Men who have sex with men
Frequently asked questions
What is Canada’s eligibility criteria for men who have sex with men (MSM)?
Men who have sex with men (MSM) are eligible to donate blood one year after their last sexual contact with another man. In June 2016, Health Canada approved our request to reduce the blood donation ineligibility period for men who have sex with men from five years to one year. Canadian Blood Services is exploring alternative screening approaches for blood donors, which could evolve the current eligibility criteria for men who have sex with men.
Why is the eligibility criteria for MSM in Canada set at one year?
Men who have sex with men account for the largest proportion of new HIV infections reported in Canada.*
In 2006, when men who’d had sex with men since 1977 were indefinitely deferred, Canadian Blood Services contracted experts to perform a risk assessment to justify reducing the deferral period. The results of the assessment showed it was safe to reduce the eligibility criteria to a five or 10 year waiting period. At that time, patient advocacy groups who represent frequent users of blood products were supportive of a five-year waiting period but nothing less.
The five-year waiting period was implemented in 2013, and a minimum of two years of data was required for re-submission to Health Canada to support a further reduction to the waiting period.
Canadian Blood Services then submitted an application to reduce the MSM eligibility criteria from five years to one year in March 2016. In 2016, Health Canada approved our request to reduce the waiting period for MSM from five years to one year and the change was implemented nationally. This change was based on scientific evidence and supported by input from stakeholders.
These incremental changes are important steps towards being as minimally restrictive as possible while also maintaining the safety of the blood supply.
*Source: Public Health Agency of Canada. (2016). HIV in Canada-Surveillance Report, 2016
Why can’t everyone donate blood?
Canadian patients 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 scientific evidence of risk, about who can and cannot donate blood.
Donating blood isn’t the only way to support patients. There are many ways that those who may not be eligible to give blood can work with us to make a valuable contribution to patients in need, such as financial donations, or by registering as a stem cell donor.
When can MSM donate blood?
In addition to meeting all other donor eligibility criteria, men are eligible to donate blood if their last sexual contact with another man (anal or oral sex) was 12 or more months ago. However, MSM who live in the Vancouver area are eligible to donate blood for important research and development projects at our Network Centre for Applied Development (netCAD).
Why is the waiting period for MSM in Canada one year when other countries have no waiting period?
Canada decided on the one-year waiting period based on several factors:
Canada’s history of tainted blood is very different from other countries. Any policy change related to donor eligibility criteria requires special prudence to maintain public trust and confidence in the safety of the system.
Because the patterns, causes and effects of HIV differ by country, there is no international scientific consensus on an optimal eligibility criteria for MSM. Some European countries have instituted lifetime bans on blood donations from MSM, while the United States and Australia have reduced their waiting periods to one year.
Some blood centres in Spain and Italy have taken the approach of asking about safe sex practices or monogamy, but those countries have different blood systems than Canada’s. In those countries, physicians interview individual donors and may be able to perform individual health assessments. It should be noted, however, that the rate of donors with HIV-positive test results in those countries is more than 10 times higher than in Canada.
What is the history of Canada’s blood donation eligibility criteria for MSM?
Few blood donor criterion are as contentious as the eligibility criteria for men who have sex with men. An indefinite deferral for men who have had sex with a man even once since 1977 was instituted in the United States in the early 1980s, before the virus that causes AIDS was identified and when men who have sex with men were noted to be a particularly high-risk group. Being solely responsible for Canada’s blood supply at that time, the Canadian Red Cross Society followed suit. This criterion was in place until July 2013, when both Canadian Blood Services and Héma-Québec reduced the eligibility criteria from an indefinite deferral to a five year waiting period following sexual contact with another man. While this change allowed only a small percentage of MSM to donate blood, it was still significant as it was the first update to Canada’s donor eligibility criteria for MSM since the criteria was implemented more than 35 years ago. All changes to screening practices were made after an extensive review of scientific and epidemiologic evidence. Equally important was the consultation with high-interest groups, including patient groups representing heavy users of blood and blood products as well as members of lesbian, gay, bisexual, trans and queer (LGBTQ+) community groups. Many of these organizations sent letters supporting the policy changes to Health Canada.
For a more detailed history of the evolution of Canada’s deferral policy for MSM, see Donor deferral policies for men who have sex with men: past, present and future, an article published in the scientific journal Vox Sanguinis in February 2018.
Isn’t all blood tested?
We test every donation for several infectious diseases, including HIV, hepatitis B and hepatitis C. While our technology is sophisticated, there is a brief period shortly after infection when HIV is not detectable. If an individual were to donate blood during this "window period" in the early stages of infection, our testing process would not detect the virus and that donation would be infectious to a patient.
