Changes in Willingness and Eligibility to Donate Blood Among Canadian Men Who Have Sex with Men Under Proposed Deferral Policies

Background: At present the Canadian blood supply remains low. Canadian Blood Services (CBS) policy dictates that men who have sex with men (MSM) cannot donate blood unless they have abstained from oral and anal sex with another man in the last 12 months. However, given that CBS HIV testing detects HIV within 16 days, more MSM might be willing and eligible to donate blood if this deferral policy was modified (i.e., reducing deferral time, more specific sexual risk assessments). Identifying willingness and eligibility of MSM to donate under current and alternative deferral policies is of utmost importance.

Methods:  As part of the longitudinal Ontario-wide #iCruise study, 447 MSM completed three surveys to establish a 12, 9, 6 and 3-month timeline documenting HIV risk, and hence eligibility to donate blood under current and alternative deferral policies. Participants indicated their willingness to donate (irrespective of their eligibility) under the current policy (Policy 1a – no oral or anal sex within last 12 months), as well as 15 alternative deferral policies: no oral or anal sex within the last 9, 6 or 3 months (Policy 1b); no anal sex within the last 12, 9, 6 or 3 months (Policy 2); anal sex but only with HIV-negative partners using condoms 100% of the time within the last 12, 9, 6 or 3 months (Policy 3); and anal sex but only with HIV-negative partners using condoms less than 100% of the time within the last 12, 9, 6 or 3 months (Policy 4). Differences within and between policies were calculated by 1) willingness, 2) eligibility, 3) both willingness and eligibility to donate under current and 15 deferral policies using percentages. McNemar chi-square tests were used to test statistical significance.

Results: Under the current deferral (12-month) policy, 109 individuals (24.4%) were willing to donate. Willingness increased significantly to 189 individuals (42.3%) with a shorter deferral period (12 vs 3 months; p<0.001). Similarly, willingness to donate increased significantly (all p-values<0.001) under all other shorter deferral policies (12 vs 3 months): Policy 2 (27.2% vs. 45.6%), Policy 3 (40.5% vs. 50.8%), and Policy 4 (38.7% vs. 45.0%).

Under the current policy, 75 individuals (16.8%) were eligible to donate, which increased to 131 (29.3%) with a shorter deferral period (12 vs 3 months). Eligibility increased significantly (all p-values<0.001) under all other shorter deferral policies (12 vs 3 months); Policy 2 (26.0% vs 40.9%), Policy 3 (26.2% vs 49.0%), and Policy 4 (35.1% vs. 79.9%).

Among the subset of participants willing to donate blood under each policy, eligibility increased significantly (all p-values<0.001) with a shorter deferral period (12 vs 3 months): Policy 1 (current;16.4% vs. 29.1%), Policy 2 (24.0% vs. 38.2%), Policy 3 (23.8% vs. 46.3%), and Policy 4 (33.3% vs. 80.1%).

Implications: Given HIV can be detected within a 3-month deferral policy, the increase in both willingness and eligibility among MSM to a shorter deferral period would allow MSM who are both willing and eligible to donate blood to add to the currently low Canadian blood pool.