Canada's policy of banning blood donations from sexually active gay men is counterproductive and needs to change, some doctors say.
Since 1983, blood agencies in Canada, the U.S., and other industrialized countries have permanently deferred blood donations from men who have sex with men because of the possibility of infection with HIV/AIDS.
At the time, the approach was justified by the lack of scientific knowledge of the infection, the higher prevalence of HIV among such men, and the lack of a blood test to screen donors for HIV infection. But in Tuesday's issue of the Canadian Medical Association Journal, Mark Wainberg of Jewish General Hospital in Montreal, Norbert Gilmore of McGill University Health Centre and their co-authors argue for the ban to be reconsidered.
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"Current policy is counterproductive in regard to loss of donors, good will, student protests, potential boycotts and lawsuits, among other negative effects," the authors conclude.
"Notably, blood donation policy has already been changed to permit, as an example, donations from persons of Haitian origin, who were previously also subject to indefinite deferral. It's time for another change in policy."
Canadian Blood Services, Héma-Québec and blood agencies in other countries require donors to fill in a questionnaire about their medical history and potentially harmful behaviour. Intravenous drug users, people with possible exposure to Creutzfeld-Jakob disease, those who have exchanged money for sex or drugs and men who have sex with men are all permanently deferred from giving blood.
Expanded donor pool
But some industrialized countries have shorter deferral periods, such as one year in Argentina, Australia, Japan, Hungary and Sweden, five years in South Africa and 10 years in New Zealand, the authors noted.
The risk of a false negative — a negative result on an HIV test when the donor is, in fact, infected with HIV, has been nearly eliminated because Canada's blood system now uses a highly sensitive nucleic acid test to screen blood, Wainberg and his colleagues say.
The window of time between when a donor may have contracted the infection and when tests can detect it has also shrunk to about 12 days from up to six months previously.
In the analysis paper, the authors outlined the benefits and risks of deferral periods ranging from one year to five years.
At five years for example, the authors cited studies suggesting the risk of transmitting HIV for men who have sex with men without risky behaviour for five years or longer are not greater than the risk of transmission for members of the general population.
If the deferral period is changed, the authors say, blood agencies would stop losing healthy donors who refuse to donate on the grounds that the indefinite deferral for gay men is discriminatory. Student societies, universities and other organizations have stopped holding blood drives because of the ban.
"A change in policy, based on scientific evidence, would remove this prejudice," the authors write. "A delicate balance must be reached between the risk of contaminating the blood supply and the benefits associated with increasing the donor pool."
Blood agencies open to change
Meanwhile, several court cases are underway in Canada challenging the ban against blood donation by sexually active gay men, arguing the donations should be permitted under carefully defined conditions.
Adrian Lomoga, who launched a Charter challenge against Héma-Québec five years ago, welcomed the analysis.
"This is a policy that is instituted without research, that was devised at a time when there weren't scientific tests to detect sexually transmissible diseases, and which hasn't changed even though the science has increased exponentially," said Lomoga, who is now a lawyer in Toronto.
Héma-Québec said it wants to change the lifetime ban to a five-year deferral period.
Canadian Blood Services said it looks at the ban issue regularly in light of new scientific evidence to keep the system as safe as it can be for recipients of blood products.
"We're open to changing the policy as long as the science and the evidence back it," Ron Vezina, communications manager from Canadian Blood Services, said from Ottawa.
"This CMAJ paper is one good voice to keep that discussion going, but it is only one voice. And there is no medical consensus on this issue."