PoPulationand Public HealtH etHics

policy
26 per cent of new infections occurred in women, and 20 per cent resulted
from heterosexual sex. In this same time period 44 per cent of incident infections
were attributed to MsM. 5 Overall, while MsM still account for new
infections, the risk from other groups is significant.
Other countries have already responded to the demographic change in HIV
infection: the uk has recently changed its policy to a fixed, 12-month deferral
period, while Australia has been using a similar policy since 2000. 6, 7 In
Canada, however, the CBs continues to employ the precautionary principle
as an ethical guide to its policy. This means that the absolute deferral will
remain absent conclusive scientific evidence that lifting the MsM deferral
would not increase the risk of disease transmission through the blood supply.
Nevertheless, there are competing moral principles to weigh: keeping the
blood supply free of disease must be balanced against the public’s need for
transfused blood. With an aging population comes an increased demand on
the blood supply, as many donors become users of the blood system instead. 8
Overly cautious donation policy could lead to a blood shortage, but relaxing
the criteria for donation could lead to preventable disease transmission, a
risk that is borne, in this case, by individuals for whom transfusion is medically
necessary.
Scenario shift
How would the risk of blood-borne disease entering the blood supply be managed
if the most significant risk came from a group comprising the majority
of the population? Consider a scenario where heterosexual sexual activity is
associated with the highest risk of transmitting a blood-borne disease. Were
this the case, indefinitely deferring all individuals engaging in unprotected
heterosexual sex might drastically decrease the number of eligible donors.
Faced with a shortage of blood for transfusions, it is possible that CBs would
need to acknowledge the disparity in risks within the population and develop
more sophisticated screening tools to identify individuals participating
in high-risk activities. This hypothetical scenario prompts the question of
whether the current policy of deferring all MsM blood donation regardless
of individual behaviour is tenable only because it involves a minority group.
Would a more nuanced policy alternative be available to address the proposed
hypothetical situation?
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