PoPulationand Public HealtH etHics

lood-borne viruses into the blood supply by refusing donations from MsM,
a population at a statistically increased risk of being infected with HIV. At
the time of implementation, there was no test to detect the virus in donated
blood, leading to a reliance on donor screening to prevent contaminated blood
from entering the blood supply.
Case
The indefinite deferral of blood donation from MsM has recently garnered
criticism and has prompted accusations of unnecessary discrimination and
stigmatization of this community. The ethical dilemma lies in balancing the
safety and sufficiency of the blood supply, a common good, against the rights
of the MsM community, and of MsM individuals, to be free from unjust discrimination.
Public health in all countries must balance these considerations
while fulfilling its obligation to use scientific evidence honestly and fairly.
In Canada, it must do so in the shadow of a tainted blood scandal that damaged
public trust in the blood supply and continues to shape risk perception
of blood-donation policies. Arguments that the MsM blood donation policy
should be reviewed in light of current evidence are grounded in significant
improvements in blood testing and the emergence of new HIV risk groups.
The science of HIV testing has improved since the late 1980s, and with it
the safety of the blood supply. Historically, blood donated in the ‘window
period’ (i.e, the period between infection and ability to detect the virus)
could not be accurately tested for HIV. In 2001, the advent of nucleic acidbased
tests dramatically reduced the window period to approximately 12
days. 3 As a result of both the deferral and the innovation in testing, the risk
of contaminated blood is currently so minimal that it can be approximated
only by mathematical models.
The groups of people at risk for HIV infection have changed since the early
years of the HIV epidemic, when the virus predominantly affected MsMs. This
group still accounts for a plurality of new infections but in reduced proportions.
Today, MsM comprise approximately half of prevalent HIV infections,
but heterosexual sexual contact, injection drug users, women and Aboriginal
groups all have higher levels of infection than in previous decades. 4 The
pattern of incident HIV infections is also shifting, with an increasing proportion
of women, Aboriginal and ethnic minorities being diagnosed. In 2008,
Deferring Blood Donation from Men Who Have Sex with Men
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