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Should Gay Men Be Allowed to Donate Blood?

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After years of lobbying from activists, Canadian Blood Services has finally proposed a policy change regarding blood donation, which will come into effect in the next few months provided it is approved by Health Canada. The new policy will lift the current lifetime ban on donations from gay men who have had sex with another man at any point since 1977 and replace it with a less restrictive one -- prohibiting donations only from gay men who have had sex with a man in the previous five years.

While I can understand the reasons behind both the initial institution of the lifetime ban (an attempt to minimize potential contamination of the blood supply by eliminating those viewed as extremely high-risk donors) and the opposition to the same (the ban is seen by many as unfairly and unnecessarily discriminating based on sexual orientation), it's unclear to me how the 5-year ban makes things any better for either side. And that's why I don't support the change.

Perhaps the lifetime ban was more of a sledgehammer than was scientifically necessary even when it was put into place, but it's hard to fault those in charge for implementing and maintaining the policy when they did. As the Calgary Herald's editorial board correctly pointed out in December: After the 1997 Krever Report's revelations about Canada's tainted blood scandal, public confidence in the safety of the blood collection system was extremely low. Canadians learned that thousands of patients had become infected with HIV, and tens of thousands more had become infected with Hepatitis C, through transfusions of inadequately screened blood products. The public was particularly disturbed to learn that plasma collected from San Francisco and U.S. prisons -- two locales likely to have high rates of HIV infection -- had been used despite the heightened risks. The ensuing fear and distrust counseled for erring on the side of safety in terms of collection policy. Moreover, the understanding of HIV infection, and how long the virus takes to be detectable in a patient's blood, was not as advanced then as it is now. So, while singling homosexual and bisexual men out as a group to be "banned" from donation -- rather than implementing a more nuanced restriction -- was undeniably problematic, it was the cautious and responsible way to go at that point in time.

Now, more than a decade and a half later, we know a great deal more about HIV detection and the risk factors for HIV transmission, so it's reasonable to want to move to a narrower, more targeted exclusion of potential donors. As a 2010 Ontario Superior Court judgment concluded, HIV infection is definitely more prevalent in gay and bisexual men than in the rest of the population, but there just isn't enough evidence to warrant a lifetime ban on donations from members of these groups. By conservative estimates, HIV is detectable in an infected person's blood six months after exposure (most people develop the detectable antibodies within about three weeks), so the idea that a sexual encounter even a year in the past -- let alone one that occurred in 1978 -- should be a reason for rejecting a donation seems unwarranted.

Add to that the fact that self-reporting of sexual behaviour is an inherently unscientific and unreliable way to screen for anything (there is no way to know if a potential donor is being truthful about his sexual history), and it seems especially unhelpful to lean on an overbroad ban of donors, rather than relying most heavily on what has become an extremely accurate method of objectively testing donations for infection.

So is a six-month or one-year ban the way to go (no donations from men who have had sex with a man in the past year)? That's what the U.K. has done, and it would be a defensible change if HIV is the primary concern. It is also not totally unreasonable, though, to worry -- as have some blood recipient advocates -- about the possibility of other sexually transmitted pathogens that we know less or nothing about, that, like HIV, could emerge first amongst gay men. And we don't know how long it would take after exposure for those pathogens to make themselves known. Trying to protect recipients from these mystery bugs is not beyond the mandate of Canadian Blood Services.

But if we're trying to protect against the unknown, rather than HIV, then decreasing the ban to five years is a pretty arbitrary action. Maybe the mystery pathogen will turn out to be detectable after seventeen days, but maybe it will be turn out to be detectable only after seventeen years. It's a complete guessing game at this point; and so changing the screening policy on this basis seems only to affirm the criticism that the ban is based on suspicions and feelings rather than hard science and epidemiology.

Truly, I would respect Canadian Blood Services more if it took a stronger position one way or the other.

Stick with the lifelong ban and admit that it's a super-cautious approach to try to mitigate against potential infections we don't yet understand based on the deadly mistakes made in the past with HIV. Or focus on the bloodborne diseases we do know about, and adjust the ban accordingly to 6-months or 1-year at the most, as would be consistent with the current science of detection. Either one of these approaches would be a more defensible posture than the arbitrary 5-year ban Canadian Blood Services has chosen to champion.

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