Canada's 'discriminatory' blood ban being replaced by screening based on sexual behaviour for all donors

A policy change years in the making, on Thursday Health Canada approved Canadian Blood Services’ submission to eliminate the three-month donor deferral period for gay and bisexual men as well as some other folks in the LGBTQ2S+ community.

Moving away from a blanket ban, the national blood donor organization will screen all donors based on higher risk sexual behaviours, regardless of gender or sexuality.

Canadian Blood Services (CBS) says it plans to introduce the new behaviour-based questionnaire approach “no later” than Sept. 30. It will apply to both blood and plasma donations, outside of Quebec.

It will mean that when all donors are screened before rolling up their sleeves, they’ll be asked whether they have recently engaged in anal sex in the context of new or multiple sexual partners within the last few months. If they have, they would not be able to donate until they had gone three months without engaging in that activity.

“We look forward to welcoming new donors into our facilities,” said Graham Sher, CEO of Canadian Blood Services during a media availability.

Health Canada, which acts as the regulator for Canadian Blood Services, took longer than the aimed 90 days to complete their review of the blood supply organization’s December submission to make this change, but Health Canada says their authorization “is based on a thorough assessment of evidence supporting the safety of the revised donor screening.”

Asked why it’ll still take months to see the screening process implemented, Sher said a main factor is that the agency had to wait for Health Canada to sign off on their planned approach before starting to train their staff.

“We have about 1,600 employees who are involved in donor-facing activities. And each of these employees is going to go through several hours of comprehensive training so that they can have appropriate conversations with all of our donors,” Sher said.

“We want to make sure our frontline staff feel equipped to have these sex-positive conversations in a respectful and meaningful way, so it’s a huge undertaking,” said the CBS CEO. “I recognize that people would like this to go into effect as immediately as possible. But I'm also very committed to us doing it well.”

POLICY HAS EVOLVED OVER YEARS

The policy started in 1992 as an outright lifetime ban following the tainted blood scandal that played out between the 1980s and 1990s and saw thousands of Canadians infected with HIV after receiving donor blood. During that scandal, the Canadian Red Cross -- which was the predecessor to Canadian Blood Services and Hema-Quebec -- failed to properly test and screen donors, resulting in thousands of Canadians being exposed to HIV through contaminated blood products.

During the nearly three decades since, the policy has been gradually eased, starting with a change in 2013 that saw the lifetime ban knocked down to a five-year deferral period. That meant, rather than outright refusing donations from men who had sex with men, or the “MSM” community as some have coined it, donations would be accepted only if the donor had not been sexually active for five years.

In 2016, the five-year deferral period was reduced to one year, and then in June 2019, the current three-month deferral period came into effect. This means Canadian Blood Services prohibits gay and bisexual men who have sex with men, as well as certain trans people who have sex with men, from donating blood unless they have been abstinent for three months.

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Earlier this year a pilot project was approved for plasma donations at centres in Calgary and London, Ont., provided donors have not had a new sexual partner or their partner has not had sex with another partner in the last three months.

The evolutions to the policy over the last several years were the result of Health Canada approving regulatory submissions, which included risk modelling showing it would be safe to do so.

As part of the latest review, Health Canada convened a panel of medical and scientific experts in the blood safety field to advise on the change, which is similar to a recent change made in the United Kingdom, and is expected to lead to no measurable increase in the risk of HIV transmission.

“Today's authorization is a significant milestone toward a more inclusive blood donation system nationwide, and builds on progress in scientific evidence made in recent years,” Health Canada said in a statement.

As CTVNews.ca has previously reported, amid questions about why the policy has been slow to evolve, Health Canada “required” two-year intervals between when the donor screening criteria could be updated to monitor potential blood safety impacts of the updated donor screening criteria, according to documents.

As has been the case for some time, every blood donation in Canada is tested for HIV. Under current testing capabilities, HIV can be detected in a “window period” of approximately nine days after infection.

A blood donor clinic pictured at a shopping mall in Calgary, Alta., Friday, March 27, 2020. THE CANADIAN PRESS/Jeff McIntosh

A blood donor clinic pictured at a shopping mall in Calgary, Alta., Friday, March 27, 2020. THE CANADIAN PRESS/Jeff McIntosh

Easing the amount of time impacted donors have to be abstinent for in the past has not resulted in an increase in the risk of transmissible disease, according to Canadian Blood Services.

Sher said that the reason the agency is still focusing on anal sex in their screening, is that the evidence shows that anal sex is still a “significantly higher risk factor for transmission of diseases such as HIV than is vaginal sex or oral sex.”

Canadian Blood Services operates blood donations in all provinces and territories other than Quebec, which is managed by Hema-Quebec. That agency was not involved in this submission, but has already been granted approval to move to a more inclusive screening process for plasma donations.

Sher said Thursday that the agency is mindful that changing their policy isn’t enough to repair the relationship with the queer community.

“For us we recognize this is an ongoing body of work…We recognize that trust building is a long process, the change in the policy being just one step towards that,” Sher said.

“Acknowledging and addressing the hurts and the harms that the previous policies have resulted in, is a very important part of repairing relationships, as we say, restoring and regaining trust.”

REMOVAL OF BAN CELEBRATED

Canadian Blood Services has been consulting with stakeholders including the LGBTQ2S+ community and patient groups throughout this process. For years LGBTQ2S+ advocates and those who are prohibited from donating have voice their frustration, saying the policy is discriminatory, homophobic, and not based in science.

