by Jasmine Amini

Graphic design by Yu-Wen Jan

Canadian Blood Services (CBS) currently requires 832 000 blood units (each of them 450mL) to be donated yearly to meet ongoing demand.¹ The landscape for organ donation is similarly fraught with high demand; more than 3 400 Canadians remained on an organ donation waitlist at the end of 2023, while over 200 patients died while waiting for a transplant throughout the year.² Despite steady need for blood and organ donations, several health organizations, including CBS, bear a legacy of refusing or deferring donations from men who have sex with men (MSM). In addition to straining available resources, policies against donation from MSM perpetuate harmful stereotypes and fail to reflect modern advances in viral testing. 

Blanket bans against blood donations from MSM were first introduced in Canada during the 1980s at the peak of the acquired immunodeficiency syndrome (AIDS) epidemic.³  The rationale for these bans was to limit the spread of AIDS, which at the time, predominantly affected MSM.³ Mystery shrouded AIDS during this period; although health officials noticed that AIDS was transmitted through blood inoculation and sexual activity, little was known about the cause, let alone the treatment, of the virus. Uncertainty around AIDS’ etiology fueled stigma against MSM, who were often harassed and socially excluded over fears of contamination, regardless of illness status.⁴ Following 1 200 accidental HIV infections through contaminated blood donations supplied by the Canadian Red Cross, a ban against blood donations from MSM was enacted in Canada in 1983. ⁵ Similar policies were soon adopted worldwide for both blood and organ donation by MSM.⁶

In 1984, scientists determined human immunodeficiency virus (HIV) to be the cause of AIDS.³ Following this discovery, research on procedures to detect HIV in blood progressed rapidly, with the first generation of HIV antibody tests being released in 1985.⁷ HIV tests advanced greatly in precision over the course of 15-20 years. While the first HIV blood test could only detect a singular antibody (IgG), the third and fourth generation tests of the late 1990’s were equipped to detect HIV antibodies, proteins produced by the immune system in response to pathogen exposure, and HIV antigens, pathogenic molecules that cause immune response. Advances in testing greatly improved test sensitivity, which then lay between 99.5-99.8%. Despite progress made in blood testing, one limitation to HIV assays remained: the test-negative window. 

The test-negative window refers to the period between initial infection to when markers of infection can be accurately detected. The test-negative window for third and fourth generation HIV assays was two weeks, meaning newly infected individuals could falsely screen negative for HIV during this period. Concerns over donor infection during the test-negative window fueled policy decisions to retain the blanket ban on blood and organ donation from MSM.³ The lifetime ban on blood donation from MSM in Canada remained in place until 2013, when it was replaced by a five-year deferral period that restricted donations from men who had sex with men within the past five years.⁵ These policy amendments came years after similar changes in Australia, the UK, and Sweden, although these countries implemented one, rather than five, year deferral periods. Canada’s deferral period was shortened to one year in 2016.⁸

Following years of research, lobbying, and advocacy, CBS officially updated their policies around blood donation from MSM in 2022, ending the one-year donor deferral period.⁸ In its place, CBS implemented a sexual behaviour screen, completed by all donors, that assesses recent sexual activity. Donors who have had anal intercourse with a new partner or multiple partners within the last three months must wait three months from last instance of anal intercourse to donate blood.⁹ Organ and tissue donations by MSM, however, remain restricted. Specifically, MSM must abstain from anal intercourse with men for at least a year prior to donation. ⁶ Organ donations by MSM who do not meet the sexual behaviour criterion, termed “increased risk” donations, may be made under exceptional circumstances in case of high need, with recipient consent.  

