Tackling Inequality: An Evidence-Based Proposal
Undoing the Ban on Gay Blood/Organ Donations
Authored by: the Queer Liberals Sponsored by: York South–Weston Federal Liberal Riding Association
Introduction
Since 1977, when the rapid spread of HIV occurred throughout Canada and the USA, blood donations by men, specifically men who had sex with men (MSM) has undergone intense scrutiny, culminating in a lifetime ban by the Canadian Blood Services/Héma-Québec (CBS/HM-QC).1
CBS/HM-QC, are the not-for-profit charitable organizations that manage the blood supply in Canada. They must submit any proposed changes in blood donation policy as regards any “operational change to the regulator [Health Canada] in order to demonstrate that it would not compromise the safety of the blood system”.2 To this end, Health Canada has the de facto final approval for any changes to blood collection or donation policy in Canada.
In December 2012, CBS/HM-QC submitted to Health Canada a new policy that would see the lifetime deferral of MSM donors changed to a five year MSM contact deferral. Health Canada accepted this new policy on 22 May 2013, and announced that it would come into effect 22 July 2013.3 Though a change, it is merely cosmetic. It is still unreasonable to expect anyone who engages in MSM (or who is sexually active) to be abstinent for a 5 year period for the sake of becoming eligible to donate blood/organs. Issues and consequences
Homophobia
As it stands, it could be argued that the current policy of a five-year deferral period for MSM blood donation is not rooted in scientific evidence, but in homophobia.4 Further to this, the fact that CBS/HM-QC discriminates against a group of people (gay/bisexual/bi-curious men) based on a stereotypical and prejudiced generalizations as to their perceived sexual behaviour (notably as to this one group being promiscuous and non- monogamous) is blatant discrimination.
Sexual orientation is one of the categories of personal characteristic against which that the s. 15(1) equality provision of the Canadian Charter of Rights and Freedoms provides legal protection. 5
Blood safety
We accept that one consequence of allowing MSM to donate blood is perceived to be that there is a potential for an increased chance that HIV could be missed in CBS/HM-QC’s blood testing. That perception does not sufficiently credit the fact that CBS/HM-QC “screens every donor and tests each unit of blood or blood product
1 "Chronology of events related to the MSM Policy." Canadian Blood Services. Web. 30 Aug 2013.
collected for a variety of transmissible diseases”6, including “hepatitis viruses B and C, the AIDS virus (HIV), [and] syphilis”.7 Nonetheless, to offer further assurance, we would encourage CBS/HM-QC to look into adopting the yet more rigorous policies and procedures of the countries (described in the International Comparisons section of this paper) that do not discriminate against MSM blood donors.
Inherent shortage in the blood supply
CBS/HM-QC also acknowledge that there is a blood shortage in the blood supply. While only 3.5 per cent of the eligible population that can donate blood does in fact donate, the average patient who requires blood transfusion needs an equivalent of 4.6 units of blood.8
If every donor were to donate blood only once per year, the Canadian blood supply would be at a 31.4 per cent annual deficit.9 Allowing more people to be eligible to donate blood would likely increase the amount of blood available to those who need it most.
On 29 July 2013, CBS/HM-QC issued a press release stating that due to unfilled appointments in the recent months and increased hospital demand, CBS/HM-QC required 51,000 blood donations by 3 September 2013 to replenish depleted stocks.10 This underscores the fragility in the blood supply system and the essential necessity that CBS/HM-QC end the donation ban on MSM and thus increase the number of donors available to give blood.
Objective
The goal of this paper is to provide an evidence-based rationale upon which the Liberal Party of Canada could advocate for the change of the current regulation, and allow all Canadians – regardless of sexual orientation or sexual preferences – to be eligible to donate blood. An essential basis upon which that rationale can rest is the second point which we make, that a system should be in place whereby screening be based on sexual behaviour, blind to sexual orientation, and supported by an updated screening protocol that emphasizes the outmost safety and latest technologies. History
Q. When and why was this ban put into place?
The original life time ban (or more specifically ban on men from donating blood if they had sexual relations with another man any time after 1977) was put into place following the Tainted Blood Scandal of the 1980’s. The history of the ban in itself shows why it should be undone.
6 "About Us." Canadian Blood Services. Web. 30 Aug 2013.
Prior to creation of Canadian Blood Service/Héma-Québec in 1998, the Canadian Red Cross Society administered blood services in Canada. It was due to their incompetence (along with that of various other third parties) that more than 28,000 Canadians were infected with HIV/AIDS and/or Hepatitis C11.
