In a move LGBTQ2S+ advocates say is long overdue, Canadian Blood Services submitted an application to Health Canada on Wednesday to end the blood ban.
In the new request to overhaul the policy, Canadian Blood Services is asking its regulator to approve a change to its blood and plasma donor eligibility criteria that would allow blood donation clinics to stop asking gay and bisexual men as well as some other folks in the LGBTQ2S+ community whether they’ve had sex with a man.
Instead, they want to ask all donors regardless of orientation if they’ve engaged in higher-risk sexual activities, ushering in a sexual behaviour-based screening model for all donors regardless of orientation.
“We aim to be an organization that is inclusive and welcoming to all potential donors with minimal restrictions… This would allow us to precisely and reliably identify those who may have a transfusion-transmissible infection, regardless of gender or sexual orientation,” reads an update on the donation agency’s website announcing the submission.
As the blood donation policy currently stands, 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. 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.
Should this submission be approved, when donors are screened before rolling up their sleeves, they’d instead be asked whether they have recently engaged in anal sex in the context of new or multiple sexual partners within a certain time frame. It’s a move Canadian Blood Services says the evidence shows would allow more equity for donors while ensuring a safe supply.
“Sexual behaviour, not sexual orientation, determines the risk of sexual transmission of blood borne pathogens,” said Dr. Isra Levy, Canadian Blood Services' vice-president of medical affairs at the organization’s latest board meeting on Dec. 3.
Canadian Blood Services had been signalling this submission is coming for several months, and it’s now up to Health Canada to review. In confirming they have received the submission, Health Canada said Wednesday it has a target of 90 days to complete their review, but “timelines can vary depending on the completeness of the data provided and discussions with the organization.”
Should the change be approved, Canadian Blood Services is warning that it could take months after the review is complete to ensure staff are trained and ready to move to the new screening system.
“We certainly recognize that many in the… community are anxious to have the opportunity to donate and feel that this is long overdue, and we're committed to taking the time to get this right,” Levy said.
Canadian Blood Services operates blood donations in all provinces and territories other than Quebec, which is managed by Hema Quebec. That agency is not involved in this submission.
A CHANGE YEARS IN THE MAKING
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.
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, in order to monitor potential blood safety impacts of the updated donor screening criteria, according to documents.
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.
“Any future changes would be authorized only once Health Canada is satisfied that the changes are safe. Health Canada is steadfast in its commitment to protecting the safety of Canada's blood system…We are also committed to supporting blood and plasma donation policies in Canada that are non-discriminatory and scientifically based,” said Health Canada in a statement.
Canadian Blood Services has also been consulting with stakeholders including the LGBTQ2S+ community and patient groups throughout this process.
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.
Easing up on 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.
“We have more evidence than ever before… that indicates this change will not compromise the safety or adequacy of the blood supply. Currently the risk of HIV being introduced to the blood system is extremely low, and according to the evidence, the proposed change will not increase that risk,” reads their website.
FEDERAL COMMITMENT CHALLENGED
The federal government has been under fire for years for failing to follow through on their long-stated 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 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 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 has informed the 2021 submission.
“The fight for equity has been long and exhausting for the LGBTQ2 community and allies. I very much look forward to the ban being fully lifted,” Minister of Women & Gender Equality and Youth Marci Ien said in a tweet reacting to the news, calling the blood ban “discriminatory.”
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, the federal government lost its attempt to block a Canadian Human Rights Commission inquiry into Health Canada’s role in the policy.
Gregory Ko, a partner with Toronto firm Kastner Lam, who is representing Karas, told CTVNews.ca on Wednesday that the matter is proceeding and that they “remain eager” to assess Canadian Blood Services’ submission to better understand what the implications may be, including for future donors.
