From the Tainted Blood scandal to the blood ban

Why Canadian Blood Services restricts sexually active gay men from donating blood

By Karina Zapata

It was 1976 when the late Randy Conners discovered a blood clotting product that was supposed to help him live a normal life. As a severe hemophiliac, all he had to do was regularly administer the product.

 

But, 10 years later, he was told he contracted HIV — a disease that, at the time, no one knew much about. Eight years after that, Conners died from AIDS. But, he never had sexual interaction with an HIV-positive partner. In fact, based on his behaviour, he wasn’t at risk for HIV at all.

 

Conners contracted HIV, which then turned into AIDS, through a tainted blood product. And he was far from being the only one.

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Randy Conners — who died from AIDS after contracting HIV through a tainted blood product — and his wife, Janet Conners, played a large role in AIDS activism. Nova Scotia was the first province to compensate individuals affected by the tainted blood scandal due to their activism. Newspaper clipping courtesy of Maclean's

More than four decades ago, approximately 2,000 Canadians contracted HIV from blood transfusions and tainted blood products collected by the Canadian Red Cross Society, who failed to test the blood for the virus or implement screening policies. Today, sexually active gay, bisexual and men who have sex with men (gbMSM) are barred from donating blood unless they abstain from having sex for three months.

 

Kevin Allen, research lead at the Calgary Gay History Project, remembers how this tragedy — known as the tainted blood scandal — affected Canada’s gay community.

 

“There was this narrative [in the] late eighties, early nineties, that the gays deserved it,” says Allen. “It wasn't until hemophiliacs started getting AIDS from the tainted blood scandal, which started this whole thing. Then there was societal compassion for the whole AIDS epidemic.”

 

HIV and AIDS: What are they?

 

HIV is a virus that affects the immune system and makes diagnosed individuals more vulnerable to other viruses and infections. If left untreated, HIV can turn into AIDS — a chronic and potentially life-threatening diagnosis — within eight to 10 years.

HIV is typically known as a bloodborne infectious virus, but it can also be contracted through sexual excretions and breast milk.  Graphic by Karina Zapata

Today, due to the advancement of technology and medication, most HIV-positive people in Canada don’t develop AIDS. According to Andrea Carter, director of programs at HIV Community Link, there are often misconceptions about HIV.

 

“HIV is considered a chronic and manageable disease,” says Carter. “Sometimes it's compared to diabetes. The idea being that if you have HIV, as long as you have access to the medication and take the medication as prescribed, then people can expect to live the same lifespan as somebody who's not HIV-positive.”

 

However, this wasn’t always the case. 

 

Allen, who has done a lot of work surrounding HIV and AIDS within the LGBTQ2S+ community, says the AIDS epidemic was once called the “gay plague” due to the amount of deaths caused by it.

 

“AIDS was an epidemic that was almost certain death in the beginning,” says Allen. “I had talked to gay men who lived through that time in Calgary and they talk about going to dozens and dozens of funerals in a 10-year period — a funeral every month.”

 

Part of this, he says, was due to a misunderstanding of the virus.

 

When HIV and AIDS emerged in the early 1980s, there was little understanding of what the virus was and how it was transmitted, other than it seemed to target marginalized populations. Prior to 1982, AIDS was called GRID — gay-related immune deficiency. At one point, HIV was called the “4H disease” as people believed it only affected hemophiliacs, heroin addicts, homosexuals and Haitians.

 

It was this lack of understanding that led to the tainted blood scandal.

 

The tainted blood scandal

 

When HIV started spreading throughout North America, Canadian Blood Services’ (CBS) predecessor, Canadian Red Cross Society, sent a pamphlet to donors about the risk factors for HIV and hoped that people at risk for the virus would abstain from donating blood.

 

What they failed to do, however, was stop accepting blood donations from American prisons, despite experts knowing that prisoners were at risk for HIV due to drug use and unprotected sex. They also failed to implement screening policies and test the blood for HIV and other infections to keep the blood supply safe.

