Sexual behaviour-based screening

All donors are asked if they’ve had new and/or multiple sexual partners in the last three months. 
 
If the answer is yes, they are asked if they have had anal sex in the last three months.  

• People who have anal sex and have had the same sexual partner for three months – or have not had multiple sexual partners in the last three months – will be able to proceed with the donation process.  
• People who have had anal sex in the last three months with a new partner or multiple partners will be required to wait three months from when they last had anal sex to donate.  

The three-month wait is in place to reduce the chances our tests may miss any very recently acquired infections.   

Per sex act, receptive anal sex has a significantly higher chance of HIV transmission than vaginal or oral sex.

This does not account for individuals’ own safe sex practices but is based on an evidence-based approach to overall risk.

The acquisition of any new sexually transmitted infection (HIV, Hepatitis B, or Hepatitis C) increases with the number of potential exposures, i.e. multiple sexual partners.

Our screening tests can miss a very recently acquired infection. This time frame is called the window period and is approximately three months.

PrEP or pre-exposure prophylaxis is a highly effective combination of medications that prevents HIV infection by the person taking it. PrEP use is recommended to maintain sexual health. There is currently a four-month deferral period in place for people who use PrEP. 

The current challenge facing blood operators is that the medications used for PrEP affect the ability of screening tests to detect low levels of HIV. Canadian Blood Services relies on accurate performance of HIV tests as part of its multi-layered approach to safety.

We are currently working with external experts in HIV testing to further understand the impact of antiretroviral medications on tests and determine how to minimize the duration of deferral for donors using PrEP.

We know that the slow pace of changes to donor criteria that have excluded many gay, bisexual, queer, and other men who have sex with men and some trans people has been painful and frustrating for many. It took time to collect the evidence needed to apply to our regulator, Health Canada, to make changes to these criteria.    

In Canada, blood donor eligibility criteria are developed within a strict, evidence-informed regulatory framework that focuses on patient safety.    

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 needed to be able to provide evidence that the proposed change would not compromise patient safety.   

As a blood operator, Canadian Blood Services is responsible for gathering sufficient evidence to make a request for change to Health Canada. Our changes are informed by the available science and the frequency and pattern of health events in a population (epidemiology).    

To make this change to gender-neutral sexual behaviour-based screening for all donors, we needed to have a bedrock of evidence in support of new criteria. The MSM Research Program, findings from the international research community, epidemiological data and our own extensive modelling informed our submission to make this change.    

This criteria change has not and will not compromise the safety or adequacy of Canada’s blood and plasma supplies.

Canadian Blood Services has a profound responsibility to the patients we serve. Safety is paramount in everything we do.  The criteria will continue to defer those with a higher chance of acquiring a new HIV infection. Other criteria already in place identify additional risk factors for acquiring HIV, and these will continue to be applied.

Health Canada alone has the authority to approve changes to donor eligibility criteria that affect human safety or the safety of blood.

For Canadian Blood Services to change the eligibility criteria, we needed to provide strong evidence to the regulator, Health Canada, that the proposed change will not compromise safety.

The evidence we have gathered through the MSM Research Program, which received funding from Health Canada, as well as findings from the international research community, epidemiological data and our own risk modelling support making this change.

Currently the chance of HIV being introduced to the blood system is extremely low, and according to the evidence, the new criteria is maintaining safety.

Yes, every donation is tested for some infections that can be transmitted by blood transfusion.  
However, no test is perfect, and there are some infections for which there is no test.  For example, there are currently no Health Canada-approved screening tests for malaria for blood production.

One reason we have such a safe blood system in Canada is the layering of a donor screening questionnaire with donation testing.

Tests that are used to test every blood donation have a limitation called the “window period”. The window period is the time between when a donor has acquired a new infection and is able to transmit it, to the time a lab test can reliably detect the infection.  If an HIV or hepatitis infection is newly acquired, testing may not pick it up.

The donor questionnaire is critical in helping identify people who may have had a recent new exposure to an infection of concern, such as HIV or Hepatitis C.

Patients in Canada 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 available scientific evidence, about who can and cannot donate blood.

Donating blood isn’t the only way to support patients. There are many ways to make a valuable contribution to patients in need, such as plasma donation, financial donation, or by registering as a stem cell donor, or an organ and tissue donor. 

Thank you for participating in the MSM Plasma Program. You have not only helped patients in Canada, but you have also helped drive this eligibility change and advance the blood system for all those who reside in Canada.  

We encourage you to continue donating plasma with the new criteria, or you could also consider donating whole blood. 

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 assessed on screening criteria ranging from 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.

Gay, bisexual and other men who have sex with men (gbMSM) 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. 

We recognize the importance and urgency of improving the donation experience for trans, non-binary, Two-Spirit, and gender diverse donors and are actively working on several short- and long-term changes to current registration and screening practices, in consultation with communities.  

Changes implemented to date: 

• Trans donors are no longer asked if they’ve had gender-affirming surgery.    
• We no longer ask donors to verbally state their gender at each donation appointment.   
• Trans and gender diverse donors with a binary gender can now register in their gender, and can make this change themselves in the Give Blood app.   
• We’ve made changes to our booking systems to ensure that a donor’s chosen name/name-to-use can be recorded in our appointment booking system.  
• We are still working on IT and software system changes to adopt diverse gender options in our registration processes and to capture chosen name/name-to-use in our donation software but expect to have these changes in place shortly.