Despite its sophistication, no test is 100 per cent perfect. Tests can fail for technical reasons or because the pathogen has mutated. In addition to testing every donation, we rely on our donors to be honest about their exposure risks when completing the donor eligibility screening criteria, which is part of a multi-tiered safety system designed to protect patients.
Why not ask about safe sex practices or monogamy instead of making all MSM wait one year before donating blood?
Canadian Blood Services is exploring the possibility of moving toward alternative screening approaches for all donors, which may evolve the current eligibility criteria for men who have sex with men. As part of the MSM Research Grant Program we are working with the LGBTQ+ community, patient groups and other stakeholders to gather the scientific evidence required to determine whether it is possible to reliably identify low-risk, sexually active men who have sex with men. This research is crucial to moving from a time-based deferral (determined by when a donor last had sex with a man) to an alternative screening approach.
How many more donors in Canada will be eligible now that the eligibility criteria for MSM has been reduced from five years to one year?
That is unknown, as it is not something we can track. Engaging new donors is not the main reason for this criteria change. Instead, we are focused on doing the right thing for Canadians and being as minimally restrictive as is necessary to manage risk.
Can MSM donate organs or stem cells?
Regulations for organ and stem cell donations are different than those for blood donation. MSM can register to become organ donors through their provincial organ donation registry. They will be asked questions on topics ranging from their general health to specific risk behaviours. Generally, MSM are eligible for organ donation if it has been more than a year since their last sexual contact with another man. However, due to the scarcity of organs available for transplant, the attending physician may make an exception (with patient consent) if a donor has had sex with another man within the past year. To find out more about organ donation, visit the Organs and Tissues section of our website.
MSM who are between the ages of 17 and 35 can also join the OneMatch Stem Cell and Marrow Network. While there is a five-year waiting period for MSM who want to donate stem cells, due to the diverse patient needs for stem cells, the attending physician may make an exception (with patient consent) if a donor has had sex with another man within the past five years. To find out more about stem cell donation, visit the Stem Cells section of our website.
Is the eligibility criteria for MSM considered to be discriminatory?
In 2010, the Ontario Superior Court ruled that the eligibility criteria for MSM is not discriminatory because it is based on health and safety considerations. However, we do understand this policy may cause strong feelings and want to emphasize it is not intended as a negative reflection on any one individual.
Can women who have sex with MSM donate blood?
If a woman has had sexual contact with a man who has had sex with a man in the last 12 months, she must wait 12 months before donating blood.
Why do the same rules not apply for women who have sex with women?
Women who have sex with women are not in a high-risk group for HIV*, which is why they are eligible to donate blood without a waiting period as long as they meet all other criteria.
*Source: Public Health Agency of Canada. (2016). HIV in Canada-Surveillance Report, 2016
What about trans individuals?
As part of Health Canada’s approval of our application to reduce the waiting period for MSM from five years to one year, a new screening process and eligibility criteria for trans donors was also approved. Learn more about the eligibility criteria for trans individuals.
What was Health Canada’s role in changing the eligibility criteria for MSM?
Health Canada is the regulator of Canada’s blood system. Any change to donor eligibility criteria that may affect recipient safety must be sent to Health Canada for approval. In June 2016, Health Canada approved our request to reduce the blood waiting period for MSM from five years to one year.
Will Canadian Blood Services submit a request to Health Canada to reduce the waiting period even further?
Canadian Blood Services has analyzed the data collected since the one year blood donation waiting period for men who have sex with men came into effect. We have discussed the results of the analysis with stakeholders and partners (such as patient groups, LGBTQ+ groups, Héma-Québec) and are submitting another request to our regulator Health Canada to further reduce the waiting period for men who have sex with men to three months. We look forward to keeping the public updated on our progress.
Canadian Blood Services is exploring alternative screening approaches for blood donors, which could evolve the current eligibility criteria for MSM.
The one year waiting period was introduced in 2016 as an incremental step forward in updating the blood donation criteria based on the latest scientific evidence. But the work doesn’t stop there. New research is underway to generate the evidence required for low risk groups to be identified and included as eligible donors while maintaining the safety of the blood supply for patients.
That’s why Canadian Blood Services, in partnership with Héma-Québec and with funding from Health Canada, is supporting 11 research projects investigating various aspects of blood and plasma donors’ eligibility criteria and screening process. This research could evolve the current eligibility criteria for MSM. A second round of funding has recently become available.
Our aim is to identify a long-term solution that prioritizes patient safety while minimizing the societal impact on certain groups of people. We have also established a working group, which includes representation from patient groups, community organizations and LGBTQ+ communities, to serve as a forum for ongoing discussion and consultation as we develop further changes for our eligibility criteria.