some other individuals whose behaviours could reasonably be deemed a risk to the supply (again, not all) donate blood. And yet we have not had any tainted blood enter the system for years, that we know of.
That is largely due to effective screening processes being in place. Tests are conducted on donated blood, and any blood found to contain pathogens is either treated to neutralize those pathogens, or disposed of. That makes sense to me. Banning well-meaning individuals from donating blood because of who they are does not.
I am a physically healthy gay man. There is nothing ‘wrong’ with my blood whatsoever. I used to donate blood regularly back before the original ban – it just seemed to me to be a civic duty. When the ban came into effect, I likewise saw it as my civic duty to respect that ban, even while I disagreed with it. At the time I felt I understood the rationale behind it.
As already mentioned, the technology has evolved considerably to a point where it really should not matter whose blood is being donated since the donations can be anonymously screened following any donation and the appropriate action taken. So why the policy? I suspect, being the cynic I am at times, it is tied up with costs. Obviously, screening XX amount of blood is more expensive than screening only X amount. Is the policy a cost-saving measure? And what price can one put on ensuring a safe supply?
