TLDR; The AIDS epidemic emerged in the 1980s. Institutional failures by the Canadian Red Cross and the Canadian government at the time led to an unsafe blood supply. Approximately 30,000 people were infected with hepatitis C and 2000 with HIV due to receiving blood and blood products that were contaminated. At the same time, men who had had sex with other men were presenting with AIDS most often and they were named a high-risk group. In response, the rule banning men who have sex with men from donating blood products – the “MSM policy” – was created as science played catch-up. Although this policy has been recently updated, the blood ban’s painful legacy continues.
The story starts when AIDS emerged as an international concern in the 1980s. More and more patients came to doctors with rare conditions that affected the immune system (for example, Pneumocystis carinii pneumonia and Kaposi’s sarcoma). In 1982, the United States Centers for Disease Control and Prevention (CDC) used the term “acquired immune deficiency syndrome” (AIDS) to describe the epidemic, though they did not yet know that HIV was the virus causing it.
Due to discrimination and prejudice, HIV was first attributed to male to male sex – even though other groups of people were also being diagnosed with AIDS (e.g., people who used injection drugs or who received blood transfusions). Attributing AIDS to men who have sex with men (MSM) both created new and perpetuated old stigma against LGBTQ+ and other MSM communities. This stigma has done immeasurable harm to these communities and continues to inform blood donation policies around the world.
In 1983, it was recognized that AIDS could be transmitted through blood transfusions. The Canadian Red Cross (the organization in charge of collecting blood donations at the time) started handing out pamphlets to donors encouraging certain groups not to donate. The groups considered high-risk included men who have sex with men (the Canadian Red Cross specifically listed “promiscuous homosexual men”), Haitian immigrants, and people who used intravenous drugs. However, refusing blood donations from these groups was not official policy until 1989, when the Donor Health Assessment Questionnaire was introduced. This questionnaire outlines official screening protocols that were used to decide who could and could not donate blood.
In 1984, HIV was discovered as the cause of AIDS and by November 1985, the Canadian Red Cross was testing all donations for HIV. However, many people had already been infected by contaminated blood and blood products (this is what’s often referred to as the ‘tainted blood scandal’ or the ‘tainted blood tragedy’). Approximately 30,000 people were infected with hepatitis C and another 2000 with HIV.
The Canadian Red Cross and the Canadian government demonstrated massive institutional failure to ensure the safety of the blood supply in the 1980s. There was an official inquiry into this institutional failure, and the results were published in 1997 in the Krever Report. The results were, indeed, scandalous. There were a number of practices uncovered in the inquiry, including:
The Krever Report recommended that a national blood service be created and operated independent of the government to deter political interference. On this recommendation, Canadian Blood Services and Héma-Québec were created. These agencies inherited the policy banning blood donations from men who have sex with men, despite evidence that the large-scale institutional failure was the larger issue. The high-profile nature of the Tainted Blood Tragedy has created a culture of fear around ending the blood ban. Only in recent years has community activism and political pressure begun to finally see change, as the donation based science plays catch-up to support more equitable policy (thanks to research funding through the MSM research program).
For more details on the Tainted Blood Tragedy, see the CBC’s archives.
Ending the blood ban has been an incredibly slow process and will unfortunately continue to be. Science is inherently slow as information takes time to collect and analyze. Research in this area has been woefully underfunded until recently. In the last decade, some progress has been made (gay, bi, and men who have sex with men are no longer banned for life), and the plasma program implemented in September 2021 enabled the first sexually active men who identified as gay, bisexual or as having sex with men to donate a blood product.
In December 2021, Canadian Blood Services applied to Health Canada to make the next step towards fairer screening – Sexual Behaviour-Based screening, or SBB. In this application, Canadian Blood Services requested to remove the questions in the donor questionnaire about sex between men and replace them with specific sexual behaviour questions. These questions would be asked of all donors, regardless of gender or sexuality. This application was enabled by new data from both the Canadian research studies and the research studies that supported a similar change in policy in the UK. You can read more about these changes on Canadian Blood Services’ website: An update on our journey to build a more inclusive blood system. Note: this link above also briefly describes changes to Canadian Blood Services’ screening practices for trans and nonbinary people.
In April 2022, Health Canada approved the changes requested by Canadian Blood Services, and, as of September 11, 2022, all donors are asked about anal sex with multiple partners (not just men). You can read more about current eligibility for plasma and blood donation. These new rules are far from perfect though, and there is still lots of work to be done before gay, bi, queer, trans, nonbinary, gender diverse, and all men who have sex with men are truly included equitably in plasma and blood donation. Read more about that here.