After decades of advocacy, Canadian Blood Services finally removed the sexual orientation-based ban on blood donation from gay, bi, and queer men last September, and replaced it with a gender-neutral, behavioural-based screening approach. While more work must be done to further improve the screening process and questionnaire, as well as counter lasting stigma and discrimination caused by the ban, this new approach represents positive change.
Not just for queer men but for all Canadians who could benefit from blood donation. Unfortunately, these same advancements have not occurred in organ and tissue donation.
A recent policy brief, led by Dr. Murdoch Leeies, physician and Director of Research with the University of Manitoba Department of Emergency Medicine, shines light on discrimination in organ and tissue donation and transplantation (OTDT).
Click here to read the policy brief
In the OTDT system, men who have sex with men are still treated differently. For example, solid organs (like the kidneys or liver) are labelled as coming from “increased infectious risk donors” if donated by a man who’s had sex with a man in the last year. This signals to the organ recipient that the organ is more likely to contain HIV and may have been donated by a queer man.
When it comes to donating tissues (like bones and skin), donations from queer men are usually rejected entirely.
These kinds of policies may have made sense in the past when our understanding of HIV — and our tools to detect it — were more limited. Now, however, we know these policies needlessly perpetuate stigma against queer people and people living with HIV.
Given what we know about HIV transmission, screening donors with questions around their behavior could replace discriminatory regulations that unnecessarily exclude Two-Spirit and gay, bi, trans, queer men (2S/GBTQ+).
While HIV can’t be detected in the body immediately upon exposure, modern HIV testing also means a 1-year abstinence period is unnecessary. Nucleic acid tests, which are available across Canada, typically detect HIV if it has been present in the body for more than 7 days. Antibody/antigen tests, which are even more accessible, consistently detect HIV if it has been present in the body for 12 weeks.
OTDT practices in Canada need to catch up with modern science if we want to improve health equity and respond to the urgent need for donated organs. But, as suggested in our new policy brief, Ending Discriminatory Practices in OTDT, we must also remove practices that were never based in science.
Among the recommendations included in the report is to remove invasive rectal exams that aim to identify “evidence” of anal sex. In many Canadian jurisdictions, these exams are performed on deceased male donors to flag those who’ve experienced anal sex; yet, these exams are not backed by science and offer no clinically relevant indication of HIV status. Moreover, these exams are considered offensive by many in the community, and wrongly suggest that sex between men is inextricably linked to HIV transmission.
The report also highlights other inequities in OTDT, including a ban on organs from sexual partners of those living with HIV — ignoring the science on the effectiveness of HIV prevention strategies such as U=U and PrEP — and a lack of recognition for trans people in the OTDT system.
Like the blanket blood ban that prevented gay, bi, and queer men for decades, tackling these inequities will require changes to Health Canada’s regulation. The government has itself recognized and committed to addressing anti-2S/GBTQ+ discrimination in OTDT: the Standing Committee on Health called for this in the 2019 report, The Health of LGBTQIA2 Communities in Canada.
We’re echoing this call for Health Canada to implement changes required to stop discrimination and stigmatization of our communities. Changes to blood donation criteria have shown it’s possible to modernize donation criteria while maintaining strict standards to ensure the safety of the blood supply.
It’s time we reflect these changes in the OTDT system too, and end the era in which queer Canadians have been considered second class donors.