A mixed methods investigation of the relationship between blood donor policy, interest in donation, and willingness to donate among gay, bisexual, and other men who have sex with men in Ontario, Canada

Abstract

Background As of 2019, men who have sex with men (MSM) in Canada are ineligible to donate blood if they have had oral or anal sex with another man in the last 3 months. Deferral policies targeting MSM are largely interpreted as unjust by gay, bisexual, and other men who have sex with men (GBMSM) – shaping their desire to donate blood and engage with blood operators. This mixed methods study explores interest in blood donation among GBMSM as well as willingness (and eligibility) to donate under four different deferral policies. Methods We surveyed 447 GBMSM who were recruited from the Ontario-wide #iCruise study. Participants were asked whether they were interested in blood donation and if they were willing to donate under each of our four deferral policies. We also completed interviews with 31 of these GBMSM. Participants were asked to describe their feelings about blood donation, their views on our different deferral policies, the impact of a policy change, as well as other means of redress. Results Most participants (69%) indicated that they were interested in donating blood. Despite this, an interpretation of the MSM deferral policy as discriminatory was common among all participants. Our mixed methods findings indicate that, among those who were interested in blood donation, the adoption of one of the alternative policies presented in this study (specifically Policy 2 or Policy 3) would significantly increase the number of participants willing to donate and be viewed as “a step in the right direction.” However, many participants who were not interested in blood donation argued that a gender-neutral deferral policy would need to be implemented for them to donate. Participants recommended that blood operators consider efforts to repair relations with GBMSM beyond policy change, including pop-up clinics in predominantly queer areas and diversity sensitivity training for staff. Conclusion We argue that the most impactful policy shift would be the implementation of an individual risk-based deferral policy that is applied to all donors regardless of sexual orientation or gender identity. However, given MSM’s historical exclusion from blood donations, blood operators should pair this policy shift with community relationship-building efforts.

Evolving the gay, bisexual and other men who have sex with men time‐based deferral to sexual risk screening for all donors: The contribution of Canadian research programmes

“…The programmes also supported social science projects that examined the views of diverse populations regarding screening criteria [45][46][47]58], including an emphasis on understanding the views of blood donation and acceptability of alternative donor screening approaches among gbMSM [48][49][50][51][52]54]. In some projects, existing community-based research efforts were leveraged [48,[50][51][52].…”

“…Mixed methods data from the research programme informed the Health Canada submission to apply a sexual behaviour-based screening approach by enabling blood operators to validate through research and evidence what they were hearing from community members regarding negative views on differential screening processes for gbMSM donors and enabled a more nuanced understanding of gbMSM and donors' views on screening criteria [48,51,52]. These data were also invaluable in understanding the operational feasibility and impact on adequacy of the blood supply [59,60] and supporting implementation of these changes with research-informed staff training [58].…”

“…Internationally, research funded by the programme was cited in the FAIR report that recommended a more individual screening approach in the United Kingdom [62]. Furthermore, research findings supported [46,49,50,54,58] gbMSM [48][49][50][51][52]54] Donors [45][46][47]60] Donor centre staff [58] Mixed methods [48] Quantitative [45, [55,58] Donors [2,3,[55][56][57] gbMSM [53,56] Quantitative [2] Qualitative [3, 55- [46,61] Donors [46,59,60] gbMSM [61] Donor centre staff [61] Mixed methods [59,60] Quantitative [46] Qualitative [61] -Less than 4% of donors indicated that they had anal sex in the previous 3 months [60] -Applying the FAIR criteria would result in donation loss of 1.0% (95% CI: 0.8, 1.1). Donation loss could be partly compensated by newly eligible gbMSM [59] -Discomfort with sexual risk questions can be alleviated by providing explanations for the questions, warning about the questions and using a selfadministered questionnaire [46] Abbreviations: gbMSM, gay, bisexual and other men who have sex with men; MSM, men who have sex with men.…”

“…Peer-reviewed publication outputs from the programmes are listed and their research findings are summarized in Table 3. These findings [2,3,[45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] together with stakeholder engagement and international research informed several recent changes to Canadian donor eligibility criteria and screening (Table 4).…”

Navigating imperfect policies to donate plasma: Survey on plasma donation and a pilot plasma donation program among men who have sex with men in Canada

“…In addition to rebuilding trust among communities impacted by the MSM donor policies, blood collection agencies should also consider communication strategies focused on the unique subset of the impacted communities who are both newly eligible and highly motivated to donate. 26…”