Men who have sex with men can now give blood in Canada – but only if they have been celibate for five years.
This change in policy by Canadian Blood Services and Héma-Québec – in response to charges that the blood-collection agencies are homophobic – is being presented as a positive but prudent step.
Sublimely ridiculous would be more accurate.
This decision is not going to increase blood donations and it's not going to make the blood system any safer (or less safe). So what's the point?
It's not so much a step in the right direction as it is shuffling forward reluctantly for damage-control purposes. Nor is it a decision rooted in science.
Let's be clear: Giving blood is not an inalienable right. Blood collection depends on trust. You need to convince donors that their gift is precious and recipients that blood is safe.
Blood-collection agencies like CBS and Héma-Québec must be both welcoming and discriminating (in the true sense of that word). The regulator, Health Canada, must be strict and demanding on safety.
That's why we have all sorts of restrictions. To give blood you have to be over 17 and under 71; you have to weigh more than 50 kilograms; you can't have a new piercing or tattoo in the past six months; you can't have the flu; you cannot have even lived in Britain or France for more than three months from 1980 to 1996 (the mad-cow era). These rules are established according to the best scientific evidence and, for the most part, they are reasonable, though the Creutzfeldt-Jakob disease-related ban is a bit dubious (but justifiable given the uncertainty about its pathology).
Gay men were banned from giving blood in Canada in 1983, at a time when the blood supply was horribly contaminated. HIV, the AIDS virus, had not been identified at the time and there was no test to detect this new infectious disease, so banning men who had sex with men was entirely appropriate. Since that time, anyone who had sex with a man "even once, since 1977" could not give blood.
Thirty years after that blanket ban was introduced, it could no longer be justified.
What is justified is deferring blood donations by men and women with multiple sex partners, whether they are homosexual or heterosexual.
What is justified is a ban on donations by people who engage in so-called high-risk activities such as unprotected anal or oral sex, paid sex work or injection drug use.
In other words, we should be screening blood donors based on their sexual practices, not on their sexual orientation.
Why do we demand that a man who has sex with men be celibate for five years before being allowed to make a blood donation and not make the same demand of a man who has sex with women?
It's frequency of partners and sexual practices that determine risk, not the homo- or hetero- prefix.
There are currently about 65,000 Canadians living with HIV-AIDS, and just over half of them are men who have sex with men. The other half are heterosexual men and women. But about 10 per cent of men who have sex with men are infected with HIV-AIDS, compared to less than one per cent of hetero men and women.
No one is suggesting that people infected with HIV (or hepatitis C or any other blood-borne disease) be allowed to donate blood.
But why are we excluding the 90 per cent of gay men who are not HIV-positive from donating? Most gay men – like most straight men – are in stable relationships. So where does this new five-year celibacy rule come from? It seems to have been pulled out of someone's hat as a compromise between a lifetime ban and no ban. It makes no sense.
The goal of screening is to minimize the number of potentially contaminated units of blood. Again, you do that by weeding out potential donors with risky behaviours. But every unit is still tested.
Caution is in order because there is a window period – a brief time when someone can be infected with HIV and it may not show up in blood tests. With new technology, that window period is no more than a couple of weeks; the chances of a HIV-contaminated blood donation sneaking through are very small.
This is not any easy issue, especially given the sordid history of tainted blood. (More than 20,000 Canadians died as a result of transfusions with blood contaminated with HIV and hepatitis C in the 1980s and 1990s.)
But blood is ever-in-demand and precious. More than 1.1-million units of blood are collected in Canada each year, but shortages are ever-looming. We can't afford to eliminate entire groups of potential donors based on whimsy. Nor can we impose bogus rules to cater to public prejudices.
Other countries like the United Kingdom, Australia, South Africa and Japan have lifted their lifetime bans on gay men donating blood. They have opted for celibacy periods too, but in the six- to 12-month range.
Not ideal, but still more reasonable than Canada's five-year rule.
Instead of patting ourselves on the back for taking a small step, we should be asking why we have not taken a larger, evidence-based step.
André Picard