In 2016, Canadian Blood Services reduced the blood donation deferment period of men who have sex with men (MSM) from five years to one. In this presentation to the House of Commons Standing Committee on Health, Gary Lacasse, Executive Director of the Canadian AIDS Society, makes the case for a behaviour-based screening policy for blood donations rather than one that focuses on populations based on sexual orientation and gender.
Chair, Vice-Chairs and members of the Standing Committee on Health:
My name is Gary Lacasse and I am the Executive Director of the Canadian AIDS Society (CAS). Thank you for inviting CAS to appear before your committee at its inaugural meeting to discuss the current blood donation restrictions imposed on men who have sex with men (MSM).
The Canadian AIDS Society is a national coalition of community-based AIDS service organizations dedicated to strengthening Canada’s response to HIV/AIDS, which includes ongoing collaboration with community partners and Canadian stakeholders to monitor and maintain the safety of Canada’s blood supply, particularly since the 1997 release of Justice Krever’s report of the Commission of Inquiry on the Blood System in Canada.
Over the years, the Canadian AIDS Society has worked closely with Canadian Blood Services (CBS) and other stakeholders to realize the July 2013 change to the blood donation deferral policy affecting men who have sex with men (MSM) from indefinitely to a period of five years (since last sexual encounter). At the time, we saw this change as a positive incremental step toward a deferral policy that would ultimately focus on gender-neutral, behaviour-based risk factor criteria rather than on sexual orientation.
Since then, CAS has continued in its collaborative and consultative role with CBS to review the evidence and scientific data collected over the last several years, and we supported Health Minister Philpott’s announcement in June 2016 to move to a one-year deferral as a step in the right direction with a view to ultimately removing any remaining barriers to MSM blood donations.
The long-standing CAS position on this issue is quite simple and straightforward. We believe that there should be a behaviour-based screening policy for blood donations rather than one that focuses on populations based on sexual orientation and gender.
In essence, CAS continues to advocate for a safe blood supply that is also respectful of human rights.
The fact is that screening guidelines have been, and remain, discriminatory. For both male and female donors, the current screening questions in CBS donor questionnaires single out specific population groups, in particular men who have sex with men, regardless of their actual behaviours and practices.
For male donors the screening questionnaire asks: In the last 12 months, have you had sex with another man?
For female donors: In the last 12 months, have you had sex with a man who, in the last 12 months, had sex with another man?
Replying in the affirmative to this question renders one ineligible to donate blood.
Similarly, transgender persons are also subject to a screening policy that discriminates on whether or not a trans person has undergone gender confirming surgery — regardless of their risk behaviour.
The current deferral period, which is not evidence based practice, operates by assuming that certain groups are more likely to taint the blood supply. CAS has and continues to advocate for studies to provide behavioural research evidence to support the move towards non-discriminatory screening criteria based on behavioural risk. With behavioural research, it will be possible to gather data on low versus high risk donors based on their sexual behaviour, irrespective of their sexual orientation or gender identity.
To this end, we welcome the recent announcement by CBS of a two-day meeting to be held in January 2017 with national and international stakeholders to identify research priorities for closing knowledge gaps that impact donor eligibility for men who have sex with men. The stated goal of the meeting is to examine alternative screening approaches for blood donors and alternative technologies to provide data to change the current donor eligibility requirements.
There is currently no international consensus on deferrals for MSM. Many countries such as the United States, the United Kingdom, Australia, New Zealand, Sweden and the Netherlands have or are implementing a one-year deferral. Others such as Italy and Spain have no deferral periods for MSM preferring to assess donor risk through specific behaviours.
In conclusion I would like to emphasize that stigma and discrimination remain key concerns and barriers in our struggle to reduce and ultimately eradicate HIV transmission in this country.
Despite the reduction in the deferral period to one-year since a last sexual encounter, this restriction applying to MSM blood donors continues to foster a culture of discrimination and stigma that hinders our ability to reach our goal.
Over the years, CAS has consistently advocated for a scientific evidence-based approach and worked closely with Canadian Blood Services and various stakeholders to create a safe blood system without discrimination against certain groups.
Even though we are not there yet, in recent years we have certainly been moving in the right direction — from a total ban of MSM in the past, to a 5 year deferral period in 2013 and moving to a one-year deferral period implemented this past August.
In the near future, we look forward to scientific and behaviour-based alternative screening approaches for blood donors, maximizing the use of new available technologies, to change donor eligibility requirements to create a safe blood supply that is also respectful of human rights.
This is a realistic and achievable goal.
Thank you once again for the opportunity to provide our views on this important matter.