In 1993, the Liberal government ordered a Royal Commission of Inquiry (known colloquially as the Krever Commission), to discover how so many Canadians were inevitably given tainted blood. The Commission learned the following:
- That the Red Cross had been importing blood plasma from American prisons and high-risk foreign supply sources during the height of the AIDS crisis 12; - that delays in implementing screening for HIV/AIDS and Hepatitis C had cost more lives; - that it had taken the Red Cross almost five years to implement a process for screening for Hepatitis C 13; and - that there had been a serious lack of communication and funding on behalf of the provincial and federal governments. 14
In 2001, the Red Cross, an American pharmaceutical company and four physicians were found to be criminally responsible by the Supreme Court of Canada for negligence.15 Those facts point to the fundamental causes of the crisis. MSM were simply a scapegoat. They were an easy scapegoat because in the 1980’s, AIDS was a poorly understood disease, so much so that gay-related immune deficiency (GRID) was its original name. At the time, gay men were perceived to be statistically at a higher, continuing and permanent risk of being HIV/AIDS positive, in comparison to their straight counterparts. That is not the case today, and yet stereotypical, outdated perceptions continue to be relied upon in Canadian blood donor policy-making.
Q. Who is getting HIV/AIDS in Canada today?
While gay men continue to represent a significant group of HIV/AIDS in Canada, increasingly the statistics show that minorities, the poor and Aboriginals are rapidly becoming more and more the face of HIV/AIDS in this country.16 Gay men have gone from representing 75% of HIV/AIDS cases down to 38%17. HIV/AIDS is a disease that affects all communities across gender, race, religious belief, age and sexual orientation. Ignoring that statistical trend and focussing policy on MSM only may be as negligent for the current blood/organ donation policy as were the practices of three decades ago. Jurisdictions
Q. Do the provinces play a role in the gay blood/organ ban? If so, what?
Each province and territory does play an indirect role in the gay blood/organ ban, since those jurisdictions are responsible for the administration and delivery of health care service.18 As long as each province/territory carries out the conditions, requirements, and services that the Canada Health Act has put in place, they can be a voice or partner to undo the MSM blood/organ ban19: “WHEREAS the Parliament of Canada recognizes: […] that future improvements in health will require the cooperative partnership of governments, health professionals,
11 http://ca.news.yahoo.com/blogs/dailybrew/20-years-tainted-blood-inquiry-blood-donation-rules-182901160.html 12 http://www.thecanadianencyclopedia.com/articles/krever-inquiry 13 Ibid 14 Ibid 15 http://www.slideshare.net/leodesousa/canadian-red-cross-tainted-blood-scandal 16 http://www2.macleans.ca/2010/07/22/its-the-1980s-in-canada-when-it-comes-to-hiv/ 17 http://www.gpiatlantic.org/pdf/health/costofaids.pdf 18 http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/ptrole/index-eng.php 19 http://laws-lois.justice.gc.ca/eng/acts/c-6/page-1.html#docCont
voluntary organizations and individual Canadians; that continued access to quality health care without financial or other barriers will be critical to maintaining and improving the health and well-being of Canadians;[…]”.20 Current Practices
Q. Is each blood/organ donation vetted for AIDS?
Every blood and organ donation is tested for AIDS, and several other pathogen borne diseases, including West Nile Virus, and Hepatitis B and C.21 As well as testing for AIDS, there is a stringent screening process which includes: a test prick of blood and 29 questions about life-style and medical history. Arms are also checked for evidence of intravenous drug use.22
As CBS reported in 2013: “Donor screening procedures are exclusionary—they exclude people who are at risk of diseases transmissible by blood. The criteria that CBS/HM-QC uses to determine the eligibility of blood donors are based on scientific knowledge of risk factors. Screening out people at greater risk of transmitting blood borne infections is necessary to safeguard the people who receive donated blood […]”. MSM are excluded, if they answer honestly, during the screening process, due to incidences of participation in anal sexual relations.
Not only do Health Canada and CBS/HM-QC ensure that all blood is tested, it also puts it through a process known as leukoreduction, which is the elimination of all white blood cells.23
Q. If gay men could donate sooner, would it add to the blood/organ supply in any significant degree?
There is no quantitative answer to how many MSM would choose to donate blood, and if so, would not be disqualified because of other diseases, life-style choices, and current/prior health conditions.24 However, we do know that if blood donation was to stop immediately, the Canadian blood supply would be depleted in four days.25
When blood is taken it is split up into plasma, red blood cells, and platelets that can be used to save up to three lives.26 Those facts provide a clear indication that a wider range of blood donors is sorely needed. Every life saved is to be considered important and worth saving, and with every extra donor there is greater chance that more lives can be saved.
