Men who have sex with men

As of June 3, 2019, men are eligible to give blood if it has been more than three months since their last sexual contact with a man, and they meet all other eligibility criteria for donation. 

As a blood operator, Canadian Blood Services recognizes that few blood donor criterion are as contentious as the eligibility criteria for men who have sex with men. We understand that individuals and groups that are not eligible sometimes take the criteria very personally, but that is not the intent. We empathize with all those who for various reasons are not able to donate. While we are committed to being as minimally restrictive as possible that commitment must be balanced with ensuring the safety of the blood supply. This responsibility for blood safety includes minimizing the risk of any infection being transmitted through the blood system to an already vulnerable patient.

All of the eligibility criteria used to screen donors is part of a science-based, multi-tiered safety system that helps save patient lives.

At the outset of every blood donation, donors are screened to assess whether they are eligible. The screening involves answering an extensive list of questions to ensure the safety of both the donor and the patient who will receive the blood products. And still, despite: 1) rigorous adherence to testing for known pathogens, 2) regular surveillance and 3) incorporation of advances in both testing and detection, there isn’t a way to anticipate pathogen mutations or other unknown risks to our system.

As new data and evidence is collected, it becomes part of a body of research used to inform recommendations and decisions about donation criteria, collection methods, equipment used, storage, transportation and all else in-between. Ultimately it is the patients who bear the risk of exposure to infection, and it is for patients that we must ensure that science-based evidence is applied in all decision-making including donor eligibility criteria.

Canada decided on the current waiting period for men who have sex with men, based on several factors. Among those are donor and population-based screening considerations specific to the Canadian context, which is different from that of other countries.  

Because the patterns, causes and effects of HIV differ by country, there is no international scientific consensus on an optimal deferral period for men who have sex with men. Some European countries still have lifetime bans on blood donations from men who have sex with men, while others have moved to a one-year deferral. For example, the United States and Australia have reduced their waiting periods to one year.  Some blood centres in Spain and Italy have taken the approach of asking about safe sex practices or monogamy, but those countries have different blood systems than Canada’s. In those countries, physicians interview individual donors and may be able to perform individual health assessments. It should be noted, however, that the rate of donors with HIV-positive test results in those countries is more than 10 times higher than in Canada. 

Men are eligible to give blood based on the interval of their last sexual contact with another man. According to data from the Public Health Agency of Canada, HIV in Canada-Surveillance Report (2017), men who have sex with men account for the largest proportion of new HIV infections reported in Canada. Exposure for the MSM category was close to half (46.4 per cent) of all new HIV infections among adults (persons >15 years of age) for 2017. Over the years, Canadian Blood Services has made incremental changes so as to be as minimally restrictive as possible while also maintaining the safety of the blood supply. 

The previous eligibility change, which was implemented in 2016, was an incremental measure based on the evidence available at the time. The data collected and analyzed over the period since 2016 (when the previous time-based eligibility change came into effect), shows that no significant risk was introduced into the system. The proposed further reduction to the waiting period represents the next available step forward in updating our blood donation criteria. As we have collected data and built an appropriate body of evidence-based research, we have evolved the eligibility criteria accordingly. This is the approach we will continue to take. 

We test every donation for several infectious diseases, including HIV, hepatitis B and hepatitis C. While our technology is sophisticated, there is a brief period shortly after infection when HIV is not detectable. If an individual were to donate blood during this "window period" in the early stages of infection, our testing process would not detect the virus and that donation would be infectious to a patient.   

Despite a multi-tiered safety system designed to protect patients, which includes: 1) rigorous adherence to testing for known pathogens, 2) regular surveillance and 3) incorporation of advances in both testing and detection, there isn’t a way to anticipate pathogen mutations or other unknown risks to our system. As new data and evidence is collected, it becomes part of a body of research used to inform recommendations and decisions about donation criteria, collection methods, equipment used, storage, transportation and all else in-between. Ultimately it is the patients who bear the risk of exposure to infection, and it for patients that we must ensure that science-based evidence is applied in all decision-making including donor eligibility criteria.  

We can’t really speculate on the timing, but we do know that additional research is necessary to generate the evidence required for low risk groups to be identified and included as eligible donors while maintaining the safety of the blood supply for patients. That’s why Canadian Blood Services, in partnership with Héma-Québec and with funding from Health Canada, is supporting 15 research projects investigating various aspects of blood and plasma donors’ eligibility criteria and screening.  This funded research could evolve the current eligibility criteria for men who have sex with men. It is possible that the criteria could change for source plasma donation sooner than for whole blood donation, given that the collection of plasma for manufacturing of plasma derived products allows for other safety steps to be put in place (such as quarantine and inactivation, as part of the manufacturing process).

Because the patterns, causes and effects of HIV differ by country, there is no international scientific consensus on an optimal eligibility criterion for MSM. Some European countries have instituted lifetime bans on blood donations from MSM, while the United States and Australia have reduced their waiting periods to one year. Some blood centres in Spain and Italy have taken the approach of asking about safe sex practices or monogamy, but those countries have different blood systems than Canada’s. In those countries, physicians interview individual donors and may be able to perform individual health assessments. It should be noted, however, that the rate of donors with HIV-positive test results in those countries is more than 10 times higher than in Canada. 

