April 4, 2011

The Blood Controversy

An examination of Canadian Blood Services’ contentious MSM ban

Gary Musson

I cannot donate blood.

I am a registered organ donor, my DNA is available worldwide for potential stem cell and bone marrow matches, but while those two are potential lifesavers in themselves, they aren’t quite as in demand or as freely available as blood is.

No, it’s not because of the piercing I had a few weeks ago (which would still only result in a temporary deferral of six months). Instead, being a queer-identified individual, Canadian Blood Services deems my blood (and lifestyle, apparently) as “high risk,” and therefore ineligible for donation. I guess getting a few blowjobs from a couple of guys is dangerous business.

So here’s the lowdown: Canadian Blood Services has a fairly controversial, yet somewhat unknown, policy. As CBS puts it, it indefinitely defers (bans) men who have sex with men from donating blood.

I won’t get into the distinction between men who have sex with men (MSM) and the various sexualities that exist out there, but for the males out there who have donated blood, you have likely answered the question “Have you had sex with a man, even one time since 1977?” with a bold, italicized, double-underlined “no.” Yet that single question is the defining factor for me, as well as all other queer/gay/MSM/whatever-they-want-to-call-themselves individuals in deeming their ineligibility to donate blood.

And while some may be taken aback when asked, “what do you define as sex?” it turns out that just about anything goes: anal, oral, handjobs, and more. Any exchange of sexual fluids between two men can mark them as indefinitely ineligible. Even not waiting the suggested half-hour after brushing your teeth to go down on someone significantly increases your risk of contracting an STI. Sorry guys.

Angie Gaddy, a spokesperson for Canadian Blood Services, put it delicately, “we know that MSM does not necessarily refer to all homosexual men. The way that we define it is ‘a man who has had sex with another man, even once’ and is considered indefinitely deferred.”

But before we get into the brouhaha about the current policy, let’s take a stroll down history lane to 1959. This was the year of the first known case of HIV in a human. This individual died in the Congo. A year later, a variant known as HIV-2 was found in West Africa. Flash forward to 1966. It was said that HIV made its first landing in the Americas by infecting a single person in Haiti. The virus then made its appearance in the United States in 1968. At this point, you could begin to see a pattern of the rapid spread of this virus, yet knowledge surrounding the virus was not widespread.

It was not until the ’80s when scientists discovered the link between HIV and AIDS. AIDS is the big killer and what some think is the main concern. While HIV is the precursor to AIDS, scientists have yet to figure out what exactly causes HIV to turn into AIDS. Someone who tests positive for HIV can theoretically lead a reasonably healthy life and never succumb to the slow, painful death that AIDS can bring.

On October 31, 1980, Gaëtan Dugas, a gay Canadian flight attendant, was deemed the first point of contact for AIDS due to his connection to many early cases in the United States. Some have correlated this to his frequent visits to bathhouses in New York City. Three months later, on January 15th, 1981, Nick Rock became the first known AIDS death in New York City, and by the end of the year, 121 people had died from the disease. 1982 is marked as the first known AIDS case in Canada, as well as the first infection in a baby from a blood transfusion.

As more research was done on the disease, it became apparent that a significant number of cases were found in gay men. In the late 1970s, concern grew that with the increase of HIV and Hepatitis C infections from high-risk populations (including the MSM community), inadequately screened blood could enter the system and further spread the disease. Something had to be done.

Enter the deferral policy. By eliminating certain high-risk groups, like the MSM community, the policy lowered the risk of HIV entering the system and freed up resources to ensure that blood entering the system was free of pathogens and available for use. Pamphlets began circulating in 1983 outlining the risks of HIV, in the hope that donors would self-exclude themselves from donating. It was only two years later, in 1985, when thousands of Canadians became infected with HIV from tainted blood (a scandal also known as known as the Krever Inquiry) that the Canadian Red Cross Society was pushed into enacting the policy.

It is also worth noting that the Red Cross, which was responsible for collecting blood donations at the time, instituted the policy. Canadian Blood Services was not created until 1998, and took over much of the work of the Red Cross.

But that was then, and this is now. It has been over 30 years since the outbreak, and much research has been put into detecting, treating, and finding a cure for HIV/AIDS. While every illness has a latency period before being detected, the window for HIV/AIDS shrank from three-to-six months to as little as two weeks.

Still, due to the nature of the disease, Canadian Blood Services does not feel comfortable with this latency period.

“Despite sophistication, no test is perfect. There is still a window period of about one to two weeks in which a person could have been infected with HIV that may not test positive,” Gaddy explains.

“And the reason that we have this deferral is based on public health data and scientific data we have now. It shows that the MSM population has the largest population of HIV cases. We do indefinitely defer other individuals of high risk categories, but for us, it has to do with the scientific data right now that is out there, that shows us the risk to the blood supply system.”

The other high-risk categories Gaddy speaks of include people who have lived in certain areas of Africa, who may have been exposed to a new strain of HIV. If you have spent three or more months in the United Kingdom or France between January 1980 and December 31, 1996, or spent five or more years living in Western Europe, the UK, or France since January 1980, you are also indefinitely deferred. The same also applies if you have received a blood transfusion while living in the same areas since 1980. Diabetes patients are also deferred, as are those who test as a false positive.

Mike Snoddon, president of the Lakehead University Student Union, questions the logic behind that decision-making process.

“When you look at those statistics, you’re like, ‘alright, you’re actively looking for statistics that you’re reporting on. However, what are the other statistics saying?’ What are we saying about straight men and women who are, in my thoughts, more promiscuous that any gay man I know, and where are those statistics?”