Discrepancies in blood and organ donation policies for MSM between Canada and countries with similar risk profiles also raises concerns over the scientific validity of these guidelines. For example, the United States of America (USA) allows organ and tissue donation from MSM who abstain from sex with men for at least 30 days prior to donation.⁶ With otherwise similar testing procedures,⁶ it seems unlikely that the risk of HIV infection from organ donation is higher in Canada than the USA to warrant the stricter policies. With the advent of nucleic acid amplification tests for HIV, which can detect infections around seven days post-exposure, the seemingly arbitrary differences in donation policies between similar jurisdictions is even more confusing.¹⁰

Although policies to defer donations from MSM in Canada stem from an abundance of caution, justifications for past and current practices are lacking from both an equity and, at times, scientific standpoint. Foremost, HIV is not exclusive to MSM. In 2023, nearly a third of new HIV infections were among females,¹¹ with the majority of those infections coming from heterosexual intercourse. CBS’ recent move to a sexual behaviour-based screening tool is positive; however, this screen fails to recognize the non-negligible, though lower, risk of HIV infection via oral or vaginal sex.¹² As such, the stigma and restrictions associated with blood/organ donation policies still primarily affect individuals from the 2SLGBTQIA+ community. 

Despite headway being made in the fight to improve equity for MSM seeking to donate blood and organs, there is still work to be done. Efforts to remove barriers for organ donation from MSM are continuing, with activists taking Health Canada to court for discriminatory organ donation policies.¹³ Calls to action, such as those being made by the Community-Based Research Centre,¹⁰ are being heard by major bodies such as the Canadian societies for Transplantation and Critical Care, demonstrating growing support for equitable reform. With continuous demand for blood and organs in Canada, it is critical to capitalize on advanced HIV testing to develop safe, equitable policies that encourage, rather than deter, life-saving donations. 

References

1. Canadian Blood Services is rallying people across the country to shine a light on the need for new donors, https://www.blood.ca/en/about-us/media/newsroom/canadian-blood-services-rallying-people-across-country-shine-light-need-new (accessed 27 April 2025).

2. Summary statistics on organ transplants, wait-lists and donors | CIHI, https://www.cihi.ca/en/summary-statistics-on-organ-transplants-wait-lists-and-donors (accessed 27 April 2025).

3. Wilson K, Atkinson K, Keelan J. Three decades of MSM donor deferral policies. What have we learned? Int J Infect Dis 2014; 18: 1–3.

4. Handlovsky I, Sidhu J, Amato AT, et al. The collective trauma of HIV/AIDS and contemporary constructions of health: Older gay men’s perspectives. SSM Qual Res Health 2024; 6: 100477.

5. Jubran B, Billick M, Devlin G, et al. Reevaluating Canada’s policy for blood donations from men who have sex with men (MSM). J Public Health Policy 2016; 37: 428–439.

6. Leeies M, Collister D, Christie E, et al. Sexual and gender minority relevant policies in Canadian and United States organ and tissue donation and transplantation systems: An opportunity to improve equity and safety. Am J Transplant 2024; 24: 11–19.

7. Alexander TS. Human Immunodeficiency Virus Diagnostic Testing: 30 Years of Evolution. Clin Vaccine Immunol CVI 2016; 23: 249–253.

8. Canada H. Health Canada authorizes Canadian Blood Services’ submission to eliminate donor deferral period for men who have sex with men, https://www.canada.ca/en/health-canada/news/2022/04/health-canada-authorizes-canadian-blood-services-submission-to-eliminate-donor-deferral-period-for-men-who-have-sex-with-men.html (2022, accessed 4 May 2025).

9. Sexual behaviour-based screening | Blood.ca, https://www.blood.ca/en/blood/am-i-eligible-donate-blood/sexual-behaviour-based-s

creening (accessed 3 May 2025).

10. Leeies M, Ho J, Gruber J, et al. Ending discriminatory practices in organ and tissue donation and transplantation (OTDT), https://www.cbrc.net/ending_discriminatory_practices_in_organ_and_tissue_donation_and_transplantation_otdt (2023).

11. Canada PHA of. HIV in Canada: 2023 surveillance highlights, https://www.canada.ca/en/public-health/services/publications/diseases-conditions/hiv-2023-surveillance-highlights-infographic.html (2024, accessed 3 May 2025).

12. Boily M-C, Baggaley RF, Wang L, et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis 2009; 9: 118–129.

13. Aiello R. Man taking Health Canada to court over ‘stigmatizing, and discriminatory’ organ donation policy. CTVNews, https://www.ctvnews.ca/health/article/canadian-government-facing-new-legal-challenge-from-a-gay-man-over-deeply-hurtful-organ-donation-policy/ (2025, accessed 4 May 2025).