Last week, Canadian Blood Services (CBS) announced that they have received authorization from Health Canada to expand their plasma donation eligibility program, implementing a new behaviour-based screening questionnaire in select cities that will no longer explicitly exclude gay and bisexual men who have sex with men (MSM) and some trans people. The new question asks if in the last three months donors have not had a new sexual partner and if their partner has not had sex with another partner. These new questionnaires are being used only in two donation centres—one in Calgary, and another in London, Ontario.
It’s one more crack in the dam when it comes to MSM blood donations, which were originally banned outright and now require a three-month deferral period. CBS has already indicated that they will be submitting new screening questions to Health Canada’s regulatory arm before the end of the year not only for plasma donation, but also whole blood.
“Health Canada approved the submission by Canadian Blood Services for changes to plasma donation in September 2021, and I am pleased to see this much needed step toward a more inclusive donation model,” writes Minister of Health Patty Hajdu in an emailed response. “This is just a step, however, and so I am hopeful this work will be expanded quickly to other sites.”
The federal government previously provided $3 million in research funding to CBS and Héma-Québec in order to eliminate the blood donation ban.
“We anticipate receiving a submission from Canadian Blood Services later this year in order for them to implement a more inclusive behaviour-based screening for all blood donors and remove the three month deferral period that is currently in place,” Hajdu adds.
Plasma donation, unlike whole blood donation, is primarily used for emergency situations, through a process that separates the plasma from other blood components. But plasma donations are already a bone of contention in Canada, as a debate rages over whether to allow paid donations—an instrumental factor in Canada’s tainted blood scandal in the 1980s. As the demand for plasma increases, the consideration for incentivizing donations with some kind of compensation is that if there is not enough of a voluntary plasma supply in Canada, it would be sourced from the United States, where donors are paid.
CBS noted in their backgrounder that while gay and bisexual men who donate in London and Calgary can do so every week, plasma will be held for 60 days as a requirement from Health Canada and the companies that manufacture specialized medicines from that plasma, until they return and have a second negative test result.
“Our upcoming submission to Health Canada requesting the removal of the eligibility criteria for men who have sex with men will not contain a hold,” the backgrounder states.
Part of the goal of these two test facilities is an exercise in training staff in the new donation criteria and screening questionnaires, and to gather data on the process.
“Canadian Blood Services recognizes that for many [gay and bisexual] MSM, there remains an emotional barrier to entering a space that has not been inclusive to them,” writes Don Lapierre, manager of CBS’ MSM plasma program, in an emailed statement. “This is why training of frontline staff is crucial to the success of the new policy.”
Nathan Lachowsky, research director at the Community Based Research Centre, says that this development needs to be taken with a grain of salt.
“This is something that we knew was coming,” Lachowsky says. “Fundamentally it doesn’t change a lot, but it does give a little bit of new opportunities for guys in the community to donate, as well as the opportunity for us to collect data to be able to inform future changes that we’re hoping to see. But at the end of the day, this is still a policy that singles out and treats men who have sex with men differently.”
Lachowsky says that he is looking for a gender-neutral solution that works for trans and non-binary people as well, and which uses the decades of behavioural science and HIV research to be able to more specifically screen out people who may have acquired HIV.
“This does represent a shift in the fact that there are some more nuanced questions being asked of these plasma donors, so that’s good, but we are still seeing them within this framework of any man who has sex with a man,” Lachowsky says. “Heading in this direction of just being more specific about which men who have sex with men doesn’t really solve the issue of the gender-binary-based discrimination, and it doesn’t use all of the information we have about who passes and acquires HIV.”
Lachowsky says that the feeling of differential treatment is what has stoked much of the activism against the blood ban and later deferral period.
“It’s great to see the policy change from Canadian Blood Services, who have especially been more responsive over the last little bit to feedback and making changes, and I’m looking forward to seeing what their submission will be later this year,” he says. “Ultimately this policy is held by Health Canada, so it’ll be their decision around what this policy is.”
Lachowsky holds out hope that the submission coming later this year will be the one that philosophically changes the current donation policy, but that CBS should take the current opportunity around plasma donation for data collection.
The change is a long time coming, and every bit of progress should be encouraged. Nevertheless, it’s another reminder that we remain a country that is very risk-averse and slow to make changes, even in the face of evidence that the existing policy isn’t having the desired effect. But change is happening, and it’s likely that by 2022, Canada will be catching up to other countries in finally allowing queer men and trans people to donate blood safely, and without all of the hoops that the new plasma policy includes.