2SLGBTQIA+ inclusion at Canadian Blood Services

Condom use, while an excellent sexual health practice, isn’t considered an evidence-based method of screening blood donors because condoms are not always effective and can break or slip. 

Our donor screening questionnaire is designed to be applied as broadly as possible to screen many potential donors. It’s not comprehensive in asking about safe sexual practices, such as condom use. 

The eligibility criteria for organ and tissue donation are different than those for blood and plasma donation. Federal regulations and standards are followed for organ and tissue donor eligibility and donor screening is conducted by the provincial organ and tissue donation programs.   

Although Canadian Blood Services does not determine organ and tissue donor eligibility, we’re committed to supporting ongoing work to make organ and tissue donation and transplantation more inclusive. We firmly believe that eligibility to donate biological products should not be based on sexual orientation. 

Our role in the organ and tissue landscape in Canada is to facilitate collaboration in the donation and transplantation community and support the development of leading practices, professional education and public awareness. One such example is the work conducted in cooperation with leading 2SLGBTQIA+ experts to develop and launch a professional education program designed to increase inclusion and belonging of 2SLGBTQIA+ folks in the organ and tissue donation and transplantation system.

The curriculum is now available and offers an interactive educational intervention with the aim of increasing the capacity of donation and transplant teams to provide inclusive care to 2SLGBTQIA+ people.

Pre-exposure prophylaxis, or PrEP, is a highly effective combination of medications that, when taken as directed, prevents HIV transmission through sex for the person taking it. Post-exposure prophylaxis, or PEP, may be prescribed to people who are HIV negative, who have had a potential exposure to HIV in the last 72 hours. 

PrEP is widely used by many people, including people in 2SLGBTQIA+ communities and is a celebrated and recommended way to maintain sexual health. The challenge facing blood operators like Canadian Blood Services, is that these medications can affect the accuracy of our blood screening tests; specifically, our tests’ ability to detect breakthrough infections. Because Canadian Blood Services relies on accurate performance of HIV tests as part of our multi-layered approach to safety, people who use PrEP/PEP are not currently eligible to donate. 

If you have recently stopped taking PrEP, or were recently prescribed PEP, you’ll be asked to wait four months after your last dose of oral medication or two years after your last injectable dose, to donate. 

Receptive anal sex has a higher chance of HIV transmission per sex act than insertive anal sex. However, when we conducted studies 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’s important that our donor screening criteria are easily understood by all donors, which is why we made the decision to ask about anal sex generally as part of sexual behaviour-based screening. 

People who have engaged in sex work are currently asked to wait 12 months after they last received money or drugs in exchange for sex before donating blood or plasma. For the purposes of assessing a person’s eligibility for donation, when we ask about sex work, we define sex as having oral, vaginal, and/or anal intercourse for money or drugs. 

Canadian Blood Services’ goal is to ensure the safety and sufficiency of Canada’s blood and plasma supply while increasing participation and maximizing inclusion in Canada’s Lifeline. We are actively reviewing current criteria against the latest scientific evidence. 

People who have recently had sex with an HIV-positive partner (including those who are taking antiretroviral therapy and have undetectable viral loads) are asked to wait 12 months after the last sexual contact, before donating blood or plasma. For the purposes of assessing a person’s eligibility for donation, for this question we define sex as oral, vaginal, and/or anal intercourse. 

Canadian Blood Services’ donor screening process focuses on each donor’s individual health, behaviours, and medical history. We do not ask donors to provide information about someone else’s medical status or medications and cannot rely on third-party health information to determine eligibility.  

Canadian Blood Services’ goal is to ensure the safety and sufficiency of Canada’s blood and plasma supply while increasing participation and maximizing inclusion in Canada’s Lifeline. We are actively reviewing current criteria against the latest scientific evidence. 

2SLGBTQIA+ people are welcome and encouraged to join the Canadian Blood Services’ Stem Cell Registry. Anyone on the registry who is identified as a potential match receives the same gender-neutral, behaviour-based screening questions to determine eligibility — regardless of their sex assigned at birth or sexual orientation. 

All potential stem cell donors are now asked if they’ve had anal sex with a new partner or multiple partners in the last three months. No matter how you respond, you will still be eligible to donate if you meet the required criteria. Please note, however, that Canadian Blood Services is mandated to provide your response, without disclosing your personal identity, to the centre requesting stem cells for their patient.  

The patient's health care team will ultimately make the decision about whether to proceed with the matching donor, not Canadian Blood Services. These decisions are based on several factors, including donor age and overall health. 

Please be aware that all individuals are asked for their sex assigned at birth when first registering to join the Stem Cell Registry, as biological sex helps inform decision making related to donor-patient matching and outcomes. 

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

However, undetectable equals untransmissible (U=U) only applies to sexual transmission of HIV. Even when a person who is HIV-positive has an undetectable viral load, the virus could still potentially be transmitted through blood transfusion.  

The chance of transmission is much higher with a unit of blood, due to the large volume of blood being transfused and the relatively higher total amount of virus present. For this reason, a person who is HIV-positive, even with an undetectable viral load, is not eligible to donate blood or plasma.