We strive to ensure an inclusive, safe, and affirming donation experience for all donors and will continue to take timely actions to expand gender registration options, prevent deadnaming in all donor touchpoints, and provide ongoing inclusion training and education to our staff.

Condom use, while an excellent sexual health practice, isn’t an evidence-based method of screening donors because condoms are not always effective and can break or slip. We also know from research that questions about condom use are less reliably answered because people don't always recall correctly.

It is important to note our current criteria and the proposed sexual behaviour-based screening questions are not comprehensive in asking about safe sexual practices, such as condom use, that can effectively mitigate the chance of acquiring HIV. 

It’s amazing that HIV care has reached a point where people’s viral loads can be undetectable.     

Undetectable equals untransmissible only applies to sexual transmission of HIV. Unfortunately, even those who have an undetectable viral load may transmit the virus through blood transfusion.     

The chance of transmission is much higher with a unit of blood due to the large volume of a blood transfusion and the much higher total amount of virus present.  

It is true that receptive anal sex has a much higher chance of HIV transmission per sex act than insertive anal sex.   

However, when we did implementation studies on asking donors about receptive anal sex, the term was not well understood, and the question was inconsistently answered.    

For the safety of our blood and plasma supplies, it is of vital importance that donor screening criteria are easily understood by all donors.    

We recognize that some people may be in sexual relationships with multiple people where their partners are not new partners. However, our criteria currently do not differentiate between those with multiple new partners or multiple partners that are not new.

With the implementation of sexual behaviour-based screening, people with multiple partners, who have engaged in anal sex with one or more of their partners in the last three months, will be required to wait three months from when they last had anal sex to donate.

Our sexual behaviour-based screening criteria will only ask donors about anal sex if they have had a new sexual partner or have had multiple sexual partners in the last three months. 

Donors who have one sexual partner they’ve been with three months or longer will not be asked about anal sex. 

Donors who have anal sex with one partner who they’ve been with for 3 months or longer will be eligible, if they meet all other eligibility criteria.

No, using sex toys/hands/fingers is not considered anal sex in the context of our donor screening criteria. 

Our sexual behaviour-based screening criteria focus on anal sex in the context of new or multiple partners, rather than vaginal or oral sex. This is because, statistically, anal sex has a significantly higher chance of HIV transmission per sex act than vaginal or oral sex.   

Multiple sexual partners can increase the chance of HIV transmission. This does not account for individuals’ safe sex practices but is based on an evidence-based approach to overall risk.   

Yes. If you have one sexual partner for at least three months, you will be able to donate if you meet all other eligibility criteria. All donors are asked if they’ve had a new partner in the last three months, or multiple partners in the last three months. Donors who have one sexual partner they’ve been with three months or longer won’t be asked about anal sex. 

In these criteria, a new partner is defined as someone you’ve never had sex with before, or someone with whom you had a past sexual relationship that ended, and with whom you have started having sex again in the last 3 months.     

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. 

Once a change is approved, we are often required to conduct studies to monitor the impact of the change on blood safety. 

Have more people from 2SLGBTQIA+ communities in Canada started donating since the implementation of sexual behaviour-based screening?  

Since the implementation of sexual behaviour-based screening, we have welcomed many new and returning donors from 2SLGBTQIA+ communities, and their allies. We are grateful to all those who have chosen to engage with us and join Canada’s Lifeline.  

Canadian Blood Services will continue to endeavor to earn the earn the trust of the 2SLGBTQIA+ community and work to ensure that all processes, policies and interactions with us are as inclusive as possible. 

On May 10, 2024, Canadian Blood Services issued an apology to 2SLGBTQIA+ communities across Canada.  The apology acknowledges the harms experienced by gay, bisexual, and queer men, trans people, and other members of the 2SLGBTQIA+ community, because of the former donor eligibility policy.  

The former donor policy was put in place in the 1980s as an intended safety measure after the blood system crisis in Canada. At the time, HIV was a new disease for which research, testing and understanding of the illness was just beginning.   

We first began addressing the need to evolve donor screening criteria in 2001. By 2013, with better understanding of HIV transmission and advances in screening tests, we started taking evidence-informed steps to reduce the waiting period for blood and plasma donation for gay, bisexual, and other men who have sex with men.  

Over the course of almost a decade, we were able to evolve eligibility criteria from a permanent deferral to a series of increasingly shortened waiting periods (a five-year, then a one-year, then a three-month waiting period) between donors’ last sexual contact and the time of donation.   

In April 2022, Canadian Blood Services received approval from Health Canada, our regulator, to remove eligibility criteria specific to men who have sex with men altogether, and put in place new, more inclusive criteria that screens all blood donors based on sexual behaviour. This change was informed by robust Canadian and international research that demonstrated to Health Canada that it was necessary and safe.  

Patient safety is Canadian Blood Services’ priority, and decisions about donor screening policies have always been based in science.  

As science has evolved, we’ve been able to evolve donor screening processes to be more inclusive, while ensuring patient safety, by implementing sexual behaviour-based screening in blood and plasma donation. 

These changes have not erased, however, the contributions of the former donor deferral policy to discrimination, homophobia, transphobia, and HIV stigma within society.  

The apology was a necessary step in our ongoing journey to make all policies, processes, and interactions with Canadian Blood Services more inclusive for 2SLGBTQIA+ communities in all their diversity.    

Learn more at blood.ca/apology.