anadian Blood Services’ updated donation eligibility criteria quietly came into effect Sunday across the Greater Toronto Area and Canada, amid criticism from advocates and experts who say the agency’s policies continue to stigmatize queer communities.
While the updated policies are a “step in the right direction,” they apply a 2SLGBTQIA+ “discriminatory lens” to blood donation criteria, said Jillian Schneidman, founder of Sex[M]ed, a not-for-profit organization dedicated to combatting sexual health inequities.
“They contain limitations and continue to disproportionately affect many within these communities,” said Schneidman, who is also a medical student at McGill University. “They really fail to fully drill down into the real mechanisms and behaviours of sexually transmitted and blood-borne infections.”
Beginning September 11, 2022, all blood donors — regardless of gender or sexual orientation — will be required to answer questions about their sexual behaviour during the screening process. Prior to the implementation of the new criteria, men who have sex with men were barred from donating blood unless three months had passed since their last sexual contact with men.
The updated criteria for eligibility stipulates that all donors who answer “yes” to having new and/or multiple sexual partners in the last three months will be asked whether they have had anal sex with any of those partners. If they have, they will be required to wait three months from the day they last had anal sex to donate blood.
Donors will not be questioned about vaginal sex or condom use — decisions that ignore critical health risks and further the exclusion of queer donors, said Christopher Karas, an advocate based Toronto. In 2016, Karas filed 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.
“Suggesting that the highest risk criteria are anal sex and multiple partners is stigmatizing. And it’s a clear indication these institutions have yet to adopt the latest scientific evidence,” Karas added.
Schneidman agrees that any unprotected sex of any kind — anal, vaginal or oral — can lead to the transmission of HIV and other STDs, and should be grounds for the deferral period. She added that non-monogamy doesn’t necessarily increase risk when it comes to STIs, especially for those who are in relationships with partners who are not new.
A spokesperson for CBS explained its screening questions can’t comprehensively screen each donor on their individual safe sex practices. The questionnaire is designed to be applied as broadly as possible to screen a large number of potential donors, and identify the possibility of new exposures to certain viruses within the window period of CBS’ testing platforms, the spokesperson added.
Before changes to eligibility, trans donors were screened based on their sex assigned at birth and could be deferred if they had undergone lower gender-affirming surgery. Under the new criteria, trans donors will not be asked where they have had lower gender-affirming surgery.
However, non-binary donors will still need to register as female or male. And donors who have had lower gender-affirming surgery are deferred from donating blood for three months after their surgery. Only after three months have passed will donors be screened using questions based on their affirmed gender.
“This policy is trans-misogynistic. It views trans women as men in a very problematic and anti-trans way,” Karas said. “It's been criticized as being a form of violence that continues to this day…It’s having very real consequences. We’re seeing a lower shoring up of our blood supply.”
The CBS spokesperson said the organization is working on changes to its policies in consultation with trans and non-binary community members as well as the registration software owner to improve registration and screening processes.
While some 2SLGTQIA+ people are excited to donate, many are still apprehensive, Schneidman said.
Schneidman added that CBS should launch educational campaigns about the updated criteria.“It’s not only about implementing the changes, but also making sure people are aware the changes are being made,” she said.
Karas said he fears he’ll never be able to donate, if blood donation policies don’t evolve past where they are now.
“It's been over six years that I’ve waited, and I’ve challenged this policy at the federal level. But we have yet to see the end of the [discriminatory practices] of this policy,” he added.
The spokesperson for Canadian Blood Services said the organization still has “considerable work” to do to build trust and repair relationships with 2SLGBTQIA+ communities. CBS recognizes that despite all donors being asked the same sexual behaviour-based questions, some of the screening criteria will continue to disproportionately affect gay, bisexual and other men who have sex with men, as well as some trans individuals, the spokesperson added.
“We also know that past and ongoing harm will not be erased with the removal of this eligibility criteria,” the spokesperson said. “We are committed to continuing to address systemic barriers, further modify our practices and policies and cultivate a diverse donor/registrant base and workforce that more fully and equitably reflects and serves Canada’s population. ”
Changes to blood donation criteria also come on the heels of varied reactions to a newly signed deal between Canadian Blood Services and Grifols, a private, international pharmaceutical company, announced Wednesday. The agreement allows for the commercial, for-profit collection of blood plasma from domestic donors, a move CBS said will afford “greater security of [plasma] supply for the country.”
“Canada needs its own end-to-end supply chain for immunoglobulins here at home — from plasma collection to manufacturing,” the spokesperson said, adding the agreement with Grifols was made following a comprehensive risk analysis on plasma and immunoglobulin security of supply, informed by a wide range of experts and others.
But advocates warn the deal could exacerbate supply shortages.
“We will see impacts on our voluntary blood supply…It’s a very concerning development. It’s something we should scrutinize and review,” Karas said. “We’re going to see a for-profit plasma collection industry grow here, and it’s most likely here to stay.”
Karas cited the Commission of Inquiry on the Blood System in Canada (known as the Krever Inquiry) a report that describes a public health disaster that occurred in the late 1970s and 1980s in which the national blood supply was contaminated with HIV and hepatitis C. The Krever Inquiry found that blood and plasma should be collected through voluntary, unpaid donations to prevent future crises.
