On April 28, Canadian Blood Services (CBS) announced that it would be changing its donor screening criteria to no longer ban men who have had sex with men in the last three months. The current policy updated previous ones that had banned men who had had sex with men at any time in the last year, last five years and before 2013, at any time after 1977.
When the new screening criteria go into effect in September, potential donors of all genders will instead be asked if they have had anal sex with new or multiple partners in the last three months. If so, they would be required to wait three months from when they last had anal sex before returning to donate.
All Blood Is Equal, a coalition of advocacy organizations, heralded last week’s news as a “long-overdue” change to a discriminatory policy.
Gary Lacasse, the executive director of the Canadian AIDS Society, has been involved in advocacy on this issue for many years. He’s happy about the change in policy, but says it doesn’t go far enough in addressing the historical stigma that CBS has perpetuated towards the queer community. Broadview spoke to him over the phone.
Emma Prestwich: Canadian Blood Services says that they’re focusing on sexual behaviour that’s associated with higher risk among all donors, rather than sexual preference. Are you satisfied with that explanation?
Gary Lacasse: I’m not satisfied with that explanation because the practices that they are going to be weeding out through the behavioural questionnaire are primarily men [who have] sex with men and others who identify as male.
EP: Canadian Blood Services says that anal sex is still a higher source of transmission of HIV than other forms of sexual activity. Does that square with your understanding?
GL: Science does say that, but there are mitigating circumstances that reduce the risk that are not on the questionnaire that can be included to ensure safe blood supply going forward. What CBS are missing is that this is a great learning and capacity development question for people coming in to give blood and to transfer some knowledge about prevention. So I think that that should be included in the objectives of giving blood — to have a natural space, because the behavioural questionnaire is based on behaviour, to be able to ramp up knowledge and transfer capacity-building materials to people who may be at risk.
EP: What other factors should be considered?
GL: Have you had penetrative anal sex? Did you use a condom or not? Condoms are a barrier that works 99 percent of the time for pregnancy. If you’re using a condom during anal sex, there’s a reduced risk of transmission of HIV and other STIs. And that should be a secondary question to the anal sex one.
EP: Can you talk more about the role of pre-exposure prophylaxis ( which people at risk of contracting HIV can take to prevent getting the virus) in this discussion?
GL: The issue of pre-exposure prophylaxis (PrEP) is that they do not have the scientific equipment at the moment to disassociate PrEP from the blood to test it for HIV. From what I understand, that equipment does exist. So we are saying to stop the ongoing stigma and hurt that they’re doing going forward, it would be good to maybe accelerate the purchase of that type of machinery. This government should have taken that into consideration of Health Canada and said, OK, this has to be done. But they did not. If they really had at heart the psychological and mental health of LGBTQ people, they would have expressly demanded that CBS and Héma-Québec update their equipment to be able to ensure that people using PrEP would be able to donate.
EP: If someone is using PrEP, they wouldn’t necessarily be excluded, right?
GL: They are automatically excluded. And after, they have a three-month [editor’s note: four-month] waiting period after discontinuing their treatment to give blood.
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EP: CBS is often overly cautious when it comes to screening out donors who might be at risk for other conditions, including where they lived at certain points in time, which country their parents were born in, etc. There are a lot of screening criteria that could exclude people from certain communities from donating. Do you see this as different from that?
GL: No, because look at the time it took for them to react to basic science and their perception of risk going forward. But they do rely on science because somebody who’s living with diabetes has been able to give blood now for the last year, which they were not allowed to before.
There are a few updates that have happened in the last year based on science. But what I’m saying is that it took years for them to listen to the science. We have the most advanced and secure blood system in the world. And still, it’s steeped in homophobia. And why is Héma-Québec still lagging [on eliminating gender-based restrictions]? The science is very clear that this behavioural risk causes less harm going forward and keeps the security of the blood system at the same levels. So why did Quebec not go further into it? We’re continuing the harm and the stigma that men who have sex with men have been living with.
EP: What is the next step in terms of advocacy on this issue?
GL: I think and I hope that the discussions that we’ve been having for the last couple of decades will continue in a meaningful way and a more engaging way with all stakeholders at the same table, so that we can continue this discussion to change the optics and to change also the parameters around blood donations in Canada to ensure that they stay safe without harming people as we go forward and continuing stigma to specific populations.
This interview has been condensed and edited for clarity.
Emma Prestwich is Broadview’s digital editor.
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