Assessing the acceptability and feasibility of a plasma donation program for gbMSM in Montréal from the point of view of cis and trans gbMSM, Héma-Québec staff and volunteers, current donors, and plasma product recipients

Until 2013, men who had sex with other men (since 1977) were permanently banned from donating blood in Canada. This policy gradually changed—first to a 5-year, then a 12-month, and in 2019, a 3-month waiting period. In 2020, Héma-Québec began exploring whether sexually active gay, bisexual and other men who have sex with men (gbMSM) could donate plasma for fractionation, a process considered safe for recipients. 

In a continuation and expansion of her MSM Research Program-funded study, Dr. Joanne Otis (Université du Québec à Montréal) examined the acceptability and feasibility of plasma donation in Montreal from the perspective of gbMSM, Héma-Québec staff and volunteers, current donors, and plasma product recipients. The project’s focus shifted following a 2022 policy change that introduced behavior-based screening, removing questions about sexual orientation from the donation process. 

From 2021 to 2024, we conducted four separate data collections with distinct participant groups, adapting each protocol to the eligibility policies in place at the time: 

Data collection #1: gbMSM (July to September 2021) 

A year before the introduction of behaviour‑based screening, we interviewed 28 HIV‑negative gbMSM. Participants were randomly assigned (single‑blind) to one of four groups, each reflecting a different combination of two program conditions for gbMSM plasma donation: with versus without donation quarantine, and with either gbMSM‑specific eligibility questions or non‑gendered questions. During each interview, we assessed acceptability of the assigned scenario and perceptions of program feasibility. 

Data collection #2: plasma product recipients (November 2021) 

We held interviews (individual and group) with 10 plasma product recipients and 7 parents of children who rely on plasma‑derived products. Participants first rated their acceptability of gbMSM donating plasma for fractionation, then evaluated various implementation scenarios (presentation order counterbalanced), and finally discussed feasibility. 

Data collection #3: current blood and plasma donors (October to December 2022) 

After Health Canada approved the new deferral policy, we convened three focus groups of current blood and plasma donors to draft items measuring attitudes toward gbMSM donation. From these, we developed two scales—cognitive (e.g., [the new eligibility approach] “will reduce stigma and discrimination against gbMSM”; “will increase Québec’s blood supply”) and affective (e.g., “I feel proud”; “I believe that this change will benefit society”). We then distributed an online questionnaire by email, incorporating both scales, to a random sample of donors who had given blood or plasma in the previous 12 months (1,587 respondents completed the survey). 

Data collection #4: Héma-Québec staff and volunteers (November 2023 to February 2024) 

Approximately one year after implementing the fall 2022 eligibility changes, we surveyed Héma‑Québec personnel with the following objectives: to document their acceptability of and comfort with the new blood-product donation criteria; to catalogue their lived experiences related to these policy changes; and to identify additional training and support needs to facilitate the transition. To inform the questionnaire creation, we first interviewed 11 key informants across various departments to map staff roles, capture experiences with the new policy, and identify training or support needs. We then sent the finalized questionnaire by email to all active employees and volunteers with any public‑facing responsibilities (102 employees and 263 volunteers completed the survey; total of 365 respondents). 

Data collection #1: gbMSM 

Among HIV‑negative gbMSM, plasma donation procedures without quarantine were generally viewed as highly acceptable. In contrast, procedures involving quarantine were perceived as discriminatory, burdensome, and discouraging. Despite these negative perceptions, some participants still expressed an intention to donate plasma, seeing quarantine as a potential transitional step that could allow gbMSM to gradually access blood donation while maintaining safety. Non‑gendered eligibility questions were seen as somewhat acceptable, with participants appreciating the consistency across all donors. However, many felt that questions about anal sex still functioned as a way to indirectly single out gbMSM. Additional eligibility questions specifically targeting gbMSM were viewed least favourably and were described as stigmatizing and discriminatory. The combination of no quarantine and non‑gendered questions was considered the most acceptable, as it aligned with the principle of equal treatment. While many participants were willing to donate, some remained mistrustful of Héma‑Québec and its motivations. 

