Stepping Stones or Second Class Donors?: a qualitative analysis of gay, bisexual, and queer men’s perspectives on plasma donation policy in Canada

Abstract

Background Men who have sex with men (MSM) are not eligible to donate blood or plasma in Canada if they have had sex with another man in the last 3 months. This time-based deferment has reduced since 2013; from an initial lifetime ban, to five-years, one-year, and now three-months. Our previous research revealed that gay, bisexual, queer, and other MSM (GBM) supported making blood donation policies gender-neutral and behaviour-based. In this analysis, we explored the willingness of Canadian GBM to donate plasma, even if they were not eligible to donate blood. Methods We conducted in-depth interviews with 39 HIV-negative GBM in Vancouver (n = 15), Toronto (n = 13), and Montreal (n = 11), recruited from a large respondent-driven sampling study called Engage. Men received some basic information on plasma donation prior to answering questions. Transcripts were coded in NVivo following inductive thematic analysis. Results Many GBM expressed a general willingness to donate plasma if they became eligible; like with whole blood donation, GBM conveyed a strong desire to help others in need. However, this willingness was complicated by the fact that most participants had limited knowledge of plasma donation and were unsure of its medical importance. Participants’ perspectives on a policy that enabled MSM to donate plasma varied, with some viewing this change as a “stepping stone” to a reformed blood donation policy and others regarding it as insufficient and constructing GBM as “second-class” donors. When discussing plasma, many men reflected on the legacy of blood donor policy-related discrimination. Our data reveal a significant plasma policy disjuncture—a gulf between the critical importance of plasma donation from the perspective of Canada’s blood operators and patients and the feelings of many GBM who understood this form of donation as less important. Conclusions Plasma donor policies must be considered in relation to MSM blood donation policies to understand how donor eligibility practices are made meaningful by GBM in the context of historical disenfranchisement. Successful establishment of a MSM plasma donor policy will require extensive education, explicit communication of how this new policy contributes to continued/stepwise reform of blood donor policies, and considerable reconciliation with diverse GBM communities.

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

“…A modification to the MSM deferral policy was interpreted as a step towards bringing it in line with significant advances to the understanding of HIV transmission as well as the evolving ability to detect HIV [ 32 ]. Some participants noted that a policy shift would be viewed as meaningful and might motivate them to donate.…”

Staff perspectives on barriers and enablers to implementing alternative source plasma eligibility criteria for gay, bisexual, and other men who have sex with men

“…Staff perspectives on the new eligibility criteria also correspond with gbMSM views on blood and plasma policies. Though some gbMSM believed shortened deferral periods (e.g., from 12 to 3 months) and other alternative eligibility criteria (e.g., quarantines) were an improvement, 10,11,26 many believed the alternatives were insufficient for addressing longstanding homophobic policies that continue to exclude and stigmatize gbMSM. 10,11,26 Staff similarly expressed positive views when comparing the new screening process to the older, more restrictive criteria while others felt the new criteria were still discriminatory.…”

“…Though some gbMSM believed shortened deferral periods (e.g., from 12 to 3 months) and other alternative eligibility criteria (e.g., quarantines) were an improvement, 10,11,26 many believed the alternatives were insufficient for addressing longstanding homophobic policies that continue to exclude and stigmatize gbMSM. 10,11,26 Staff similarly expressed positive views when comparing the new screening process to the older, more restrictive criteria while others felt the new criteria were still discriminatory. Staff in our study were aligned with gbMSM views that a more equitable policy would ask all donors the same screening questions and would have a strong scientific rationale.…”

“…Staff are further tasked with providing donors with deferral explanations that are based on criteria that may be viewed as offensive and discriminatory. 10,11 Despite the critical role staff play in implementing criteria changes, recruiting plasma donors, 12 fostering positive donor experiences, 13 providing donor education, and encouraging return donations, [13][14][15] few studies have documented staff perspectives regarding eligibility changes and how they are impacted by evolving donation policies. We, therefore, sought to identify possible barriers and enablers to implementing new plasma criteria from the perspective of donor center staff in Canada prior to the regulatory approval of the new program.…”

Title: Advances in blood donor policies in relation to gay, bisexual and other men who have sex with men (gbMSM) and transgender populations as donors: A scoping review.

“…Only two published studies speci cally examined gbMSM views on plasma donation (2,14). Given the direction that Canadian Blood Services is intending to take with the Fall 2021 Health Canada submission to allow sexually active gbMSM in long term monogamous relationships to donate blood and the worldwide shortage of plasma (34,35) to manufacture into puri ed plasma protein products, this dearth of plasma related research is concerning.…”