Assessing alternative donor screening questions in current donors

In 2022, Canadian blood operators removed the time-based deferral periods for gay, bisexual, and other men who have sex with men (gbMSM), replacing them with gender-neutral sexual behaviour-based questions used to screen all donors. These changes have been welcomed by some gbMSM donors, but there is a paucity of research on how the broader Two-Spirit, lesbian, gay, bisexual, transgender and queer (2S/LGBTQ+) communities perceive blood operators, and there is a notable lack of information specifically on how transgender donors experience blood donation.   

This project set out to examine the perspectives of members of gbMSM and trans communities during the transition between donor eligibility policies regarding feasibility and acceptability of donating apheresis plasma for fractionation, and feasibility and acceptability of a 2-step system of sex and gender questions in the donor questionnaire. 

This study examined 2S/LGBTQ+ people’s perspectives on blood donation, including awareness of donor screening changes related to sexuality and views of blood operators’ efforts to be more inclusive with respect to sexuality and gender.  

First, the team conducted an international scoping review of existing donor policies for gbMSM and apheresis plasma donation, and other technologies, and policies, processes, and programs being used to reduce blood-borne pathogens from whole blood donation. In total, 51 peer-reviewed empirical studies from Organisation for Economic Co-operation and Development (OECD) countries from 1997 to 2020 were reviewed to provide a synthesis of research on the international policy shift in reducing the lifetime ban and/or removing the ban for gbMSM to donate blood.  

A qualitative portion of the study was led by Dr. Jacquie Gahagan, in which a question guide was developed with input from community advisory committee members from a variety of organizations and twelve semi-structured interviews were conducted with trans and gender diverse participants across Canada. Data were analyzed using open inductive coding methods to inform recommendations for how blood operators can improve processes for 2S/GBTQ+ donors. A quantitative portion of the study was co-led by Dr. Lachowsky and Community-Based Research Centre (CBRC), who surveyed over 2000 adult community members living in Canada who were gay, bisexual, queer men (cisgender and transgender), non-binary, or Two-Spirit (2S/GBTQ+) on their current attitudes and perceptions of the new individual-based gender-neutral screening process in early 2024. 

From the qualitative interview data, the team identified four main themes:   

1. Training of staff - Most participants flagged the issue of greater training needed as a key mechanism to improve (re)engagement with blood operators. Concern about the lingering bias against 2S/LGBTQ+ clients and an overall lack of awareness of trans and gender diverse remains a deterrent to both plasma and blood donations.  

2. Increase awareness - While most participants were aware of the ‘blood ban’, there was a lack of clarity on what the rationale was for the ongoing policy debates in relation to trans and gender diverse donors. Specifically, many were unaware of whether or not they were eligible to donate and felt that greater national awareness is needed to counter the lingering, stigmatizing legacy of the ban.  

3. Trust (re)building - To counter distrust of blood operators, participants felt that more needed to be done to share testimonials with trans and gender diverse communities, noting that some were unaware that they can donate.  

4. Plasma does not equal blood - Confusion about plasma apheresis versus whole blood donation was seen as contributing to furthering stigma. Many participants were unaware of the possibility of plasma donation and questioned the reasons why they can donate one and not the other.  

The quantitative work concluded that 2S/GBTQ+ community attitudes towards blood donation in Canada have shifted over time as policies have evolved from gbMSM-specific deferrals to gender neutral individual donor assessment. However, results highlighted that 60% of 2S/GBTQ+ participants still perceived the gender-neutral blood donation screening criteria to be discriminatory, and only 51% felt that these criteria were justified.

This is a marked improvement from the previously used gbMSM specific screening policies. The vast majority (85%) of 2S/GBTQ+ survey participants felt that blood operations could do more to repair the relationship with 2S/LGBTQ+ communities. One in five participants (18.2%) articulated that anticipated stigma/discrimination within blood donation centres was a barrier to donating. Two-thirds (62.9%) of participants desired more precise screening of sexual practices and one-third (37.2%) wanted improved sexual/gender diversity training for donation centre staff. 

Findings recommended that blood operators in Canada (and globally) continue to improve relationships with 2S/LGBTQ+ people and blood donors. Specifically, themes identified during the study activities indicated:   

1. There is a need for improved communication with 2S/LGBTQ+ communities surrounding changes to donor policies and guidelines pertaining to sexuality and gender;
2. Policies and procedures should be changed to become more trans-inclusive; and
3. Culturally responsive and equity-informed staff training should be implemented for people working at donor centres to improve interpersonal experiences around sexual and gender diversity. 

Manuscripts have been submitted to peer-reviewed journals and are forthcoming.  

One additional article is also available in pre-print (non-peer-reviewed):  

• Gahagan J, Haw J, Butler-Foster T, et al. Advances in blood donor policies in relation to gay, bisexual and other men who have sex with men (gbMSM) and transgender populations as donors: A scoping review. 28 February 2022, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-1217762/v1]

To mobilize knowledge generated through the project, the team completed presentations and other dissemination activities, including:    

• Wright I, Gahagan J, Lachowsky NJ. Legacies of the Canadian blood ban: Implications of past HIV prevention approaches for transgender and gender diverse Canadians. Oral Presentation. Annual Conference of the Canadian Association for HIV Research (CAHR). May 1-4, 2025. Halifax, Nova Scotia, Canada. Researchers.
• Lachowsky NJ, Klassen B, Curtis TJ, Rohani K, Lo R, Shah M, Amato A, Gahagan J. Evolutions in Canada’s Blood and Plasma Donor Screening Policies: 2S/GBTQ+ Community Attitudes to New Gender-Neutral Sexual Behaviour-Based Screening. Poster Presentation. Annual Conference of the Canadian Association for HIV Research (CAHR). May 1-4, 2025. Halifax, Nova Scotia, Canada. Researchers.
• Lachowsky NJ, Klassen B, Curtis TJ, Rohani K, Lo R, Shah M, Amato A, Gahagan J. New Gender-Neutral Sexual Behaviour-Based Blood Donor Screening: 2S/GBTQ+ Community Attitudes. Oral Presentation. Annual Conference of the Canadian Association for Health Services and Policy Research (CASHPR). May 26-29, 2025. Halifax, Nova Scotia, Canada. Researchers. 
• Lachowsky NJ. Successes and challenges in ongoing efforts to liberalise blood donation policy in Canada. Invited presentation for panel on International innovations in blood donor policy affecting GBM. SPOTS Symposium, University of Auckland. January 30-31, 2025. Auckland, Aotearoa New Zealand. 
• MacAllister-Caruso F, Lachowsky NJ. Key Research Contributions: Community Response to Blood Donation Policy Changes in Canada. Webinar presentation. Pride at Work. March 26, 2025. Online. 
• Vesnaver E, Miguel G, Palumbo A, Lachowsky N. What’s Happening with Blood Donation Policy and Implementation Research? A Community Discussion on Research, New Policy, and Intervention Co-Development. Community Based Research Centre Summit. November 22, 2025. In-Person. Montreal, Québec, Canada.