For Aaron Crowe, donating blood is a valuable way to contribute to society, having received blood donations himself.
But he remains barred from giving, even in the wake of a decision by Health Canada last week that put an end to the blanket ban on blood donations from men and some transgender women who have had sex with men in the last three months.
That’s because Crowe’s partner of six years is HIV-positive, and Canadian Blood Services (CBS) continues to bar individuals from donating if they’ve had sex with a person who is HIV-positive in the last 12 months. This despite the fact that Crowe’s partner has an undetectable viral load due to medication, and therefore can’t transmit the virus to him.
Crowe is just one of what critics say will be a “significant” number of individuals who will continue to be barred under the new blood donor policy, set to take effect by Sept. 30.
Advocates say the new policy — championed as a long-overdue milestone by federal politicians including Prime Minister Justin Trudeau — will still effectively ban many men who have sex with men, while continuing to perpetuate stigmas about them and people who live with HIV.
“The initial coverage of it was really exciting because it sounded like they were making meaningful changes to stop discriminating against gay men and other people,” Crowe said in an interview, “but when you actually looked into the way they were changing it, it seems like they’re really whitewashing the same policy.”
The new rules prohibit all individuals — regardless of sexual orientation or gender identity — from donating if they’ve had anal sex with a new or multiple partners in the last three months.
All blood donations are tested for diseases including HIV and Hepatitis B and C. The blood agency says there’s a window of about nine days after an HIV infection when a person may transmit the virus and it is not picked up by testing, hence the need for screening questions.
The agency said it uses a three-month deferral period because the window for other pathogens like Hepatitis B “is considerably longer,” and three months is the time frame used in the U.K.
Critics point out that although everyone will now be asked about anal sex — which carries a higher transmission risk of HIV than other sexual practices — it’s a sexual activity more commonly practised among men who have sex with men, and they will continue to be disproportionately excluded unless in a monogamous relationship.
“If Canadian Blood Services is expecting a real increase in donations — which at times we’ve really needed — this policy shift doesn’t seem to suggest, in our view, that that will be the case,” Dane Griffiths, director of the Gay Men’s Sexual Health Alliance.
“Once you really look into the details of who is excluded … This will still render many of us ineligible to donate.”
The concern is the new policy “will continue to bar a significant number of gay, bisexual and queer men from donating,” said lawyer Gregory Ko, who represents Christopher Karas, who brought a human rights complaint against the blood donation system.
To allow more men to donate while maintaining the safety of the blood supply, CBS should be asking about safe sexual practices, advocates say, such as condom use. CBS says condoms can break.
CBS also bans individuals who are taking preexposure prophylaxis (PrEP) — medication that prevents the transmission of HIV. The agency said PrEP, which has become an increasingly popular safe sex practice in the LGBTQ community, affects the sensitivity of their tests, and it’s unclear if PrEP can prevent HIV from appearing in a blood transfusion.
Individuals must be off PrEP for four months before they can donate blood, a criterion implemented at Health Canada’s request in 2019, Canadian Blood Services said.
“For most gay and bisexual men, especially for those who use PrEP — those same folks we’ve been encouraging to use the tools available to us to reduce the impact of HIV in our community — they’ll be ineligible to donate,” Griffiths said.
The head of the Canadian AIDS Society, which has been consulted by Canadian Blood Services for years, said the government should have invested more in research on the impact of PrEP and testing.
“It’s very disingenuous for Trudeau to take a stand with his comrades in arms, the gay caucus, and say, ‘Hey, we’ve done this now,’” said society executive director Gary Lacasse. “There’s been too much harm done, and it’s being perpetuated even more now.”
CBS also continues to ban people like Crowe who have had sex with a person who is HIV-positive — regardless of the status of their viral load — in the last 12 months. In recent years, a number of organizations and governments, including Ottawa, have adopted the position that an undetectable viral load means that HIV cannot be transmitted sexually.
“I continue to be a strong proponent for the Undetectable = Untransmittable (U = U) message,” chief public health officer of Canada Dr. Theresa Tam said in 2018. “This is a principle firmly grounded in science.”
CBS says U=U does not apply to blood transfusions, saying a small amount of virus could still be transmitted by an HIV-positive person donating blood. As for partners of people who are HIV-positive with undetectable viral loads, the agency said that due to privacy concerns, it “cannot ask donors for detailed information about the test results of their partners.” CBS says it plans to review that donor question in the future.
A Dalhousie University professor, who has spent years researching the blood donation system, said Canadian Blood Services must be held to account for failing to address homophobia and anti-Black racism, and how the two intersected in preventing Black gay and bi men from donating — going as far to say the agency needs new leadership.
One example was the presence for years of an online donor questionnaire that asked people if they were born or ever lived in Africa, accompanied by photos of elephants and acacia trees — questions that have since been removed, said OmiSoore Dryden, the James R. Johnston Chair in Black Canadian Studies at Dalhousie’s faculty of medicine.
“When you use these images of Africa to always be around vegetation, animals, dirt, you’re perpetuating a particular racist stereotype about people who were born or lived in Africa,” she said.
The questionnaire “depicted Africa as if it was one country … as if the entire continent of Africa was riddled with AIDS, and these racist stereotypes have never been addressed appropriately.”
CBS said the questions about Africa were “imposed” on the agency by Health Canada because of concerns over new strains of HIV in certain African countries that may have been less detectable during testing.
“We were able to convince Health Canada that our methods were adequate to detect these new strains, and the questions were removed entirely in April 2018,” the agency said. “We … acknowledge that some of our donor screening questions currently and in the past have disproportionately impacted Black and other racialized Canadians.”
Dryden said it’s “really juvenile understanding” to think that by simply removing or reframing questions, “then the stigma is gone.”
Crowe says by continuing to ban people like him from donating blood, CBS is unnecessarily perpetuating stigma around HIV, which he said prevents people from getting tested and the treatment they need.
Crowe’s partner, Randy Davis, has had an undetectable viral load thanks to antiretroviral medication almost from the start of his diagnosis seven years ago, and has therefore not transmitted the virus to Crowe.
“There’s lots of couples who are in the situation we are, and they’re primarily on the LGBT spectrum, so I feel that the new rules are still very discriminatory against LGBT people,” said the 53-year-old software consultant.
“One of the big issues with being able to combat the HIV epidemic is combating stigma, and this just only further stigmatizes people living with HIV and the people living with them.”
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