Men who have sex with men
History and timeline
2021
- September: Canadian Blood Services approved to expand source plasma donor eligibility for men who have sex with men at our Calgary, Alta. and London, Ont. sites.
- December: Canadian Blood Services makes a submission to Health Canada to stop asking men if they’ve had sex with another man and instead focus on high-risk sexual behaviour among all donors.
2019
- Health Canada approves reduction of the waiting period for MSM from one year to three months.
2018
- A new request to further reduce the waiting period for men who have sex with men from one year to three months is submitted to Health Canada.
- A new round of consultation meetings with stakeholders and partners takes place to discuss planned submission to Health Canada to further reduce the waiting period for men who have sex with men to three months.
- Four additional projects were awarded funding after a second round of funding was made available as part of the MSM research grant program.
2017
- The MSM research grant program launched Feb. 1
- A two-day meeting was held in January with national and international stakeholders to identify research priorities for closing knowledge gaps that impact donor eligibility for men who have sex with men.
2016
Health Canada approved Canadian Blood Services’ proposal to reduce the blood donation ineligibility period for men who have sex with men from five years to one year.
2013
Health Canada approved the change in donor selection criteria for men who have sex with men from an indefinite deferral period for any man who has had sex with other men, even once, since 1977 to a time-based deferral of five years since last sexual contact.
2011
Canadian Blood Services’ board of directors approved plans to move away from the long-standing permanent deferral for men who have sex with men since 1977 to a defined term of not more than 10 years and not less than five years since last sexual contact.
2010
In response to the Charter of Rights and Freedoms challenge launched in 2002, the Ontario Superior Court ruled that the deferral criteria for men who have sex with men is not discriminatory because it is based on health and safety considerations. Justice Aitken of the Ontario Superior Court ruled that:
- Blood donation is a gift, not a right
- There is no requirement under law to accept the gift of blood
- Donors have a duty to answer questions honestly
- The men who have sex with men deferral is not discriminatory, but is based on health and safety considerations
- The need for lifetime deferral period was not demonstrated
2007
Canadian Blood Services’ board of directors concluded the current men who have sex with men deferral criteria should be maintained, but Canadian Blood Services should actively gather information to gain more knowledge on the subject.
2006
Canadian Blood Services conducted a thorough review of the men who have sex with men eligibility criteria.
1992
Blood products became regulated by the national blood system regulator, Health Canada, and the criterion affecting gay, bisexual and other men who have sex with men was ‘grandfathered’ into existing regulations.
Mid-1980s
Canadian Blood Services’ predecessor, the Canadian Red Cross Blood Transfusion Service, introduced a donor selection criterion that excluded all men who have sex with men (as of 1977) to protect the blood supply from HIV.
MSM research grant program may lead to change
In partnership with Héma-Québec and with funding from Health Canada, Canadian Blood Services is supporting 19 research projects investigating various aspects of the eligibility criteria and screening processes.
The goal of the MSM research grant 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.
With funding from Health Canada, Canadian Blood Services is supporting 4 research projects as part of the MSM Plasma Program, which aims to establish evidence-based alternative screening and collection approaches for source plasma donors.
Frequently asked questions
What is Canada’s current eligibility criteria for men who have sex with men (MSM)?
Men are currently eligible to give blood if it has been more than three months since their last sexual contact with another man.
Canadian Blood Services’ goal is to stop asking men if they’ve had sex with another man and instead focus on high-risk sexual behaviour among all donors. To this end, we made a submission recommending this change to Health Canada, our regulator, in December 2021.
How do you respond to the comment that the deferral of men who have sex with men is “not based on science”?
We know that few blood donor criteria are as contentious as the eligibility criteria specific to men who have sex with men. Canada has one of the safest blood systems in the world. Eligibility criteria are part of a science-based, multi-tiered safety system that saves patients’ lives.
Our current criteria are based on a broad statistical picture of risk rather than individual risk assessments.
According to data collected by the Public Health Agency of Canada, the incidence of HIV and hepatitis C is substantially higher in Canada among men who have sex with men than it is in the rest of the population.
We understand, however, that individuals within a group are not all the same. This is part of the reason why we are working towards a new way of screening donors that looks at the risks of specific sexual behaviours.
We want to change our screening approach to focus on higher-risk sexual behaviours among all donors, regardless of their gender or sexual orientation. We made a submission recommending this change to Health Canada, our regulator, in December of 2021. The submission is currently under review with Health Canada and we hope it will be approved in the coming months.
Why does Canada’s approach differ from that of other countries?
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.
How do you know it’s safe to change your screening approach to asking all donors about higher-risk sexual behaviour?
