Assessing unintentional creation of bias against men who have sex with men as a function of exposure to blood donor screening questionnaire: A national randomized controlled trial

Abstract

Background: Canadian Blood Services (CBS) screens donors based on group status (e.g., men who have sex with men, MSM) instead of specific, high-risk sexual practices (e.g., occurrence of condomless sex). The MSM screening question is embedded in a cluster of questions about stigmatized attributes such as history of imprisonment and illicit substance use. This juxtaposition of the "MSM question" and stigmatized attributes may unintentionally cause blood donors to perceive MSM more negatively. The aim of this research is to determine whether the CBS donor eligibility questionnaire generates negative bias against MSM.Study Design and Methods: A national, randomized online study of 903 CBS donors was conducted. Participants completed either the existing blood donor eligibility questionnaire or a modified donor questionnaire that repositioned the MSM question among neutral questions. After completing the existing or modified questionnaire, bias against MSM was measured using the sexuality implicit association test (IAT) and Modern Homonegativity Scale -Gay Men (MHS-G). Lastly, participants estimated prevalence rates among MSM of certain stigmatized behaviors.Results: Participants who completed the existing donor eligibility questionnaire more strongly associated gay men with negative attributes on the IAT (p one-tailed = .045), suggesting question position generated implicit negative bias toward MSM. Responses to the MHS-G (p one-tailed = .506) and prevalence estimation task (p = .443) indicated that question order had no significant impact on explicit bias.Discussion: Positioning the MSM screening question among stigmatizing questions creates implicit negative bias against MSM. Policy makers should be mindful of question positioning when designing donor questionnaires.

Improved access yet inequitable experience: gay, bisexual and other men who have sex with men’s views of more inclusive criteria for source plasma donation

“…Any policy changes may influence perceptions of the impacted communities among donors who must answer these questions, and within the larger Canadian society. Hofkirchner and colleagues examined bias against MSM/2SGBTQ + depending on the placement of the question about sex with men in the donor screening questionnaire [37]. They compared the placement of the question at the time of the study which was among stigmatizing behaviours (such as intravenous drug use and sex work) to a more neutral placement (within medical history).…”

Alternatives to blood donor deferral of gay, bisexual, and other men who have sex with men: Acceptability of screening the sexual risk behavior of all blood donors

“…Asking about specific sexual behaviors helps to ensure a more equitable screening process for all donors. In the last 3 The above screening questions were placed among questions that were not related to sexual behaviors, such as having a tattoo, skin or ear piercing, having acupuncture, and others. This placement reflects the existing DQ.…”

“…1 In Canada, progress has been made in reducing the gbMSM deferral period from lifetime deferral to 5 years (in 2013), 12-months (in 2016) and 3-months (in 2019). [1][2][3] Moreover, Canadian Blood Services (CBS), one of two blood operators in Canada, received Health Canada regulatory approval to eliminate the population-based approach to deferring all sexually active gbMSM and replace it with individual sexual behavior-based screening of all donors as of September, 2022. 7,8 Blood donor eligibility screening in relation to sexual behavior is now based upon assessment of an individual's reported sexual behavior in the 3 months prior to donation with respect to having had a new sexual partner, more than one sexual partner, and if 'yes' to either of these behaviors, participation in anal intercourse.…”

“…The change to an individual sexual behavior‐based screening approach represents a welcome advance in donor inclusiveness 2,9–15 and a step back from stigmatization of gay males, 3 and is arguably as safe—or safer—than screening out gbMSM as a group 3,5 …”

“…Over the past decade, blood operators have responded to advances in testing technologies, new manufacturing processes, and changing social and political views to evolve donor policies concerning gbMSM/2SLGBTQ+ (i.e., two‐spirit, lesbian, gay, bisexual, transgender, queer or questioning, and additional sexual orientations and gender identities) 1 . In Canada, progress has been made in reducing the gbMSM deferral period from lifetime deferral to 5 years (in 2013), 12‐months (in 2016) and 3‐months (in 2019) 1–3 . Moreover, Canadian Blood Services (CBS), one of two blood operators in Canada, received Health Canada regulatory approval to eliminate the population‐based approach to deferring all sexually active gbMSM and replace it with individual sexual behavior‐based screening of all donors as of September, 2022 7,8 .…”