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

Abstract

Background Canada has incrementally reduced restrictions to blood and plasma donation that impact men who have sex with men, gay, bisexual, and queer men, and some Two Spirit, transgender and non-binary individuals (MSM/2SGBTQ+). Prior to the launch of a pilot program in 2021 enabling some MSM/2SGBTQ + to donate source plasma, we explored the acceptability of the program among individuals who could become eligible to donate in the program. Methods We invited men identifying as MSM/2SGBTQ + to participate in two consecutive semi-structured interviews to explore their views on blood and plasma donation policy, plasma donation, and the proposed Canadian plasma donation program. Interview transcripts were analyzed thematically and acceptability-related themes were mapped onto the Theoretical Framework of Acceptability. Results Twenty-seven men identifying as having sex with men participated in 53 interviews. Eighteen themes were mapped onto the seven construct domains of the Theoretical Framework of Acceptability. Underlying all aspects of acceptability was a tension between four primary values influencing participants’ views: altruism, equity, supply sufficiency, and evidence-based policy. The program was viewed as welcome progress on a discriminatory policy, with many excited to participate, yet tension with inequitable aspects of the program undermined support for the program and interest to contribute to it. The high demands of the program are unique for MSM/2SGBTQ + and are only tolerable as part of a program that is an incremental and instrumental step to more equitable donation policies. Conclusion Findings highlight past experiences of exclusion in Canada as a unique and critical part of the context of the donation experience among MSM/2SGBTQ+. Despite the program’s goals of greater inclusivity of MSM/2SGBTQ + individuals, the anticipated experience of the program included continued stigmatization and inequities. Future research should seek to understand the experienced views of MSM/2SGBTQ + donors to ensure that as policies change, policies are implemented equitably.

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

“…We speculate that some the participants accepted the differential treatment in the pilot program because information was provided about how the program would lead to better policies. In this study, like in others, a portion of the sample do not find incremental steps to be acceptable 5,6,27 . The finding that policies that include differential processes were unacceptable contributed to the understanding in the Canadian context of an intolerance toward differential treatment among gbMSM.…”

“…This study offers important findings about impacted community members' views on plasma donation and the acceptability of a pilot plasma program that was implemented as a step toward removal of the question about sex between men on the blood donation screening questionnaire. Previous research has shown that acceptability of the policy influences intention to donate 26,27 . With careful ordering of the survey section, this was the first study to examine general barriers and enablers for plasma donation among gbMSM assuming eligibility, without specifying a policy context.…”

“…Given that there is very little information about plasma donation in the Canadian media and in blood donation recruitment campaigns, it is unlikely that the item assessed true awareness. Participants may have applied their understanding about the need for blood to plasma 27 . Further research is needed to understand what Canadians know about plasma‐derived therapeutics and plasma donation.…”

“…Inherent to the pilot program was the opportunity for donated plasma to help evolve the policy further. In programs where this is the case, making this transparent may improve participation 27 . Items with lower means may offer the greatest opportunities for intervention as there is more room for improvement if targeted as a mechanism to enhance intention 39 .…”

“…Items with lower means may offer the greatest opportunities for intervention as there is more room for improvement if targeted as a mechanism to enhance intention 39 . Of the items with lower means, three addressed the unique context of controversial eligibility policies: “Donating plasma would feel alienating if I still can't donate blood,” “Donating plasma would support a system of homophobia within the Canadian health system,” and “Donating plasma would make me feel conflicted.” The majority responded affirmatively to these statements, indicating that the act of donation would not be purely positive and may involve a tension between participants' values of altruism and of social justice 5,27 . The view among impacted communities that the MSM donor criteria and the institutions that uphold them are homophobic 6,27 will undermine donation behavior in this population.…”