Because of this, in 1985, approximately 2,000 Canadians who received blood transfusions and blood products from Canadian Red Cross Society contracted HIV. Another 30,000 people were infected with hepatitis C virus. The majority of those infected were hemophiliacs, much like Conners, who eventually passed on the virus to his wife.

 

In November of that year, Canadian Red Cross Society began testing blood products for HIV, with hepatitis C testing following five years later. 

 

And years later, in fear of a repeat of the tainted blood scandal, they introduced the blood ban.

The blood ban

Canada's Tainted Blood Scandal

In the 1980s, thousands of Canadians contracted HIV through HIV-positive blood and tainted blood products. This is how it happened. Video by Nathan Woolridge

In 1992, the Canadian Red Cross Society introduced a policy which made all gbMSM ineligible to donate blood indefinitely. This policy, also known as the blood ban, was deemed as discriminatory by gbMSM and allies across the country.

 

Allen, for one, was a regular blood donor since the age of 16. But, because of the introduction of the blood ban, that had to change as soon as he became sexually active in university.

Kevin Allen has worked alongside the LGBTQ2S+ community in Calgary for years and has seen firsthand the impacts of HIV and AIDS on gay men. Photo by Karina Zapata.

“I just remember saying that was unfair to the public health nurse, or whoever was taking it, and she said, ‘Well, you're still allowed to donate blood but we're just going to throw it out,’” says Allen. “That says something about your worth as an individual.”

 

Since then, the deferral period in which gbMSM can donate blood has decreased. In 2013, the policy — now run by Canadian Blood Services (CBS) — went from a complete ban to a deferral period of five years since last sexual contact. In 2016, that deferral period was decreased to twelve months. Lastly, in June of 2019, the policy changed to the current deferral period of three months since last sexual contact.

 

Fraser Tripp, an LGBTQ2S+ activist, believes this policy is still discriminatory, regardless of how much they’ve decreased the deferral period.

 

“I would love to be able to give my blood to someone who might benefit from it,” says Tripp. “But I'm being told that my blood is lesser than other people who may have actually more of a risk pattern than me because I am having sex with men.”

Canadian Blood Services' MSM-donor policies

After the tainted blood scandal, Canadian Blood Services introduced donation restrictions on sexually active gay men to protect the blood supply. Video by Nathan Woolridge.

The deferral period

 

CBS’ current three-month deferral period set in place is based on the 'window period' — the period between an individual being infected with HIV and when the test gives an accurate result.

 

According to the CBS website, “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.” 

Carter says there are two main tests being used in Alberta, including fourth-generation testing and nucleic acid testing. 

For fourth-generation testing, which is utilized by Alberta Health Services, the window period is three weeks to three months — hence the three-month deferral period. 

However, nucleic acid testing, which is generally more expensive and not the standard type of testing, has a window period of nine to 10 days.

 

CBS uses both tests.

 

Nathan Lachowsky, an assistant professor for the School of Public Health and Social Policy at the University of Victoria, says CBS’ policy can and should be changed according to the nine day window period.

“They can detect HIV in someone's blood as soon as nine days, roughly, after they've acquired it. What that means is that if we wanted to create a policy that made sure there was no chance of having HIV, we could just say that anyone has had sex in the past nine days is ineligible to donate,” says Lachowsky. “That would mean that we would screen out everyone who's been sexually active and then everyone else would just get tested.”

 

Searching for scientific evidence

 

According to Carter, this isn’t the only part of the policy that isn’t based on science. She says that, while there are higher proportions of gbMSM who are HIV-positive, the number is decreasing regularly. However, she emphasizes that gbMSM aren’t the only ones who have HIV.

 

“In Alberta, for several years now, quite consistently, the largest proportion of new HIV cases are among heterosexual people — not men who have sex with men. I think it just goes back to that part that it’s the first community that HIV was identified in that there's a stigma. There's a sort of misunderstanding that it's a gay men’s disease.”