20 Ibid 21 http://www.bloodservices.ca/centreapps/internet/uw_v502_mainengine.nsf/page/Testing?OpenDocument 22http://www.bloodservices.ca/centreapps/internet/uw_v502_mainengine.nsf/page/The%20Screening%20Process?OpenDocument 23http://www.bloodservices.ca/centreapps/internet/uw_v502_mainengine.nsf/page/Leukoreduction?OpenDocument 24http://www.bloodservices.ca/CentreApps/Internet/UW_V502_MainEngine.nsf/page/Donor+FAQs?OpenDocument 25http://www.bloodservices.ca/centreapps/internet/uw_v502_mainengine.nsf/page/Are_you_bloody_smart?OpenDocument 26 Ibid
Recent Changes
Q. What exactly are the recent changes Canadian Blood Services has implemented?
In May 2012, CBS/HM-QC released a statement that Health Canada had given approval for the lifetime ban to be lifted and replaced with a five-year deferral period.27 Gay/bisexual/bi-curious men were now able donate blood as long as they have not had a sexual encounter with another man within the last five years.28 This change brought blood donation policies in line with organ donation policies passed by Health Canada in late 2007.29
Q. Why have they changed this policy now?
CBS/HM-QC passed a motion in 2011 to re-examine the indefinite ban upon MSM donating blood.30 However, before beginning to re-examine the policy, and prior to any evidence being gathered by such examination, the Board of Directors stipulated that whatever the facts might be, the deferral period would nonetheless be no less than five years, and no more than ten years.31
Q. Is Canadian Blood Services the only not-for-profit group that operates blood donations in Canada?
While Canadian Blood Services is the best known not-for-profit group operating blood donation services in Canada, it is not the only one. As mentioned at the beginning of this paper, there is another non-profit group called Héma-Québec.32 This group operates blood services solely for province of Québec.33
Q. What is the status of gay organ donations in Canada?
Under Health Canada Policy, a gay/bisexual man has to have practiced abstinence for a minimum of five years before being able to donate organs.34 Additionally, the policy states that any heterosexual man who has had an MSM (same sex) experience within the past five years cannot be an organ donor.35
Q. What role does Health Canada play in all of this (both blood and organ ban)?
Health Canada is responsible for overseeing both the policies for blood and organ donations.36 It therefore also oversees both Canadian Blood Services and Héma-Québec policies.37
27 Canadian Blood Services, “Changes to blood donor guidelines: Deferral policy for men who have sex with men reduced from indefinite to five years” (22 May 2013) online:
International Comparisons
Q: Are there other jurisdictions that have changed their bans recently?
There are several other jurisdictions which have changed their bans recently. In February 2010, Sweden lifted its lifetime ban, moving instead to a one-year deferral for MSM. 38 In 2011, the UK followed suit.39 Both jurisdictions continue to discriminate on the basis of sexual orientation.
In December 2012, Mexico approached the issue differently. It lifted its lifetime ban and instead of discriminating based on sexual orientation, it simply banned those who engage in risky sexual practices from donating blood.40 Under Mexico's new policy, there are strict requirements that potential donors must meet; they must (a) have a history of using condoms, (b) not inject drugs, and (c) not be sex workers.41
Chile lifted its lifetime ban on gays and lesbians donating blood in April 2013 and enacted a policy similar to Mexico’s.42
Q. Are there countries that have no bans?
There are several countries which do not have bans specifically directed at MSM. They include Chile, Mexico, Italy, Spain, Portugal, and Russia. 43 44 45 46
Q. For the above jurisdictions, is there a proven higher chance of receiving tainted blood?
According to SOS-Homophobie, there is no data indicating that there is an increase in risk to public healthcare in Spain, Portugal, and Italy.47
The National Health Service (NHS) in the UK states on its website that the risk of contracting HIV through contaminated blood is only 1 in 6.5 million. 48
In Central Asia, there is some indication that there is a slightly higher risk of receiving tainted blood. However a 2008 World Bank report indicated the underlying causes for such risk: the testing methods being used for blood donations were inadequate, and sanitation in the hospitals were a problem. Catheters were being reused and so
38 End the Ban! Canadian Federation of Students, “Signs of Change” online:
were unclean syringes.49 The study also stated that the incidence of HIV infected blood was estimated to be 0.2%, whereas the risk of blood contaminated with Hepatitis B, C, or Syphilis was much higher (2.7%, 3%, and 3.6% respectively).50
Q. Is Canada alone in its policy?
Canada is not alone in its five-year deferral policy. There is one other country with this policy, that being New Zealand. In 2008, New Zealand Blood Services published a report setting out the basis for its decision in choosing a five year deferral period instead of a one year period.51 The report stated that MSM were forty times more likely to be HIV positive in New Zealand than their heterosexual counterparts; thus a one year deferral period would reduce the likelihood that earlier infections would not be caught given available testing methods.52 However, a five year deferral period was chosen instead of a one year deferral period for ‘prevalent groups’ (MSM and people from countries with high HIV prevalence) to increase the likelihood that donors with longer standing infections would not donate.53
Sweden, Japan, Australia, and the UK have one-year deferral periods.54
South Africa has a 6 month deferral period.55
Support
Q: Are there any other groups, companies, charities, celebrities, religious groups or organizations who also support this or are also advocating for this ban to be undone? Groups / Organizations
1) Position of Canadian Blood Services (CBS): a “first and prudent step forward” Dana Devine, VP-medical, scientific, and research affairs Phone: 604-822-7270E-mail: [email protected] 2) Coalition: ‘End the Ban’ (http://endtheban.cfs-fcee.ca) [email protected]
The above coalition is made up of Canadian Federation of Students (main advocate/organizer), Canadian AIDS Society, Egale Canada.
