2SLGBTQIA+ inclusion at Canadian Blood Services

We are committed to making our donor centres as accessible and inclusive as possible, including for donors with disabilities.

• We arrange for certified sign language interpreters to accompany donors who are Deaf, deafened or hard of hearing through the donation process.
• Donors who are blind, partially sighted or who have low-vision can have a Canadian Blood Services employee read any required information to you during the screening process and assist you to the donation floor (if required).  
• Service animals may accompany donors in all permanent donation centres and throughout the donation process.
• Donors who use wheelchairs or other mobility aids may self-report their height and weight during the screening process at our dedicated plasma donor centres. We unfortunately don’t have height-adjustable donation beds, and our employees aren’t trained to transfer donors onto our donation beds. However, donors may bring a support person with them to their appointment to assist them onto a donation bed.

More information about accessibility practices in our donor centres can be found here.

Condom use, while an excellent sexual health practice, isn’t considered an evidence-based method of screening donors because condoms are not always effective and can break or slip.

Our donor screening questionnaire is designed to be applied as broadly as possible to screen many potential donors and it’s not comprehensive in asking about safe sexual practices, such as condom use.

The eligibility criteria for organ and tissue donation are different than those for blood and plasma donation. Health Canada determines organ and tissue donor eligibility, and donor screening is conducted by the provincial organ and tissue donation programs.  

Although Canadian Blood Services has no role in determining organ and tissue donor eligibility, we’re committed to supporting ongoing work to make organ and tissue donation and transplantation more inclusive. We firmly believe that eligibility to donate biological products should not be based on sexual orientation.

Our role in organ and tissue donation in Canada is to facilitate collaboration in the donation and transplantation community and support the development of leading practices, professional education and public awareness.

We’re actively working, for example, with leading 2SLGBTQIA+ experts to develop a professional education program that aims to increase the capacity of donation and transplant teams to provide inclusive care to 2SLGBTQIA+ people. 

Pre-exposure prophylaxis, or PrEP, is a highly effective combination of medications that prevent HIV infection for the person taking it and is recommended to maintain sexual health. Post-exposure prophylaxis, or PEP, may be prescribed to people who are HIV negative or don’t know their HIV status and may have been exposed to HIV in the last 72 hours.

There is a challenge facing blood operators, however, in that the medications used for PrEP/PEP affect the ability of our blood screening tests to detect low levels of HIV present in the case of a breakthrough infection. Because Canadian Blood Services relies on accurate performance of HIV tests as part of our multi-layered approach to safety, people who use PrEP/PEP are not currently eligible to donate.

If you have recently stopped taking PrEP, or were recently prescribed PEP, you’ll be asked to wait four months after your last dose of medication to donate.

We are continuing to review scientific evidence in this area to better understand the impact of PrEP/PEP on HIV testing and connect with experts in the field to learn about new studies and developments.

Receptive anal sex has a higher chance of HIV transmission per sex act than insertive anal sex. However, when we conducted studies asking donors about receptive anal sex, the term was not well understood, and the question was inconsistently answered.

For the safety of our blood and plasma supplies, it is important that our donor screening criteria are easily understood by all donors, which is why we made the decision to ask about anal sex generally as part of sexual behaviour-based screening.

People who have engaged in sex work are asked to wait one year (12 months) after they last received money or drugs in exchange for sex, before donating blood or plasma. For the purposes of assessing a person’s eligibility for donation, when we ask about sex work, we define sex as having oral, vaginal, and/or anal intercourse for money or drugs.

Canadian Blood Services’ goal is to ensure the safety and sufficiency of Canada’s blood and plasma supply while increasing participation and maximizing inclusion in Canada’s Lifeline. One way we do this is by regularly reviewing our eligibility criteria against the latest scientific evidence, as well as advancements in technology and testing.  

People who have recently had sex with an HIV-positive partner (including those who are taking antiretroviral therapy and have undetectable viral loads) are asked to wait one year (12 months) after the last sexual contact, before donating blood or plasma. For the purposes of assessing a person’s eligibility for donation, for this question we define sex as oral, vaginal, and/or anal intercourse.

Canadian Blood Services’ goal is to ensure the safety and sufficiency of Canada’s blood and plasma supply while increasing participation and maximizing inclusion in Canada’s Lifeline. One way we do this is by regularly reviewing our eligibility criteria against the latest scientific evidence, as well as advancements in technology and testing.  

2SLGBTQIA+ people are welcome and encouraged to join the Canadian Blood Services’ Stem Cell Registry. However, it is important to know that the donor screening process for stem cell donation is different than that for blood and plasma donation. Health Canada sets the regulations for stem cell donation, in compliance with Canadian Standards Association (CSA) standards. 

Currently, when you register to become a stem cell donor, you are not asked any questions about sexual behaviours or sexual orientation. If you’re later identified as a potential match for someone, however, you will be asked about your gender (though what the question is really seeking to understand is sex assigned at birth) and then asked one of the following questions during subsequent screening: 

• Prospective stem cell donors who identify as ‘male’: Have you had sex with a man, even one time, in the past 12 months? 
• Prospective stem cell donors who identify as ‘female’: In the past 12 months, have you had sex with a man who has had sex, even one time, in the past 12 months with another man? 

No matter how you respond to these questions, you will still be eligible to donate, if you meet other required criteria. In other words, your sexual orientation does not have any impact on your eligibility to donate stem cells. 

However, Canadian Blood Services is required to provide your response to the above questions to the centre requesting the stem cells for their patient.  A patient and their health care team ultimately make the decision about whether to proceed with the matching donor, not Canadian Blood Services. Decisions are based on several factors, including donor age and overall health.

Although Canadian Blood Services has no role in determining stem cell donor eligibility criteria, we have provided evidence  advocating to the CSA to shift its current standards for screening stem cell donors to align with sexual behaviour-based screening for blood and plasma donation. 

A proposed amendment to these standards is currently before the CSA. Once these standards have been updated, Canadian Blood Services will be able to update our stem cell donor questionnaires.

We anticipate we will be able to implement sexual behaviour-based screening in the stem cell donation process sometime before the end of 2025.

Improving the donation experience for trans, non-binary, Two-Spirit and gender diverse donors is an urgent priority of ours. We’ve been actively working on several short- and long-term changes to our registration and screening practices, in consultation with impacted communities. 

Changes implemented to date include:

• Trans donors are no longer asked if they’ve had gender-affirming surgery.  
• We no longer ask donors to verbally state their gender at each donation appointment.  
• Trans and gender diverse donors with a binary gender can now register in their gender, and can make this change themselves in the GiveBlood app 
• We’ve made changes to our booking system to ensure that a donor’s chosen name/name-to-use can be recorded in our appointment booking system.   

We’re currently working on IT and software system changes to adopt diverse gender options in our registration processes and to capture chosen name/name-to-use in our donation system.

We strive to ensure an inclusive, safe and affirming donation experience for all donors and will continue to take timely actions to expand gender registration options, prevent deadnaming in all donor touchpoints, and provide ongoing inclusion training and education to our staff.  

We anticipate we will be able to make some of the further necessary changes to our donor registration process by 2026.  

It is incredible that HIV care has reached a point where people’s viral loads can be undetectable.

However, undetectable equals untransmissible (U=U) only applies to sexual transmission of HIV. Even when a person who is HIV-positive has an undetectable viral load, the virus could still potentially be transmitted through blood transfusion.

The chance of transmission is much higher with a unit of blood, due to the large volume of a blood transfusion and the relative higher total about of virus present.

For this reason, a person who is HIV-positive, even with an undetectable viral load is not eligible to donate blood or plasma.