This Magazine

Progressive politics, ideas & culture

May-June 2023

Blood Feud

Canada has made changes to be less discriminatory toward queer blood donors, but is it enough?

Maddy Mahoney

Photo by Dieter Meyrl

Last spring, Prime Minister Justin Trudeau and six other suited-up politicians held a press conference announcing a long-awaited change to Canada’s blood donation system. Given that the change they were making—eliminating the blood donor screening question that deferred men who’d had sex with other men in the last three months—was really a matter of a few words, six people trading places at the microphone for nearly half an hour may have seemed like overkill. Those words, though, had both a long history and far-reaching implications. Forty-three years prior, they had emerged in their first iteration as a lifetime ban on blood donations from “men who have sex with men” or, in its most reductive but more common phrasing, “MSM.” The Canadian Red Cross, which was responsible for the blood supply at the time, imposed the ban when fears around the newly discovered HIV, which was spreading rapidly in Canada, were colliding with pre-existing stigmas. While the myth of HIV as a ”gay disease” had been debunked by then, the “blood ban” remained in place when Canadian Blood Services (CBS) took over Canada’s donation system in 1998.

Over the years, many queer activists spoke against the policy, saying it was unscientific and blatantly targeted the queer community. Students at universities across the country played a major role, writing letters and petitions and protesting Héma-Québec blood drives, and 2SLGBTQ+ organizations called for CBS to re-evaluate. In 2013, CBS changed the policy to a five-year ban. In 2016, Christopher Karas, a gay man, brought a complaint about the policy before the Canadian Human Rights Commission. Eventually, the ban was lowered to one year, and then three months.

Now, finally, the question that had historically excluded many gay and bisexual men, as well as trans women, would be replaced with a set of gender-neutral questions about sexual behaviour. It was Seamus O’Regan, Canada’s minister of labour, who described the change in the most grandiose terms. “Now each of us are afforded the benefit of the doubt,” he said, “and each of us must answer to the same questions.”

The move to gender-neutral questioning around sexual behaviour is inarguably a significant milestone. However, a closer examination of CBS’s donation policies suggests that O’Regan’s sweeping declaration of equality is premature. Beyond lingering issues with how current sexual behaviour screening affects queer people, it would be a mistake to think that the removal of a single question could fundamentally change a system that has historically excluded the most marginalized within the queer community. Stepping back from the MSM question, it becomes clear that CBS needs to continue addressing how its past and present policies have stigmatized not just gay and bisexual men, but trans people, Black queer people, and 2SLGBTQ+ sex workers. Until that happens, no ban will have been lifted.

What was announced on that day in April, and went into effect in September, was the removal of one line of questioning from CBS’s blood donor screening questionnaire, and the addition of a series of replacement questions. A change like this can only happen when CBS applies to its regulator, Health Canada, and gets their approval. However, CBS must initiate and gather the required research to support any changes—so while Health Canada gets the final say, CBS sets the agenda. After Health Canada approved the change, all potential donors, regardless of their gender, are now asked if they’ve had new or multiple sexual partners in the last three months and then, if yes, whether they’ve had anal sex in that period. If they answer yes to that, they are ineligible to donate. Health Canada and the Canadian government both framed it as a historic move away from singling out the queer community.

On the surface, this policy no longer excludes gay and bisexual men. However, Trevor Hart, the director of the HIV Prevention Lab at Toronto Metropolitan University, says that it’s unclear how many queer men actually became eligible. “What it ends up doing is excluding anybody who had anal sex,” says Hart, with the notable exception of gay and bisexual men in monogamous relationships. Still, says Hart, “that is a big chunk of men who have sex with men anyway.” The three-month deferral period is also a barrier, possibly a bigger one than the science warrants. It’s widely acknowledged that there is a window of time where a newly acquired HIV infection may not be detected by tests, and would therefore go unnoticed. However, the CBS itself says that window only lasts about nine or 10 days after the initial infection.

And while the focus on anal sex does have its basis in research—anal sex carries the highest risk for HIV transmission—Hart notes that there’s a limit to this distinction. The current policy screens exclusively for anal sex, which means that donors with unlimited new vaginal sex partners are eligible, but donors with a single new anal sex partner are not. “That’s not consistent with the science,” says Hart. “We know women engaging in heterosexual vaginal sex, for example, are contracting HIV.”

There are also two major advancements in HIV prevention and treatment that current CBS policy does not account for. The first is the development and availability of pre-exposure prophylaxis (PrEP), a highly effective medication taken to preemptively lower one’s chances of contracting HIV. Right now, CBS chooses to defer donors who have taken PrEP in the last four months, saying it interferes with their ability to detect the presence of HIV in blood. “Well, yes, it probably would,” says Hart, “because it prevents somebody from contracting HIV.” Secondly, anyone who has a sexual partner who lives with HIV is also deferred from donating for 12 months. It’s a policy that ignores antiretroviral treatment, which allows many people living with HIV to have undetectable viral loads. Antiretroviral therapy, in the form of a daily medication, can prevent the virus from making copies of itself—when taken as prescribed, a patient’s viral load (the amount of HIV in their blood) becomes so low that standard tests cannot detect it. It is globally recognized that when this is the case, HIV would not be transmitted through sexual intercourse, which would prevent someone with HIV from passing it on to a sexual partner.

Since gay and bisexual men still account for the majority of new AIDS cases in Canada, these questions are likely to disproportionately affect queer people while also having a dubious scientific basis. “The straight person who isn’t taking nearly as many precautions to protect their sexual health is able to donate, whereas queer and trans folks who are taking so many precautions are not able to donate,” says Tyler Boyce, who, after years working in HIV care, is now the executive director of Enchanté Network, a 2SLGBTQ+ advocacy organization. “To me, that doesn’t sound like a blood ban has been lifted.”

