Canada’s current limitations on blood donations from men who have sex with men don’t match the science, according to some HIV researchers.
Currently, gay men can donate blood if they have not had sex with a man for at least five years. On August 15, that waiting period will be reduced to one year.
That’s still much longer than warranted, said Dr. Paul MacPherson, an HIV researcher with the Ottawa Hospital Research Institute’s chronic disease program and associate professor of medicine at the University of Ottawa.
Although gay men are at higher risk of HIV infection — they represent slightly less than half of HIV cases in Canada, according to estimates by the Public Health Agency of Canada — he believes that the risk of HIV getting into the blood system if that timeline was reduced is very low.
That’s because of how Canadian Blood Services tests donations, he said. Blood Services does two tests on every batch: a test for antibodies and a “nucleic acid test”. The concern is what’s known as the “window period” — the time between when someone contracts HIV and the time at which it can be detected.
For an antibody test, he said that the window is about 42-50 days. For the nucleic acid test, results can be detected in approximately nine days, according to Canadian Blood Services. That’s much less than a year.
“I would say the window period should match the science,” he said. “I think Canadian Blood Services is just being super extra-cautious in putting it out to a year, but there’s really no good data to say it needs to be one year.”
So, to be cautious, he thinks the window period should be closer to two months.
And both he and Dr. Mark Wainberg, a professor of medicine and director of the McGill University AIDS Centre, believe that Canadian Blood Services should include some questions about donor behaviour in its screening of gay men.
“If you’re a man in a long-term, stable relationship and you and your partner are both negative, then the risks are exactly the same as those of a heterosexual couple,” said Wainberg, who is also a former president of the International AIDS Society.
“Why is it ok for a heterosexual college student who’s 19 years old who’s had sex with 40 women during his hormonal years, why is he able to give blood and a gay man who’s in a long-term stable relationship is not? It’s just stigmatizing, it’s demeaning, and it doesn’t make any scientific sense.”
“All gay men are not at risk for HIV,” said MacPherson. “A good proportion of gay men, like heterosexuals, are in monogamous relationships. So yes they may have had sex yesterday, but if they’re in a closed partnership, you can’t introduce HIV unless they’re having sex with multiple partners. So is it gay men, or should it be people who are sexually active?”
Canadian Blood Services’ policy regarding men who have sex with men dates from the 1980s, when HIV screening was nowhere near as good as it is now.
Originally, it was a complete ban on donations from any man who had had sex with a man anytime from 1977 onwards.
Then, in 2013, it was reduced to banning any man who had had sex with a man in the last five years.
This was seen as an “incremental step” toward opening up the policy, said Dr. Mindy Goldman, medical director of donor and clinical services for Canadian Blood Services.
“It was a safe change. We did not see any decrease in safety, any increase in the number of donors found to be HIV-positive for example after going to the five-year deferral period.”
Soon, it will be a one-year deferral — something that she agrees is “greatly in excess” of their testing window periods. But testing isn’t everything, she said.
“How it’s supposed to work is we complete all testing before products are put into inventory, so that blood products of people who test HIV-positive or for hepatitis or whatever are destroyed and are not used,” she said.
“But you could have situations where your test doesn’t work properly or you have an error and products are put into inventory or you’re in an emergency situation where you cannot do the test before shipping product, etc. For those types of situations obviously you would prefer not to have a lot of HIV-positive units in that.”
Canadian Blood Services will monitor the effects of the new one-year limitation on blood donations, looking for whether more HIV-positive samples are detected, and surveying donors to see whether they truthfully answered all the questions on their screening form, she said.
And, the agency will consult with interest groups like patient groups, the medical community and LGBTQ groups to come up with an updated donation policy — a process that could take years. It took three years to reduce the waiting period from five years to one, and further changes will require research, as there are fewer examples from other countries to look to, she said.
All that means that it’s unlikely the restrictions on donations from gay men will be lifted during this current federal government’s mandate — as the Liberals promised during the election campaign.
And although Wainberg believes that it’s a sensitive and delicate issue, he thinks that policy change has been held back by political interest groups to the point where it no longer makes sense.
“We now have these fantastic ultra-sensitive screening tests. We didn’t have those in 1983 and 1984 and now we do. So you have to really ask the question, is it still worth maintaining an official policy of discrimination against gay men in light of all this advance in technology? And when they say the science supports this, I think that’s nonsense. The science doesn’t support it.”