Framing Risk: The Homophobic Legacy of Blood Donation Discrimination in Canada

By Lucas Youmans (Spectrum)

Spectrum is a student initiative aimed at professional and career development for LGBTQ+ students. We aim to foster an inclusive environment to ensure LGBTQ+ students and their allies have resources, information, and connections to maximize personal and professional success.

On a recent CBC podcast, former federal cabinet minister Stockwell Day suggested that the LGBTQ2+ movement has progressed to a point where systemic discrimination has been virtually eradicated. This rhetoric is heard all too often— that the LGBTQ2+ movement achieved its end goals of constitutional protection and marriage equality and is now reducible to anti-bullying campaigns and the politics of representation. In reality, many laws and policies across Canada continue to systemically perpetuate LGBTQ2+ discrimination in a myriad of ways. One salient example is the continued blood donation restrictions placed on men who have sex with men (MSM), who under current regulations must abstain from sexual activity for three months in order to be eligible to donate.

Before delving into the policy considerations surrounding MSM blood donation, it is important to understand the historical context under which the “gay blood ban” and subsequent restrictions emerged. Amidst the chaos and tragedy of the 1980s HIV/AIDS crisis, blood products in Canada were managed by the Canadian Red Cross Society, a non-profit organization with substantial government funding. Their flawed implementation of HIV and Hepatitis C screening procedures and their poor coordination with federal and provincial governments led to the 1980s Tainted Blood Scandal in which thousands of Canadians were infected with contaminated blood. The scandal exacerbated growing hysteria and misinformation surrounding the transmission of HIV, in turn fuelling homophobic sentiments toward a gay population experiencing skyrocketing rates of infection. Conservative religious leaders and politicians characterized HIV as a “gay plague” serving as divine retribution for sexual immorality, while others held more moderate (but still deeply bigoted) fears about the cleanliness of gay sex and the dangers of making physical contact with gay men.

Social stigmatization aside, it is understandable that within the context of the HIV/AIDS crisis, the Canadian Red Cross Society permanently banned MSM from donating blood (or banned them until science would later advance enough for eligibility criteria to be revisited). In 1997 the Royal Commission of Inquiry on the Blood System in Canada investigated the Tainted Blood Scandal and recommended the creation of Canadian Blood Services and Héma-Québec to overtake the administration of blood services in Canada. With these agencies in place, research and advocacy relating to the MSM permanent ban expanded, alongside the improvement of HIV screening technology. In 2013, the lifetime ban was reduced to a five-year deferral period, meaning that a man could donate blood if he had abstained from sexual activity with other men for five years. In 2016 the deferral period was reduced to one year, and in June 2019, it was further reduced to three months.

While the three-month deferral is certainly a move in the right direction, the cautious incrementalism of Canadian Blood Services’ MSM policy remains highly controversial. There is an approximate nine-day “window period” after the contraction of HIV when it may go undetected by the screening tests, so a deferral period that matches this window period may warrant consideration. However, the MSM policy jumps from nine days to three months with little to no public justification. Presumably the underlying reasoning is that MSM remains a high risk donor category so extra precaution is warranted; indeed, MSM accounted for approximately 46% of new HIV diagnoses in 2017. But many argue that this caution is more rooted in long-standing assumptions and biases than in evidence-based logic. Prospective MSM donors are uniformly cast as sexually reckless before they even have a chance to fill out their donor risk assessment forms.

The blanket categorization of MSM as high-risk disregards the actual risk that individual MSM donors present given their particular sexual behaviours. Is a gay man in a monogamous relationship with an HIV-negative partner riskier than a straight man who has sex with strangers on a weekly basis? Is a bisexual man who diligently practices safe sex riskier than a straight college student who routinely forgets to use protection? What about the fact that MSM seek STI testing more routinely than their straight counterparts, and are also much more likely to use PreP (Pre-Exposure Prophylaxis), a prescription drug which is 99% effective in preventing HIV transmission?

As these questions demonstrate, monolithically painting a population as dangerous negates the reality that every person’s risk profile is unique given their behaviour. Being MSM is not necessarily a risk-creating factor in itself; it is the behaviours assumed to accompany the MSM stereotype that are risk-creating. Screening for these underlying individualized behaviours would more efficiently target risk, expand the donor pool, and reduce MSM stigmatization. If cisgender, heterosexual people are already trusted to report on their risk-creating habits or conditions to determine their eligibility, why are MSM donors not afforded this same level of trust when it comes to reporting their sexual behaviours? Is there any argument for the blanket exclusion of all MSM donors that doesn’t rely on harkening back to prejudiced historical caricatures?

Thankfully, moving from a categorical deferral to an individualized behavioural model was included in the Liberal Party’s 2019 election platform, and was recently reinforced in the Minister of Health’s Mandate Letter. To the government’s credit, Canadian Blood Services’ MSM Research Grant Program is currently funding 15 different research projects targeted at evolving MSM eligibility criteria with a focus on behavioural assessment. This is of course positive, but there remains concern that this evolution is too slow and should have occurred years ago. Other countries, for example Spain and Italy, have already adopted behavioural models. Moreover, urgent blood shortages across the country demand swift action to expand the donor pool. Looking to the future, it is therefore critical that the Canadian public hold the government accountable to dismantling the homophobic legacy of MSM blood donation discrimination.

Lucas Youmans is a Joint Juris Doctor and Master of Public Policy Candidate at the University of Toronto. He also holds a Bachelor of Arts in Sociology from McGill University. His research experience in the academic, non-profit, and public sectors has included working as a public international law research fellow with Amnesty International Canada, and serving on the Senior Editorial Board of the peer-reviewed Journal of Law and Equality. Looking to the future, he intends to pursue a career at the intersection of public interest law and human rights advocacy

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