His personal stance, as well as that of the union, is “with the technology that is available now, the [ban] is one that isn’t needed. The student union opposes Canadian Blood Services within any LUSU space until the [ban] is changed.”

Though it isn’t just HIV they test for. Every single unit of blood that is donated goes though the NAT (nucleic acid testing) process, which includes blood group and antibody testing and testing for syphilis, hepatitis B and C, West Nile virus, Chagas disease, human T-lymphotropic virus 1 and 2, and HIV. Any units testing positive for these diseases are automatically rejected.

Despite the continued backlash from the public and LGBTQ community, Canadian Blood Services says they have been moving forward in attempting to reverse this policy. In 2008, they released a joint research opportunity with the Canadian Institute of Health Research (CIHR), making available a $500,000 research grant for any researchers or scientists willing to tackle assessing the potential risks of changing the policy. The funds must be spent within Canada. Three areas the grant is to focus on is donor deferral strategies and the risk of blood-borne diseases, policy development and social aspects of blood system risk, and emerging pathogens in specific populations.

To date, no researchers have made use of the funds.

In the same year they began a working group consisting of 16 LGBTQ organizations across the country to serve as a resource to help educate CBS on the issues surrounding the community and promote research.

Some would say that the overall impact of the ban is negligible compared to the overall picture. And CBS’ reliance on statistics would confirm this idea. Out of the nearly 150,000 deferrals in 2010, only four per cent of them were indefinite. Within the four per cent, HIV/AIDS risk only ranked in fourth (at 0.41%), while vCJD (a human form of Mad Cow disease) was first (at 0.6%).

Even then, the main issue opponents have is the lumping of individuals into one broad category. While the statistics have shown that the MSM population is at considerable risk for contracting HIV, this does not mean that the community on the whole is a cesspool of rampant unprotected sex and disease. The main reason HIV spread so fast within the MSM community was the sheer lack of knowledge and technology available at the time for screening, prevention, and care. No one really knew about it, nor did they know which precautions to take.

To those who can say that MSM individuals hell-bent on donating can simply lie, they very well can. At no point during the entire donation process are donors forced to divulge sensitive information about themselves. However, opponents will argue that there is no justified reason an individual who is clean and is regularly tested should be forced to hide something that should be a non-issue. If we are raised in a society that touts equality, regardless of sex, gender, race, and orientation, then why is this deferral in place? Many, including myself, say it is discriminatory.

What CBS has to say on this matter is “we take any kind of risk to the blood supply system very seriously. The [Record of Donation] questionnaire is our first line of defense and it is very important that people assert this. The patient bears 100 per cent of the risk of someone lying.”

More recently, the case of Kyle Freeman vs. Canadian Blood Services wrapped up, in which Freeman lied about his sexuality and donated blood for a number of years. Justice Catharine Aitken ruled the ban was not discriminatory, siding with the CBS’s views that “it is based on health and safety considerations; namely, the prevalence of HIV/AIDS and other blood-borne, sexually transmitted pathogens in the [men who have sex with men] populations, and the corresponding risk this creates for the safety of the blood supply system.” The court also ruled the CBS is not a government agency and is not covered under the Canadian Charter of Rights and Freedoms and dismissed a counterclaim filed by Freeman.

So yes, CBS does say they are working forward with trying to change this policy, but are they really moving at an appropriate pace relative to the issue? Rather than approaching scientists about research proposals, the CBS and CIHR have allowed the grant to sit stagnant. The requirement that the funding only be spent in Canada plays a large role in limiting the market of available research teams. Suggestions of simply reducing the deferral period have been nixed under the notion that such a period would still display tokenism toward other communities (why should a gay monogamous couple remain celibate for a year just to donate blood?).

Perhaps this reluctance to change is based on the restrictions CBS has mandated by Health Canada. In an email, Health Canada explained, “As the regulator of Canada’s Blood System, Health Canada will not approve changes to blood operations, which will increase risk.”

The email continues, “As such, Canada has one of the safest blood systems in the world due to its strict licensing, inspection, and surveillance requirements.”

In writing this article, I have developed a newfound ambivalence on the issue, albeit one tinged with frustration. While the statistics and risk analysis don’t necessarily lie (though they can most certainly be misrepresented) I still do not understand why I cannot join in with the majority of everyone else in saving lives. My day-to-day life does not include any high-risk activities (at least when it comes to blood) and I take every precaution necessary when it comes to protecting my sex life. Aside from my preferences, I am no different than any other person. On the other hand, should we be focusing so much of our efforts in forcing CBS to change, or should our efforts also be directed at Health Canada?

I do want to make it abundantly clear: I am in no way trying to demonize Canadian Blood Services. While I, alongside the LGBTQ community, may not agree with the policy, the work CBS does significantly improves the lives of those who do truly need it. I strongly encourage everyone that is eligible to take some time out of their schedule and to donate blood and save some lives and not boycott the organization. It is more than possible to push for change while contributing to a greater cause.

For those looking to get involved, the Canadian Federation of Students has a nationwide End the Ban campaign online at endtheban.cfs-fcee.ca/en. A petition circulated by LUSU at the start of the year garnered 85 signatures, which to Snoddon indicated there was interest by the student body in pushing this issue further. He hopes to launch a more active campaign in the upcoming 2011/2012 year.

As Snoddon said, “I think the [CBS] on the whole needs to look at where it’s putting up its defenses, because they are very soon going to tread into something that is much, much worse than ‘don’t ask, don’t tell.’”

Category: Features

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