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Yesterday’s announcement by Health Canada—that the blood donor deferral policies for men who have sex with men would be replaced with a gender-neutral, risk-based model—saw many headlines celebrating the end of this long-held homophobic policy. Queer community members have been fighting for the repeal of this policy for over 15 years, so it is understandable that people would be excited about this news.
While this announcement can be seen as moving in the right direction, the policy change itself is very minor. We can acknowledge the move, but cannot call it a repeal of the gay blood ban. It is merely a modification of the existing policy. After all, technically gay men could have always donated blood if we had never had sex with another man.
The best way to understand this change is through its impact.
Beyond the headlines, it looks like the change will mean this:
1) No longer asking men seeking to donate blood if they have had sex with another man in the last three months.
2) Asking all potential donors if they have had any new sexual partners or multiple sexual partners in the last three months and, if so, whether or not they had anal sex.
From what we can gather, this means that men who have sex with men who are either in a monogamous relationship or who have had sex other than anally will be able to donate blood. That is, as long as they are not taking PrEP and haven’t for at least four months. And as long as their partner doesn’t have HIV (even if they are on treatment and undetectable).
As part of this policy change, some straight people now won’t be able to donate blood, but only if they have had anal sex with a new partner in the last three months. The vast majority of people impacted by this deferral policy remain men who have sex with other men.
Notably, the current deferral policies ignore the advancements in HIV diagnosis, treatment, and prevention over the last 20 years. The proposed rules actively ignore the effectiveness of condoms to prevent sexually-transmitted pathogens and Pre-Exposure Prophylaxis (PrEP) in preventing HIV transmission.
Overall, the way that sex shows up in the donor screening questionnaire is outdated and problematic. And in many ways, these questions reflect the biases of researchers and reviewers. It is clear in the other questions of the screening survey that sex is assumed to mean penetrative, but this is not always how it is interpreted by front-line staff. Often, front-line staff will explain that “sex” means any type of sexual activity—including oral sex or mutual masturbation.
And so this results in the donor screening process being framed as science-based, but in reality it is fraught with stigma and bias.
Take, for example, the question on sex with a partner who has HIV. It has been known scientifically since the release of the Swiss Statement in 2008 that someone living with HIV who is on treatment and has reached an undetectable viral load cannot pass on HIV via sex. And yet, the policy still includes a 12-month deferral for anyone who has had sex with someone living with HIV, regardless of their viral load. There is no consideration here for the type of sex, for the viral load or health of the people involved, or for the other ways that someone might prevent HIV transmission when they have sex.
The same is true for the questions about sex work. There is nothing inherent in giving or receiving money in exchange for sex that increases the likelihood of HIV transmission. It is easy enough to understand that an erotic massage and penetrative sex are substantially different in this respect. And so it comes back to addressing the actual physical behaviour that increases the likelihood of HIV transmission, if we strip away the stigma and bias.
The language used in yesterday’s announcement is concerning in the way it continues to link gay sex with risk. Without naming gay and bisexual men specifically, the language clearly links specific sex acts that are mostly engaged in by gay and bisexual men with an increased risk of disease transmission. There is, of course, a long history of governments and government agencies viewing queer sex and sexuality in a negative or suspect light. By calling anal sex a “high-risk behaviour,” Health Canada and CBS are maintaining that a single instance of anal sex (even with condom use and PrEP use) carries a greater risk to the blood supply than hundreds or thousands of instances of vaginal sex in the same period.
All things considered, yesterday’s announcement is better than no movement at all. We look forward to both Health Canada and Canadian Blood Services announcing their plans for ensuring the blood donor screening questionnaire is fully based in the most current scientific research and completely removing stigma and bias from our national blood donation system.