Reacting to the news, the Community-Based Research Centre (CBRC) which has long pressed all involved to change its screening policy, said it’s glad to see Canada is “finally catching up to other countries,” but that more work needs to be done to dispel the stereotypes and misconceptions this ban perpetuated.

“Health Canada’s original policy was discriminatory and encouraged stigma and ignorance around queer men’s and trans people’s health. It also undermined Canada’s blood supply, which can run precariously low,” said CBRC’s Acting Executive Director Michael Kwag in a statement.

The federal government has been under fire for years, including from LGBTQ2S+ opposition MPs, for failing to follow through on their 2015 promise to lift the ban. Prime Minister Justin Trudeau has also been criticized for making recurrent pledges in recent years that the policy change was imminent.

Key cabinet ministers responsible for the file over the years have dismissed calls to force a change to Canada’s Blood Regulations rules unilaterally, saying the agency has a “limited role” to intervene and that it was up to Canadian Blood Services to ask for a change to the policy.

The Liberals did fund $5M worth of research projects that were aimed at helping bolster the evidence-based, decision-making process, including studying donors’ eligibility criteria and alternative screening processes. CBS has said this evidence, risk modelling based on Public Health Agency of Canada data, and also international research informed their 2021 submission.

Prime Minister Justin Trudeau stands with Minister of Labour Seamus O'Regan, Minister of Sport Pascale St-Onge, Minister of Tourism Randy Boissonnault and Liberal MP Rob Oliphant during an announcement on the ending of the Canadian Blood Services’ blood ban, in Ottawa, on Thursday, April 28, 2022. THE CANADIAN PRESS/Justin Tang

Prime Minister Justin Trudeau stands with Minister of Labour Seamus O'Regan, Minister of Sport Pascale St-Onge, Minister of Tourism Randy Boissonnault and Liberal MP Rob Oliphant during an announcement on the ending of the Canadian Blood Services’ blood ban, in Ottawa, on Thursday, April 28, 2022. THE CANADIAN PRESS/Justin Tang

The prime minister addressed the coming policy change in a press conference on Parliament Hill on Thursday afternoon, accompanied by some LGBTQ2S+ members of his caucus as well as Health Minister Jean-Yves Duclos.

“Our government welcomes this decision. It’s been a long time coming,” Trudeau said, adding that he agrees with many who feel the change “took too long,” and should have been made a decade ago.

“The current approach was discriminatory and wrong,” he said.

In their remarks, Liberal MPs Randy Boissonault and Rob Oliphant said seeing the blood ban end was affirming, because now all donors will be asked the same questions, and they thanked those in the LGBTQ2S+ community for keeping up the pressure to see this day come.

“Thirty years ago my first partner died of, of Aids. And in those intervening years, in those dark years there was huge stigma and I understand why Canadians were worried… But science evolved and social attitudes evolved, and our understanding evolved,” Oliphant said.

“They pushed, we pushed, and it’s been heard. Canadians can have confidence in their blood system and gay men or men who have sex with men can now donate blood and save another person’s life. What a gift that is.”

In a statement, the NDP critic and deputy critic for 2SLGBTQI+ rights Randall Garrison and Blake Desjarlais called the news "a long-overdue victory for men who have sex with men, community members and allies who have worked tirelessly for years to push the government to act."

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"Advocates against this discriminatory policy have been working to lift the ban for years. They should be congratulated for their ongoing, effective advocacy and tireless effort. Without them, the government would not be moving this important change forward," said the NDP MPs, vowing to assess the new policy once it comes into effect.

Out gay Conservative MP Eric Duncan, who gained notoriety in 2020 for challenging the government in the House over the policy and sharing his personal experience of being unable to donate, questioned why it’ll still be months before the policy change is implemented.

“Finally, after multiple delays Canada is one step closer to ending the longstanding and discriminatory blood ban in this country,” Duncan said. “It did not need to take this long. After years of delay, we are still at least five months away from this change taking effect. Discrimination like this should not take this long to resolve.”

DISCRIMINATION CASE CONTINUES

Questions over the policy and whether the federal government has discriminated against LGBTQ2s+ donors by upholding it, continue to play out at the Canadian Human Rights Tribunal.

In 2016, Christopher Karas brought a human rights complaint against Health Canada, alleging the agency discriminated against him on the basis of sexual orientation by denying him the ability to donate blood.

In June 2021, the federal government lost its attempt to block a Canadian Human Rights Commission inquiry into Health Canada’s role in the policy, essentially moving to remove the federal agency from the litigation.

Asked by CTVNews.ca whether the government, in admitting the policy was discriminatory, would stop fighting the matter, Trudeau said he knows there will be “legal consequences.”

“This will have far reaching consequences on a number of things... And yes, I'm sure there will still definitely be legal consequences that the Justice Department and others will be looking through, on how we move forward in a way that is consistent with this,” Trudeau said. “But we will always continue to fight for an end to discrimination, to move the yardsticks forward.”

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Gregory Ko, a partner with Toronto firm Kastner Lam, who is representing Karas, told CTVNews.ca on Thursday that while the move is “a historic achievement” for Canada, the complaint against Canadian Blood Services and Health Canada remains active “on account of the historic discrimination caused by the decades-long policy,” that they feel

Ko said they are also reviewing the policy change “to ensure that the new blood donor questionnaire does not have indirect barriers,” that would continue to prevent LGBTQ2S+ members from donating.

“We want to be mindful to ensure that any new questionnaire that is put forward does not reproduce the same stigmatizing nature of the original questionnaire, a questionnaire that targets for instance, sexual behaviors that map on to sexual orientation or gender identity, would still be of concern,” he said.