Boyce’s own first interaction with the blood donation system was accompanying his mother to an appointment when he was about 10. On the way to their local CBS in Ottawa, she explained to him how one person’s blood could save another person’s life. He was surprised, then, when she came out of her appointment in a hurry, visibly offended. Later, he would learn that she did not donate at all that day—in fact, she was turned away due to the lifetime ban on donors born in Africa. Boyce left CBS feeling small and disempowered, and with the knowledge that he would have to navigate the blood donation system as not only a queer person, but as a Black queer person. “You’re pushed into a situation of advocacy,” he says.

Conversations around a “blood ban” in Canada often revolve exclusively around the sexual behaviour screening questions, but this laser-focus reveals how narrow our understanding of the queer community can be. If we step back and look at the CBS donor questionnaire as a whole, it becomes clear that there are other significant barriers, past and present, that further discriminate against the most marginalized members of the 2SLGBTQ+ community.

Like queerness, Blackness has long been associated with stigma around HIV and AIDS, and that’s been borne out in CBS policy. From 2005 until 2015, CBS asked if people were born or had lived in Africa since 1977, and whether they’d had sex with someone or received blood products from any African country since then. This question unscientifically lumped together the rates of HIV in all 54 African countries. While that policy was removed, the effects have been lasting—just last year, CBS faced critical shortages, in part due to a lack of racialized donors. “We would be really naive to think that just because you removed the question, the systemic discrimination and anti-Blackness also disappears,” says Boyce.

CBS also has a long history of policies that target people who do sex work, something that, in Canada, trans and non-binary people are more likely to engage in than their cisgender counterparts. From 1977 until last year, there was a lifetime ban on anyone who had “taken drugs or money for sex.” CBS says that this is one of the policies that is undergoing an “incremental shortening of duration,” and it’s since been changed to a 12 month deferral. However, this is still notably longer than the three month deferral for other groups identified as high risk for HIV. Hart says the exclusion of these populations is problematic. “Does the virus work differently in people that are sex workers versus people who are not sex workers?” asks Hart. “I would question that scientific rationale.”

And, zooming out from the donor questionnaire itself, the policies behind simply registering as a donor also have implications for the queer community. Until 2016, trans donors had to register in the CBS system under their sex assigned at birth, unless they had undergone lower body gender-affirming surgery. While that policy has been eliminated, non-binary donors still have to register as either “male” or “female.” “It’s a form of discrimination and violence to radically shift your perception of yourself in that way,” says Cat Haines, the executive director of JusticeTrans, an organization that focuses on improving access to justice for two-spirit, trans, non-binary, and gender non-conforming people in Canada. While CBS says it is looking into changes to the registration system, that’s not the only issue. “Beyond that,” Haines says, “we see at some CBS facilities a lack of gender-neutral restrooms or gender-neutral facilities.”

OmiSoore Dryden is the James R. Johnston endowed Chair in Black Canadian Studies at Dalhousie University’s faculty of medicine, and she studies blood donation and the experiences of Black queer and trans communities. She says the idea that a blood ban for queer people has been lifted reflects a limited and inaccurate view of queer life. “How is it a success that this question was removed when the systemic barriers to donation still remain,” she asks, “when no substantive apology or accountability has been made, and when sex workers and others have been sacrificed for this inclusion?”

Haines used to donate blood regularly, but after she transitioned and had partners who were also trans women, she found herself barred from donation because of the MSM policy and her unwillingness to register using her correct gender. While the screening questions have since changed, the damage done means she no longer wants to interact with CBS. “I was at a point of like, I just will never donate blood again,” she says.

When it was created in 1998, CBS was charged with safely collecting and distributing blood donations—but that wasn’t all. It was also tasked with educating the public about what a safe blood supply looks like. By enforcing policies that unfairly discriminate against queer people, CBS has perpetuated stigma that it has not, in the eyes of many, sufficiently addressed. “What happened historically has shaped the public view,” says Nathan Lachowsky, the research director at the Community- Based Research Centre, a non-profit that specializes in queer and gender-diverse people’s health. “The system should be accountable to the harm that’s been done.”

Dryden says that the removal of bans on African and MSM donors is the bare minimum. It does not, Dryden says, take the place of removing unnecessary barriers for trans people and sex workers, nor does it take the place of a public acknowledgement of anti-Black racism and anti-Black homophobia in the CBS. (While CBS says it is working to increase participation from Black and otherwise racialized potential donors through critical engagement, no such statement has yet been given.)

Boyce says that bans on PrEP users and those living with undetectable viral loads of HIV remain in place because of long-standing stigma. “Science can only go as far as we let it,” he says. If diverse voices aren’t heard in the research process, the kinds of projects needed to make blood donation equitable won’t even be on the table. “Stigma is a huge barrier to the kind of science that we need to move towards an effective, low-barrier blood donation system in Canada and a strong, well-contributed-to, safe blood supply.”

CBS has initiated some of this work. They are seeking studies on the effects of PrEP on HIV testing and are in the midst of consulting with the trans community on registration software that accommodates a wider range of gender identities.

But the results remain to be seen. Given the decades of advocacy that took place before CBS removed the MSM policy, it’s unclear how long queer people will have to wait. “I would love for us to be innovators and really create inclusive spaces,” says Haines. “I would love to be able to go donate blood again. But with things where they’re at in this particular moment, it doesn’t feel safe.”

Maddy Mahoney is a freelance journalist who’s interested queer storytelling, subcultures, and weird internet trends. Her writing can be found at Xtra, Toronto Life, CBC Arts, and elsewhere. She is the co-editor of The Otter, a scrappy online magazine for narrative journalism, and was formerly the production editor of The Review of Journalism and an editorial intern at Maisonneuve.

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