Canadian patients depend on us to provide a safe, secure and cost-effective blood system that meets their full range of health-care needs. Our screening practices are in place to protect both patients and donors. All donors are subject to the same eligibility criteria. These criteria ensure that we accept donations only from individuals from whom it is safe for patients to receive blood. To protect the safety of patients who rely on blood products for treatment, we often have to make difficult decisions, based primarily on scientific evidence of risk, about who can and cannot donate blood.

Donating blood isn’t the only way to support patients. There are many ways that those who may not be eligible to give blood can work with us to make a valuable contribution to patients in need, such as financial donations, by registering as an organ and tissue and/or as a stem cell donor. 

Currently, in addition to meeting all other donor eligibility criteria (at the time of screening), men are eligible to donate blood if their last sexual contact with a man (anal or oral sexual contact) was three months before. In addition, MSM who live in the Vancouver area are eligible to donate blood for important research and development projects at our Network Centre for Applied Development (netCAD). 

An indefinite deferral for men who had had sex with another man (even once since 1977) was instituted in the United States in the early 1980s, before the virus that causes AIDS was identified and when men who have sex with men were noted to be a particularly high-risk group. Being solely responsible for Canada’s blood supply at that time, the Canadian Red Cross Society followed suit. This criterion was in place until July 2013, when both Canadian Blood Services and Héma-Québec reduced the eligibility criteria from an indefinite deferral to a five year waiting period following sexual contact with another man. While this change allowed only a small percentage of MSM to donate blood, it was still significant as it was the first update to Canada’s donor eligibility criteria for MSM since the criteria was implemented more than 35 years ago. All changes to screening practices were made after an extensive review of scientific and epidemiologic evidence. Equally important was the consultation with high-interest groups, including patient groups representing heavy users of blood and blood products as well as members of lesbian, gay, bisexual, trans and queer (LGBTQ+) community groups. Many of these organizations sent letters supporting the policy changes to Health Canada.

Canadian Blood Services is exploring the possibility of moving toward alternative screening approaches for all donors, which may evolve the current eligibility criteria for men who have sex with men. As part of the MSM Research Grant Program we are working with the LGBTQ+ community, patient groups and other stakeholders to gather the scientific evidence required to determine whether it is possible to reliably identify low-risk, sexually active men who have sex with men. This research is crucial to moving from a time-based deferral (determined by when a donor last had sex with a man) to an alternative screening approach.

We don’t have an estimated number because it isn’t something we have a way of tracking. Engaging new donors is not the main reason for making this particular change. Our goal is to maintain the safety of the blood supply while being as minimally restrictive as possible.

Regulations for organ and stem cell donations are different than those for blood donation. MSM can register to become organ donors through their provincial organ donation registry. Organ and tissue donors are asked questions on topics ranging from their general health to specific risk behaviours. Each case is assessed in consultation with the attending physician and based on patient consent. To find out more about organ donation, visit the Organs and Tissues section of our website.

MSM who are between the ages of 17 and 35 can also join the Canadian Blood Services Stem Cell Registry. Similarly, to organ donations, stem cell matches require input from an attending physician as well as patient consent. To find out more about stem cell donation, visit the Stem Cells section of our website.

The current eligibility criteria does not permit sexually active MSM to donate plasma. However, the longer storage time of plasma combined with the additional steps involved in the production of plasma protein products makes it feasible that this would be the first type of donation that low risk MSM may be eligible to make. France has implemented a similar program for plasma for transfusion. The feasibility of alternative criteria that would enable MSM to donate source plasma is one of the projects being funded through the MSM Research program.

If a woman has had sexual contact with a man who has had sex with a man in the last year, she must wait three months from last sexual contact before donating blood. 

Women who have sex with women are not in a high-risk group for HIV, which is why they are eligible to donate blood without a waiting period as long as they meet all other criteria.

As part of Health Canada’s approval of our application to reduce the waiting period for MSM from one year to three months, eligibility criteria for trans donors has been approved. Trans donors are asked MSM risk questions based on their anatomical sex (genitalia) at the time of donation. Donors who have not had lower gender affirming surgery are screened based on their sex assigned at birth, and are eligible to donate or are deferred based on these criteria. Donors who have had lower gender affirming surgery are deferred from donating blood for three months after their surgery. After the three months, donors will be screened in their affirmed gender.

Health Canada is the regulator of Canada’s blood system. Any changes to donor eligibility criteria that may affect recipient safety must be sent to Health Canada for approval. Over the years, Health Canada has reviewed and approved our requests to reduce the blood waiting period for MSM based on the evidence presented in our joint submissions with Héma-Québec. 

In 2010, the Ontario Superior Court found that blood donation is a gift, not a right, and that Canadian Blood Services’ donor eligibility criteria for MSM are not discriminatory based on sexual orientation, but rather are based on epidemiology and safety considerations. However, we do understand that these criteria may cause strong feelings and emphasize that it is not intended as a negative reflection on any one individual. 

Canadian Blood Services, in partnership with Héma-Québec and with funding from Health Canada, is supporting 15 research projects investigating various aspects of blood and plasma donors’ eligibility criteria and screening process. The goal of this unique research funding program is to generate adequate evidence to inform alternative screening approaches for blood and plasma donors, which could evolve the current eligibility criteria for men who have sex with men. This new research is necessary to generate the evidence required for low risk groups to be identified and included as eligible donors while maintaining the safety of the blood supply for patients. A second round of funding was introduced in April 2018. Information about the MSM Research program is available on our website (new info may be added as soon as Nov. 2018). Any change related to donor eligibility criteria demands extra prudence to maintain public trust and confidence in the safety of the system.