Canadian Blood Services and Héma-Québec are supporting research for screening plasma donors differently from whole blood donors as a way to expand the eligibility criteria for men who have sex with men, according to Canadian Blood Services representative Catherine Lewis.
Lewis says this is the next step in evolving the blood-screening process. Blood plasma is used in the creation of a category of medicine called plasma protein products for conditions such as hemophilia A and B and for major surgeries. The process of manufacturing plasma protein products significantly decreases the possibility of transmission of infectious diseases.
The deferral criteria exist to filter out what Lewis indicates is a “high-risk” demographic for HIV transmission. According to the HIV in Canada Surveillance Report, 46.4 per cent of new HIV cases in Canada have appeared in men who have sex with men.
However, the three-month wait period for men since their last sexual contact with other men before they can donate blood does not correspond with the ability to accurately test for HIV in blood, says Nathan Lachowsky, research director at the Community Based Research Centre, a non-profit organization dedicated to putting members of the LGBTQ+ community at the head of HIV research. Lachowsky says HIV only needs to be present in a donor’s system for nine days to be reliably picked up by modern testing equipment.
“Not all sex between two men is equally risky,” says Lachowsky. He says a move to behaviour-based deferral would go further in making the LGBTQ+ community more welcome in donating blood. Lachowsky adds that the ideal deferral process would be based on gender/sexuality neutral factors such as if a person is in a long-term monogamous relationship, whether safe sex is practiced, or if a person is taking an HIV preventative medication such as pre-exposure prophylaxis (PrEP).
Some of the less common illnesses that men who have sex with men are at greater risk for have longer dormant periods before they can be detected in donated blood. Hepatitis B is another sexually transmitted infection that can go undetected in the blood for 23 days. That’s more than twice as long as HIV’s dormant period, which Lachowsky says further strengthens the case for behaviour-based deferral.
The eligibility restriction can be traced back to the 1997 tainted blood scandal in which roughly 2,000 people were infected with HIV through donated blood. Since then, testing has improved significantly both in scope and accuracy. Lewis says all blood donations are screened for syphilis; hepatitis B and C; human immunodeficiency virus (HIV-1 and 2); human t-cell lymphotropic virus (HTLV-1 and 2); West Nile virus (WNV); Zika; cytomegalovirus (CMV) and Chagas disease (Trypanosoma cruzi).
The U.S. Food and Drug Administration earlier this month reduced its deferral period for whole blood donation for men who have sex with men from 12 months to three months, the same as Canadian Blood Services.
While blood service agencies in Canada are contemplating changes for plasma, any changes to the criteria for whole blood will take longer. Lewis says Canadian Blood Services is pushing “to be as minimally restrictive as possible while also maintaining the safety of the blood supply. We’re not done yet – we see the changes so far as incremental steps, not the destination.”
Some in the LGBTQ+ community are hoping the testing changes are adopted soon. “I really want to see a world where I’m able to help people with what I’m given. I still get phone calls from them, even though I know they wouldn’t take my blood,” says Jacqueline Rachel, a first-year Sexual Diversity Studies student at the University of Toronto. Although non-binary, Rachel was assigned male at birth and has been tested as a man when donating blood.
Lewis says Canadian Blood Services understands the disappointment. “Being turned away from donating blood can leave a donor feeling hurt and rejected, especially because blood donation is a purely altruistic gift.
“The research required to generate evidence-based changes to the eligibility criteria for blood donation is ongoing, and we hope to see further changes to the eligibility criteria for men who have sex with men in the upcoming years.”