In Canada, men who have had sex with men (MSM) at least once in the past five years are not allowed to donate blood. As the Trudeau government is interested in making blood donation policy more inclusive, it’s time to take a look at the facts.
It is often argued that this sort of discrimination is demeaning, unfair and ultimately offensive to these men. For clarity, we will use the term “MSM” instead of “gay men,” as it is the act of having sex with men and not one's sexuality that is the basis for this discriminatory policy. Canadian Blood Services says the reason it has the five-year deferral period for MSM donors is to allow “time for new or emerging infectious diseases to be identified and appropriate measures taken.” Is this reasonable, or is it time for change?
Why are MSM specifically targeted for discrimination? MSM are much more likely to obtain an HIV infection than the general population. According to a study in the U.S., MSM account for only two per cent of the population, but about two thirds of the new HIV incidences. By eliminating this one small segment of the population from the potential donor pool, we can vastly reduce the risk of spreading HIV positive blood, while affecting relatively few people.
What about the MSM who have safe sex? Do we not trust them? It is argued often that MSM who practice safe sex, perhaps monogamously, are at no greater risk of contracting HIV than the average person. This may indeed be true in some cases, but it is beside the point for two reasons. Firstly, in a policy meant to apply to an entire country, it would be extremely difficult to accurately distinguish between MSM who practice safe and unsafe sex, however we define it. Secondly, even if we could accurately distinguish between those groups with the screening questionnaire, we would be relying on the accuracy of their information. Of course, we have no reason to think these people are being malicious and trying to lie, but we have to consider that they, like anyone, may not have the necessary knowledge to report their activity accurately. If we go beyond the basic, simple questions, people tend to make honest mistakes.
Why does it matter, if we test the blood anyway? Although there is still some risk of HIV positive blood making it through screening and into the general supply, that risk has been drastically reduced due to recent improvements in testing. Nucleic acid testing (NAT) for HIV, which is employed to test all blood donations, can detect the virus even as soon as a few days after infection. The chance of receiving infected blood that does not yet test positive is greatly limited, but not eliminated. False negatives are exceedingly rare, such that it takes only a handful of cases to make the news in the medical literature, but it does occasionally happen, and people still do get HIV infections from donated blood.
The safety of patients is more important than the feelings of potential donors who feel excluded. Permitting MSM to donate blood would change the blood supply very little as they make up such a small proportion of the population. Your conclusion here will depend on how you comparatively value the feelings of exclusion of MSM, the risk of infection to blood recipients, and the small potential increase in blood supply from this donor population. My conclusion is that, balancing these factors, we should wait before abolishing the five-year deferral period, to allow more time for technological advancement and study so we can make an extremely informed decision. This is not the place for political rhetoric.
Brayden Whitlock is a podcaster at TheWhyShow.com and a PhD student at the University of Alberta.