 

Carter says that parts of the donation restriction aren’t based on science — particularly when it comes to CBS including oral sex as a high-risk behaviour for HIV.

 

“It's possible to contract HIV through oral sex, but the risk is considered very, very low,” says Carter. “It's extremely uncommon that it would be contracted through oral sex. If somebody acquired HIV through oral sex, it would most likely be because they had some type of open wounds or trauma essentially inside their mouth or in their throat.”

 

HIV and AIDS are often used interchangeably, but they are two different health conditions. For one, HIV is a virus that attacks an affected person's immune system, while AIDS is a medical condition. Graphic by Karina Zapata.

David Brennan, social work professor at the University of Toronto and research lead of a CBS-funded study about alternative screening policies, agrees with Carter. He says that oral sex should never have been included as part of CBS’ screening policies.

 

“There's virtually zero evidence that HIV is transmitted orally. Of course, there are people who have become HIV infected through oral sex, but the number is so tiny that compared to unprotected anal sex, for instance, that it really doesn't make sense,” says Brennan.

 

“Your oral sex policy is not based on science. There's no reason to exclude people for oral sex. That alone makes you not believable in the eyes of the community.”

 

He also says part of the problem is that CBS treats all gbMSM equally, although not every individual has the same risk patterns for HIV.

 

“There are so many guys who are not infected and never will be because of the way they live their lives. It might be monogamy, it might be that they take PrEP, it might be that they use condoms all the time. They just will never be at risk,” says Brennan.

 

Tripp and Allen are both in long-term monogamous, HIV-negative relationships, yet are still unable to donate blood.

 

“It makes you feel lesser — like for some reason, because of who I am attracted to, my blood is somehow tainted,” says Tripp. “I know that my partner and I are both HIV-negative. We practice safe practices. We've been together for nearly nine years and even then, I would still have to wait three months to donate and that just seems unacceptable.”

Nolan Hill, the gay men’s health specialist at the Centre for Sexuality in Calgary, says this restriction proves that CBS is falling behind.

 

“I think that a lot of these restrictions come from some myths and come from some long-standing stigmas or long-standing misinformation about this population and about this community and they haven't maybe caught up with what we have learned since,” says Hill.

 

HIV prevention: PrEP

 

PrEP is one of the main technological advances that have changed the way HIV functions.

 

PrEP, which stands for pre-exposure prophylaxis, is the usage of antiretroviral medications to prevent HIV from establishing in an HIV-negative person’s body. Research shows PrEP is 99 per cent effective when a HIV-negative person is taking the medication daily as prescribed.

Fraser Tripp, a Calgary-based activist, previously wrote an article about how not being able to donate blood affects his life. Photo courtesy of Fraser Tripp.

This means if individuals who take PrEP have sex with an HIV-positive person, the medication works to keep the virus from infecting the cells it would normally infect, making a very low risk of contracting HIV.

 

“PrEP is really an important tool in ending or changing the landscape of an HIV epidemic in any jurisdiction or any country,” says Hill.

 

Some provinces, such as Alberta, have made PrEP free for medically-eligible individuals, while other provinces are slow to catch up.

 

Brennan believes that PrEP plays a vital role in decreasing the amount of people contracting HIV, subsequently lowering risk rates altogether. He says this is something CBS should be paying attention to when navigating their gbMSM donation policies.

 

“I know that CBS is not trying to do evil things. They are making policies that make sense from their perspective,” says Brennan.

 

“We view the reductions in waiting period for men who have sex with men as incremental steps to be as minimally restrictive as possible while also maintaining the safety of the blood supply,” says CBS in a statement response to our questions. “As a science-based organization, the eligibility criteria to donate blood are subject to change. As science evolves, so do eligibility criteria.”

 

However, Brennan is still waiting for a change.

 

“But the problem with policy done in this way is that it has a secondary impact on others and the secondary impact has been marginalization and exclusion,” says Brennan. “Saying, ‘Oh, your blood's no good’ feels very discriminatory and it's created some rupture in the relationship between CBS and the gay community.”