Official policy recommendations:
The “End the Ban” campaign advocates the following changes to the current deferral criteria: 1. The deferral policy should strive for clarity and simplicity. 2. The CBS/HM-QC must adhere to its responsibility to the broader public to pass along accurate messaging, in the interests of public health, rather than propagating anti-gay propaganda.
49 World Bank, “Blood Services in Central Asian Health Systems: A Clear and Present Danger of Spreading HIV/AIDS and Other Infectious Diseases” (May 2008) online:
3. The blood supply must be kept safe and the way to do that is through explicit donor screening that is based on behaviours, not demographics. 4. The Government and its blood collection agents’ principle of striving for non-discrimination should be adhered to when drafting and enforcing all policies of its respective ministries.
Example of activism: students’ association at Carleton University bans blood clinics in their spaces on campus in opposition to the CBS/HM-QC’s policy
The campaign Facebook group is active – includes links, different student groups on campuses that are focusing on the policy, change.org petition links https://www.facebook.com/groups/127957047242760/
1) Canadian Federation of Students
Adam Awad, National Chairman Toby Whitfield, Ontario Representative Main number: (613) 232-7394 2) Canadian AIDS Society
Monique Doolittle-Romas, CEO (613) 230-3580 x 118 [email protected]
- Called the CBS/HM-QC policy change a good first step but not enough
- Said her group would intensify its efforts to push for a screening process based on donor behaviour rather than sexual orientation.
3) Egale Canada
Helen Kennedy, Executive Director Main number: 416-964-7887
- Said the advances in blood testing make any deferral policy antiquated.
“It’s still a discriminatory process,” Ms. Kennedy said. “They’re saying that a person’s sexual orientation and gender identity is reason enough to have a five-year deferral. It’s no different than an indefinite deferral.” Other
4) PFLAG Canada
Francine Proulx-Kenzle, President [email protected]
- Said any deferral could be viewed as discriminatory.
- Also said she is heartened by Canadian Blood Services’ openness to reviewing its policy and making adjustments.
Prominent Individuals
5) Andre Picard, Public Health columnist at the Globe and Mail
http://www.theglobeandmail.com/life/health-and-fitness/health/new-blood-donation-rules-put- damage-control-ahead-of-sound-science/article12076627/
- “It’s frequency of partners and sexual practices that determine risk, not the homo- or hetero- prefix.”
- Of the new policy, Picard wrote that: “It’s not so much a step in the right direction as it is shuffling forward reluctantly for damage-control purposes. Nor is it a decision rooted in science.”
6) Dr. Mark Wainberg, McGill University HIV Researcher and former President of the International AIDS Society
Dr. Wainberg is often quoted in the media, and does related research work. Other Legislators
7) NDP MPs Libby Davies and Randall Garrison http://randallgarrison.ndp.ca/post/statement-on-canadian-blood-services-proposal-to-end-ban-on-blood- donations-by-gay-men
Conclusion
CBS/HM-QC already have in place more vigorous donor testing methods compared to the Red Cross era which involves screening the blood of each donor so as to ensure safety in the blood supply system. Further, evidence from Spain, Portugal, and Italy has found that allowing MSM to donate blood did not result in an increased risk to public healthcare. The current five-year deferral policy for MSM donors discriminates against sexual orientation and sexual preferences punishing those who fall within a certain demographic regardless of one’s behaviour. It is without a doubt that the current regulation should be changed to allow all Canadians to be able to donate blood should their blood pass strict Canadian Blood Services/Héma-Québec testing regimens based on behaviour.
The face of AIDS is no longer just gay/bisexual men but is increasingly the poor, minorities and Aboriginals. Maintaining a discriminatory policy put into place after the incompetence and criminal negligence of twenty-five years ago is no longer supportable in the here and now.
We submit that the Liberal Party of Canada take the bold step to undo the ban on MSM from donating blood/organs and put in a new system that looks at de facto individual sexual behaviour. That new system must learn from advancements in current international practices and use the latest screening methods to ensure safety for all donors and recipients. Science and equality must triumph over ignorance and fear.