African, Caribbean, and Black men and MSM blood donation

At a population level, men who have sex with men (MSM) continue to be disproportionately affected by HIV, but the risk is not the same for all MSM. Identifying low-risk groups of MSM or applying behavior-based screening to all donors could balance acceptable risk with a more inclusive blood donation policy. To effectively address concerns regarding blood deferral for MSM, it is necessary to acknowledge the diverse nature of the MSM community in Canada. The participation in blood donation of low-risk African, Caribbean, and Black (ACB) cis- and trans MSM may be impeded by exclusionary eligibility criteria and their experiences with the donor questionnaire. This project aimed to identify the range of factors that influence ACB MSM responses to the donor questionnaire and to improve the gender and cultural appropriateness of the donor questionnaire. This project also aimed to identify low-risk ACB MSM by determining the best predictors of a seronegative HIV test among ACB MSM.

Using a multi-method approach, the research was conducted among ACB MSM in Canada in three phases (Aim 1, 2, and 3). Participants were recruited from 4 study sites (Toronto, Ottawa, Halifax, and Montreal). The goal of Aim 1 was to identify the best predictors of non-reactive HIV test at any time of screening. We recruited a total of 288 participants from the 4 study sites for this phase: Toronto (164), Montreal (83), Ottawa (29), and Halifax (12). In Aim 2, we used in-depth interviews (a combination of concurrent think-aloud and verbal probing) to explore the range of factors that influences ACB MSM responses to the blood donor questionnaire. A total of 50 participants the 4 study sites participated in this phase of the study: Toronto (20), Montreal (20), Ottawa (5), and Halifax (5). We used results from phase 1 and 2, as well as literature review and expert review to prepare an initial draft of a newly proposed blood donation policy and pilot-tested the modified donor questionnaire in Aim 3. We conducted a total of 6 focus group discussions (2 in Toronto; 2 in Montreal, 1 in Halifax, and 1 in Ottawa). 

While data analysis is on-going, initial results indicate that a larger proportion of the participants had never donated blood, mainly because they were banned by CBS, and others indicated that they are not encouraged by CBS to donate blood. Also, majority of the respondents were not aware of policies that deferred a lot of people from Africa for donating blood in Canada; however, they were aware of policies that banned gay men. Systemic racism continues to support the idea that HIV began in Africa, and these were not questionable questions, and it is not surprising that many ACB MSM don’t know about these specific policies. Participants also reported that the questions do not adequately reflect the current science regarding HIV transmission in their communities. While the removal of the unscientific questions regarding Africa may be a step in the right direction, they are confused as to why Canadian Blood Services hasn’t made this change clear to Canadians nor has engaged ACB communities to repair harm caused. They feel that the current discussions regarding MSM blood bans do not adequately capture the experiences of diverse queer and trans people in Canada. Interestingly, the respondents felt that the proposed modifications to the donor questionnaire through our project was meaningful and related well with them. They expressed their satisfaction with the modified questionnaire during the pilot-testing. Addressing anti-Black racism and centering Critical Race Theory (CRT: a theoretical framework that views that race is a socially constructed concept rather than a biological one, and that racial inequality emerges from social, economic and legal differences that maintain white interests) is the cornerstone of all effective Equity, Diversity and Inclusion initiatives. Anti-Black racism is a #GayBlood (MSM) issue.

The belief that MSM and ACB are separate groups in need of study means that the information gathered is incomplete. The Canadian Blood Services separation of MSM from Trans folks, from African people (people of African descent) has not facilitated the types of evidence Canadian Blood Services claims to seek and require. Beyond the increased surveillance of ACB MSM communities, Canadian Blood Services must take direction from these communities and be prepared to engage in the difficult conversations of racial discrimination raised by Black MSM Canadians (instead of mocking and dismissing Black gay Canadian concerns). In order to engage with Equity, Diversity and Inclusion (EDI), the agency needs to name racism, ask how racism is operating (within MSM research), and then organize and strategize to make effective change. EDI is not about intention; it is about systemic organizational and policy change.

Research methods that effectively engage ACB+MSM in Canada are not readily available. RDS and Starfish are structured within Eurocentric understandings of the community and therefore not effective for QTBIPOC community focused research. This remains a gap that this project is grappling with. Although this study includes trans and gender nonconforming ACB MSM, information is still lacking regarding ACB trans communities in Canada. Therefore, future research should actively involve these underserved groups using well structed anti-racist and gender+ inclusive methods to help understand their experiences and contribute to the continuing growing body of evidence.

Dryden, O. H., Sinno, J., Cadri, A., Lee, E., Marshall, Z., Mbuagbaw, L., & Nelson, L. (2022). #GotBlood2Give: Exploring the experiences of African, Caribbean, and Black men who have sex men (cis and trans) with blood donation in Canada. In Transfusion Medicine, 32, 35-35. https://doi.org/10.1111/tme.12933

Dryden, O. H. (2022). Blood is a politic of place-making: Blackness, queerness and the construction of the donor. In R. Cummins and N. Caple (Eds.), Harriet’s Legacies: Race Historical memory and Futures In Canada (pp.304-321). McGill-Queen’s University Press. A book chapter critically analyzing how distinct blood donor policies intersect to permanently ban black queer (cis and trans) people from donating blood.

Dryden, O.H. (2019). It’s in us to give: Black life and the racial profiling of blood donation. In R. Diverlus & S. M. Ware (Eds.), Black Lives Matter Canada: A Blueprint for Black Liberation (pp. 211-224). University of Regina Press. A book chapter critically analyzing how specific donor policies target black people.

Building off this research, The National Coalition for Confronting Anti-Black Racism in Donation is working directly with decision making bodies to ensure greater accountability and sustainable change.