Data collection #2: plasma product recipients 

Plasma product recipients viewed gbMSM‑donated plasma as acceptable. Most recipients supported the change, viewing it as necessary and beneficial—an attitude often anchored in their trust in Héma‑Québec and its safety processes. However, many also expressed concerns about recipient safety and felt powerless over the policy shift. Participants said that clear, accessible information on how the change affects donation safety would help reassure them. Across interviews, participants emphasized that ensuring recipient safety must remain the top priority. 

Data collection #3: current blood and plasma donors 

Out of 1,587 respondents (mean age 48.3 ± 16.5 years; 83% with > 5 lifetime donations), 87.4% expressed a “strong” intention to return under the new donation policy, and only 0.7% had “no intention at all.” Using a multiple linear regression analysis adjusted for age, no personal characteristics or life experiences were associated with intention to return; stronger cognitive (β = 0.290) and affective (β = 0.364) attitudes toward gbMSM donation, as well as knowing someone LGBTQ+ (β = 0.364) were all significantly associated with intention to return (all p < 0.001). Donors who had already experienced the new screening reported slightly higher comfort with sexual‑behaviour questions (mean 6.44 / 7) than those who had not (6.27 / 7; p < 0.001). 

Data collection #4: Héma-Québec staff and volunteers 

Staff and volunteers with public‑facing roles showed high perceived social approval of gbMSM donations (mean 3.44 / 4), positive overall attitudes to the fall 2022 changes (3.56 / 4), and acceptability of sexual‑behaviour questions (3.60 / 4). They felt comfortable interacting with gbMSM, trans, and non‑binary donors (3.63 / 4) but slightly less so discussing the new policy (3.31 / 4). Knowing someone LGBTQ+ was associated with more positive attitudes, lower stress about the implemented changes, stronger personal endorsement of the policy, and fewer safety concerns. Most respondents (72.2%) reported no impact on job tasks; 12.8%—35.7% of staff and 3.4% of volunteers—reported at least one difficult situation with clients, though the majority did not escalate these issues. Despite training offered by Héma-Québec, 25.1% of volunteers and 14.6% of employees indicated a need for further training or information on the policy changes and LGBTQ+ realities.

To boost acceptability of the new eligibility criteria and enhance service quality, Héma‑Québec should:  

1. Improve data transparency: Clearly share the evidence and statistics underlying the recent policy changes, so all parties involved understand the safety rationale. 
2. Engage gbMSM communities: Establish ongoing dialogue to build trust, ensure practices reflect community realities, and address concerns or misconceptions. 
3. Strengthen and sustain staff training: Offer continuous, targeted training for employees and volunteers—covering the specifics of the new eligibility criteria, current issues in sexual and gender diversity, and strategies for managing sensitive situations during donor interactions. 

This study provided snapshots at three key points—before, during, and one year after the eligibility changes. Our data suggest that certain acceptability dimensions (e.g., comfort, perceived preparedness, and risk perception) are likely to fluctuate with ongoing exposure to the new policy. It would therefore be valuable to resurvey these groups now that the changes have been in place longer and to repeat these assessments periodically to track evolving attitudes. 

Benoit, J., Caruso, J., Germain, M., Myhal, G., Monteith, K., & Otis, J. (2024). Plasma-derived product recipients' views on the acceptability of implementing a programme of plasma donation for fractionation from men who have sex with men. Vox Sanguinis, 119(10), 1058-1064. 

Thibeault, C., Caruso, J., Otis, J., Germain, M., Lewin, A., Myhal, G., ... & Daunais-Laurin, G. (2023). CO7-4 Acceptabilité d’un questionnaire non genré chez les donneurs d’Héma-Québec et intention de retourner faire un don. Transfusion Clinique et Biologique, 30, S53-S54. 

All findings were delivered directly to Héma‑Québec and integrated into their decision‑making. Study results from our first 2 data collections informed Héma‑Québec’s submission to Health Canada for regulatory approval of the new eligibility criteria. They also shaped the implementation strategy—guiding website content about the change, defining the curriculum for employee and volunteer training, and underpinning all related communication materials.