Our operations are built around patient safety. Canada has one of the safest blood systems in the world. Since Canadian Blood Services began managing Canada’s blood system in 1998, there has not been a single transfusion-transmitted blood-borne infection from either hepatitis C or HIV.
In Canada, blood donor eligibility criteria are developed within a strict, evidence-informed regulatory framework that focuses on safety, which includes quality and efficacy.
As the system regulator, Health Canada is responsible for reviewing and approving blood operators’ donor selection criteria when there is a potential impact on the safety and quality of blood products.
We are working diligently toward greater inclusivity for donors while maintaining a safe and adequate supply of blood products for the patients we serve.
We want to change our screening approach to focus on higher-risk sexual behaviours among all donors, regardless of their gender or sexual orientation. We made a submission recommending this change to Health Canada, our regulator, in December of 2021. The submission is currently under review with Health Canada and we hope it will be approved in the coming months.
The evidence we have gathered through the MSM Research Program, as well as findings from the international research community, epidemiological data and our own extensive modelling support the proposed change. Currently the risk of HIV being introduced to the blood system is extremely low, and according to the evidence, the proposed change will not increase that risk. External scientific committees have reviewed the details of the evidence and support our conclusion that blood safety will not be compromised by our proposed approach.
Isn’t all blood tested?
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.
What’s next, when can you make additional changes?
Canadian Blood Services’ goal is to stop asking men if they’ve had sex with another man and instead focus on high-risk sexual behaviour among all donors. To this end, we made a submission recommending this change to Health Canada, our regulator, in December 2021.
Our criteria have always been intended to protect the safety of the blood system while being as minimally restrictive as possible. We believe we now have the evidence needed to make a request for change with our regulator, Health Canada, and that our proposed approach will preserve the safety of the blood supply.
Why can we not just adopt approaches used in other countries, such as Spain and Italy, rather than doing our own research?
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, others such as the U.S. and Australia use waiting periods like we do currently, and 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.
The model we are proposing to Health Canada in our upcoming submission is a different approach, based on the work done in the U.K. The evidence we have through the MSM Research Program, as well as findings from the international research community, epidemiological data and our own extensive modelling support the proposed change. The safety of Canada’s blood supply will always be paramount for Canadian Blood Services. We have more evidence than ever before indicating this change will not compromise the safety or adequacy of the blood supply.
Why is screening necessary, shouldn’t everyone who wants to contribute be able to donate?
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.
Are there any conditions that make it possible for gay, bisexual and other men who have sex with men to donate blood?
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, sexually active gay, bisexual and other men who have sex with men 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).
Gay, bisexual and other men who have sex with men may be able to donate source plasma at our London and Calgary donor centres. At these centres, if you are a man who answers “yes” to having had sex with a man in the last three months, you will be eligible to donate source plasma if:
- You have not had a new sexual partner in the last three months,
- You and your partner have only had sex with each other in the last three months, and
- You meet all other criteria for donation.
Why not ask about safe sex practices or monogamy instead of making all men who have sex with men wait three months before donating blood?
Canadian Blood Services’ goal is to stop asking men if they’ve had sex with another man and instead focus on high-risk sexual behaviour among all donors. To this end, we made a submission recommending this change to Health Canada, our regulator, in December 2021.
How many more donors in Canada will be eligible now that the eligibility criteria for men who have sex with men has been reduced from one year to three months?
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 evolving this criteria. Our goal is to maintain the safety of the blood supply while being as inclusive as possible.
Can men who have sex with men donate organs or stem cells?
Regulations for organ and stem cell donations are different than those for blood donation. Men who have sex with men 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.
Can men who have sex with men donate source plasma?
Currently, sexually active men who have sex with men can donate source plasma at our collection centres in Calgary, Alta. and London, Ont. if they have not had a new sexual partner in the last three months, and if their partner has not had sex with another partner, and they meet all other eligibility criteria. Learn more about the gbMSM Plasma Program.
Can women who have sex with men who have sex with men donate blood?
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.
Why do the same rules not apply for women who have sex with women?
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.
What about trans individuals?
Currently, trans donors are asked risk questions based on their anatomical sex (genitalia) at the time of donation. Donors who have not had lower gender affirming surgery are screened using questions 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 using questions based on their affirmed gender.
Our upcoming submission to Health Canada, if approved, would remove the requirement to ask trans donors about lower genital gender-affirming surgery.
What is Health Canada’s role in changing the eligibility criteria for men who have sex with men?
Health Canada is the regulator of Canada’s blood system. Health Canada alone has the authority to approve changes to donor selection criteria that impact human safety or the safety of blood. For Canadian Blood Services to apply to make a change, we must be able to provide evidence that the proposed change will not compromise safety.
Is this legal? Isn’t it a person’s right the give blood?
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 men who have sex with men 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.