HIV activists at Vancouver’s ninth annual Gay Men’s Health Summit challenged Canadian Blood Services’ (CBS) ongoing — albeit shortened — ban on gay men giving blood, Nov 7.
Health Canada’s new blood donation policy — which replaced its lifetime ban on men who have had sex with men once since 1977 with a five-year deferral — took effect on July 22. Under the new policy, men who refrain from having sex with other men for five years are now eligible to donate blood.
The gay blood ban was implemented in the 1980s after the national blood supply was contaminated with hepatitis C and HIV, infecting more than 1,200 people with HIV and more than 25,000 with hepatitis C. The ban was enacted at a time when HIV testing was less reliable, but new tests, such as pooled nucleic acid amplification testing, can now detect the virus seven to 15 days after infection.
While the window period has shortened, it still presents a risk to the blood supply, says Don Lapierre, CBS’s manager of stakeholder relations.
“During that window period, if I were just infected today and I went to give blood tomorrow, then all of the recipients of my blood would then also become infected with HIV. But we would not know that because of the technology and the testing measures that are in place right now,” he told the summit.
However, Lapierre said, the five-year deferral drastically reduces risk of HIV infection to the blood supply.
“The incremental is less than one HIV-infected unit of blood entering the blood supply in every thousand years, so that was obviously very compelling evidence to present to Health Canada,” he said.
“On a purely scientific level, we know that a one-year deferral would equally protect from risk,” he acknowledged. “But we have to move through this in sort of baby steps, if you will, in order to be able to be granted the right to be able to change the policy.”
Some audience members were unconvinced.
“There’s something about protecting the rest of the population from gay men,” said Len Tooley, who asked if there were any other populations who are excluded based on identity.
“We look for travel to areas where malaria may be occurring, for example,” replied Margaret Fearon, CBS’s executive director of medical microbiology. “We ask about behavioural practices which may put folks at risk for HIV or hepatitis B. We ask whether folks have lived for specific periods of time in the United Kingdom during the variant CJD outbreak, because that may put them at risk for variant CJD.”
Prior to its change in policy, CBS consulted with stakeholders, including representatives of the queer community, as well as patient groups composed of people whose lives depend on blood and blood products.
Jennifer Breakspear, executive director of Options for Sexual Health and co-chair of CBS’s MSM deferral policy working group, said the end goal is a gender-neutral, behaviour-based survey.
“The threat is not who you are and who you love; the threat is about how you perform an activity and does that activity threaten the activity of your blood,” she said. “That is where I hope we’re getting, though we weren’t being offered that as an option.”
Breakspear said that during the course of discussions she learned that it’s Health Canada — not CBS —preventing gay people from donating blood.
“We were told that the best they would accept or consider is a five-year ban, so I see this as incremental progress. And in fact when Health Canada came back accepting this submission they gave a number of conditions they put on Canadian Blood Services that you can do this but you need to do the following things while you are doing it. You need to collect all this data demonstrating the blood supply is still safe. You need to show us that it brought more young people into your clinics.”
“Advocacy and activism needs to continue, and as it has been mentioned already and I’ll just restate it: Canadian Blood Services does not dictate this policy,” said Patrick Loftus, CBS’s medical services coordinator.
Loftus urged audience members to forward their comments, concerns and questions to Health Minister Rona Ambrose in order to “keep the issue on the front burner.”
Both Lapierre and Fearon, however, confirm that a directive to look at a five- to 10-year deferral came from the CBS board of directors and not Health Canada.
Blain Butyniec denounced the five-year deferral as “discrimination-light” and accused CBS of advocating for a fear-based policy rather than something rooted in science.
“I’m saying you have this discriminatory policy against gay men because of this fear of them all having HIV, and I’m saying that in Manitoba it’s actually only about 20 percent of new cases are from within the MSM community, so should you not be looking at barring heterosexuals from donating in Manitoba?” he asked the panellists.
“I’m not the epidemiologist there, but depending on which data you look at, MSM are many, many, many times more likely to be HIV-positive than a man who doesn’t have MSM activity,” replied David Page, executive director of the Canadian Hemophilia Society.
“Using the science is how we’ve been able to persuade Health Canada to start leaning away from indefinite deferral to a five-year deferral,” Fearon said. “This is just the first step, but they are going to want proof that what we’ve now implemented has not impacted on safety.”
Page said patient groups would be willing to consider reducing the five-year deferral if certain conditions are met.
“The first would be the development of pathogen reduction processes for fresh blood components. They exist in Europe for platelets,” he said. “We expect them to be here very soon for platelets and possibly plasma. Red blood cells are going to take a bit longer, but they will add a third level of safety after donor screening and testing.
“And then a message which you might not like but I think something which is quite realistic: it would be a reduction in the transfusion-transmitted infection rates among MSM to levels that are comparable to males without a history of MSM activity. That would certainly change the whole ball game.”
Wayne Robert, executive director of the Health Initiative for Men, said he would like to see health organizations move beyond defining gay men only by their prevalence of HIV.
“Right now that’s the only information you have to work with because nobody’s done the work to put it in the census to talk to gay men about the entire spectrum of their experience,” he said. “One of the comments was ‘If the prevalence levels were more similar’; well, I don’t know how’d you answer that question if you don’t have any information on how many gay men exist. All you have is how many gay men have HIV.”
Sexually active gay and bisexual men in the Lower Mainland who wish to donate blood are able to do so at netCAD, the research arm of CBS, which uses the blood for research and analysis rather than transfusions.