Dec. 6, 2021 -- The end of Canada’s ban on gay and bisexual men from donating blood based on sexual orientation alone may soon be history.
Canadian Blood Services (CBS) plans to ask Health Canada to screen potential blood donors based on higher-risk sexual behaviors rather than on gender or sexuality. The approach is similar to what’s already followed in many other countries, and it’s one that advocates in the U.S. are also proposing.
The submission to request the change ''is imminent," says CBS spokesperson Catherine Lewis, who expects the request to be finalized before the end of the year. Health Canada, the federal department responsible for the national public health of Canadians, needs to approve it. "If approved, we'd seek to implement expediently,” Lewis says. “We'd likely need several months to make system changes and train staff."
The Canadian proposal follows a similar change in approach in the United Kingdom. On World Blood Donor Day, June 14, National Health Service Blood and Transplant launched a new policy, with eligibility to donate based on a more personal assessment rather than on a risk assigned to a population or group. Now, deferrals are based on behaviors known to carry a higher risk of sexual infection.
After the U.K. policy change, a perspective published this year in The New England Journal of Medicine suggested the U.S should follow suit.
"We believe this updated policy should serve as a call to action for the Food and Drug Administration (FDA) to reevaluate and rewrite its own deferral policies for potential blood donors," the authors wrote.
Under current guidelines, a 3-month deferral period is imposed on men after their last sexual encounter with another man. While men who have sex with men do have a higher prevalence of HIV than others in the population, the guidelines in the U.S. fail to consider individual behaviors, the authors wrote, including those of other groups that can be just as risky.
The U.S. guidelines even exclude gay and bisexual men who maintain a low risk of contracting sexually transmitted infections -- such as monogamous married gay men -- while not deferring others who engage in high-risk practices.
The U.K. policy follows the lead of France, Argentina, and Brazil, the perspective authors wrote. Those countries have individual assessments or no restrictions, they said.
New Approach Details
The shift in Canada is welcomed by many, including Nathan Lachowsky, PhD, an associate professor of public health and social policy at the University of Victoria. He and others have been advocating for the ''removal of the MSM (men who have sex with men) specific ban for over a decade," he says.
Currently, in Canada, men who have sex with men are eligible to donate if it has been more than 3 months since their last sexual contact with a man.
If the change to behavior-based screening is approved, Lachowsky says, ''there will be new questions they are asked during the screening process."
While Lewis says those questions will be released soon, Lachowsky says they are expected to ask about details such as relationship status, the number of partners, new partners, and types of sexual practices.
Besides an end to what Lachowsky and others view as discrimination, "we expect that this change will mean that there are a number of new donors to contribute blood."
This anticipated increase in the donor pool, he says, would include not only gay and bisexual men, ''but also others who stayed away from donation because of the discrimination that was in place."
In his research, Lachowsky has found that gay and bisexual men are willing to donate blood if they are deemed eligible. When he surveyed 39 men, most said they were low-risk, were willing donors, and would ''gain satisfaction and civic pride from donation."
Some cited feelings of discrimination from the current policy.
U.S. Efforts to Change Policy
In the U.S., the latest FDA guidance calls for a 3-month sexual abstinence period before donating blood for all men who have sex with men. The policy applies to men married to other men as well as two men in a mutually monogamous relationship. A woman who has had sex during the past 3 months with a man who has had sex with another man in the past 3 months is also not eligible to donate.
But an FDA study is underway to find out if assessing personal risk instead of mandating a blanket deferral will keep the nation's blood supply just as safe. Called the ADVANCE Study (Assessing Donor Variability and New Concepts in Eligibility), its goal is to enroll 2,000 men at eight study locations.
But enrollment has been slower than expected, due partly to COVID-19 restrictions that limit opportunities to reach out at community events for volunteers, says Brian Custer, PhD, the principal investigator for the study and vice president of research and scientific programs at the Vitalant Research Institute. With events such as PRIDE and other social events canceled, it has been harder to find people to take part in the study, he says.
Yet the study is still due to be finished by mid-2022, Custer says. No early analyses have been completed yet.
Andrew Goldstein, PhD, an associate professor of molecular, cell, and developmental biology and urology at UCLA, who is taking part in the ADVANCE Study, says: ''The current guidelines are discriminatory and hurtful." There are critical blood shortages, ''so it is frustrating that healthy donors are turned away based on an outdated rule."
Filling a Need
Lifting the restrictions would mean more blood donors at a time when blood supplies are running extremely low. On Nov. 26, Blood Services Canada issued a call for donors, saying it needs to fill 38,000 appointments by Jan. 4 to maintain inventory.
In the U.S., a severe blood shortage continues, according to the American Red Cross. In late October, the Red Cross said that donor turnout had reached the lowest level of the year, and that September and October had the lowest national blood inventory levels in more than a decade.
Lewis will update as soon as they submit the request…with info on questions, etc.