Vancouver conference discusses deferral policies, trans accessibility
On Saturday, Sept. 16, Canadian Blood Services (CBS) held a conference in Vancouver titled “Donor Screening for MSM and Trans Individuals: Dialogue with Student Leaders.”
At the conference, students from B.C. campus blood donor clubs and LGBTQ groups gathered to discuss ways in which CBS can move forward in removing restrictions for donors — specifically, men who have sex with men (MSM) and trans donors.
Debates around deferrals
In the early 1980s, 2 000 people in Canada were infected with HIV after accidentally receiving contaminated blood. This ‘tainted blood scandal’ led to a national inquiry and the creation of the CBS.
One response to the crisis was to permanently ban MSM from donating blood, due to the high percentage of new HIV infections within the LGBTQ community. In July 2013, this deferral was reduced to a five year waiting period (meaning donors had to abstain from sex with other men for five years before donating blood). In June 2016, this was again reduced to a one year deferral. This deferral also applies to women who have sex with MSM.
While CBS has received a great deal of pressure to change their MSM deferral policy, most countries in the world maintain permanent stance on MSM donor deferrals. Those that permit MSM to donate have waiting periods ranging from six months to one year. The exceptions are Italy and Spain, where physicians can individually assess donors, and the U.K., which has announced a shift to a three-month MSM deferral period beginning in 2018.
The conference was designed to gain students’ perspective on the policy, with the general hope that the CBS would follow the U.K.’s lead in a shortened deferral period, as well as Japan’s risk-based approach. At the meeting, the U.K.’s shortened deferral was called a “game changer” that, following monitoring and the collection of data, could lead to widespread global change.
All blood gathered by CBS is tested for HIV and Hepatitis B and C, but there are two main reasons why CBS still deems donor deferrals necessary: there always exists the possibility of machine failure, and the results of an HIV test depend on how long the donor has had HIV.
In Canada, sexually active MSM currently represent disproportionate rates of new HIV infections (54.3 per cent, as reported by CBS).
While individuals diagnosed with HIV are unlikely to try to donate blood, the Public Health Agency of Canada estimates that approximately 21 per cent of HIV positive individuals are not aware of their diagnosis. It is these people who pose the greatest risk to CBS—if they were to contract the disease shortly before donating blood, the virus might not fully show up in testing but could still infect the recipient. It takes between 9–17 days for HIV to fully show up (as viruses don’t replicate at the same rate in all bodies). This is why the U.K. believes a three months deferral is enough time to include outlier data.
The Japanese donor deferral period is six months long, but is required of any donor who has recently changed their sexual partner (not just MSM). Participants were warned, however, that the Japanese and Canadian donor contexts cannot be looked at as apples to apples –Japan does not have the same history of scandal as Canada does. As such, CBS is looking for what they call as “made-in-Canada solution.”
Trans accessibility also discussed
The conference also discussed ways to make the blood donation process more mindful and accepting of trans donors. The first question asked of new donors is if they are male or female — but this can become complicated for trans individuals who are in different stages of the transition process. Trans men also expressed frustration at being asked whether they had been pregnant at any point (as antibodies created during a pregnancy can be potentially harmful to donation recipients).
Moving forward, conference participants suggested, above all else, a shift towards gender-neutral questions that focus on a risk-based approach. Potential questions may ask if a donor is in a long-term monogamous relationship or if they have recently had a number of different sexual partners (regardless of their gender).
Reflecting on the conference
Stan Liang, co-president of the UVic Blood4Life Club, said there were three things that stood out to him over the course of the conference.
“[The first] was the balance CBS had to take approaching social issues, as there is a line where they wanted the best for the recipient of the blood and what was best for the donors (especially those who were more at risk of carrying certain diseases; eg. MSM),” he wrote in an email to the Martlet after the conference.
“The second thing is that the presenters acknowledged mistakes from CBS in the past and were trying really hard to correct the problem moving on (from criticisms they realized that their screening procedures for the LGBTQ community had offended people).
“Lastly, the thing I ended up being most excited for was the progression in technology from scientists. [One of the presenters, Dr. Dana] Devine was very passionate in her discussion of upcoming technology that will purify all blood that gets donated. This way, there will essentially be no donors who will be excluded. We could be expecting this technology to show itself in the next few years and will be more affordable in the near feature.”
Liang believes the goings-on from the conference will likely not impact the UVic Blood4Life Club too greatly, though he is optimistic of what the future of Canadian blood donation holds.
“This conference is a progressive step CBS is taking and it really shows that their goal in mind is ultimately helping others.”
The next scheduled blood donation clinics on campus are Oct. 30, Nov. 6, and Feb. 26.
*Editor’s note: Due to the privacy agreement set at the conference, no quotes can be attributed to individuals.