Rapid HIV kit tests Canada's blood policy

A new instant HIV test may push Canadian Blood Services to change its long-standing policy of prohibiting men who have sex with men from donating blood.

The INSTI HIV-1/HIV-2 Rapid Antibody Test delivers results in one minute.

The test has been available in Vancouver at the Health Initiative For Men (HIM) Sexual Health Centre at 421-1033 Davie St. since the clinic opened in September.

“You walk in, do the test, and you walk out and you know the results,” said Hans Bosgoed, the clinic coordinator at HIM.

Now that technology exists to immediately screen for HIV, groups that oppose the blood services’ current policy say the organization needs to update its position.

“Policy states that any man who has had sex with a man, even once, since 1977 is permanently deferred from donating blood,” said Angela Poon, spokesperson for the blood service.

According to the Canadian Blood Services’ website, “[t]he basic premise for the deferral criteria is that the prevalence and incidence of HIV is much higher in males who have had sex with other males than it is in individuals having exclusively heterosexual sex.”

This information is based on 2005 Public Health Agency of Canada statistics.

Michael Olson, national executive representative for the Canadian Federation of Students, British Columbia, said rapid testing should have a significant impact on future policy amendments.

The federation holds a seat on the advisory panel of the national Lesbian, Gay, Bisexual, Trans, Two-Spirit, Queer working group. The blood service formed the working group in September of 2008 to educate the public on issues like the men who have sex with men policy.

Olson said the policy is outdated and does not reflect scientific advancements that have been made since it was implemented in 1988 by the Canadian Red Cross.

According to the federation’s general position statement, “[t]he current Canadian Blood Services’ policy is based on stereotypes of [men who have sex with men] populations and a lack of evidence that allowing the [men who have sex with men] population to donate would increase the risk of HIV transmission.”

Poon said the blood services’ policy is under constant review and that they presently have a research proposal put out through the Canadian Institutes of Health Research for more relevant statistics that would support any amendments.

Time still an issue

Although the INSTI test can provide results within 60 seconds, there is a possibility that an individual may be infected and test falsely negative within three months of possible infection.

The rapid test detects antibodies to HIV-1 and HIV-2, but it can take months for an infected person to develop an antibody response.

“Optimally, we would have a test that could say with certainty whether any donor had HIV or not at the time of donation and really the reason that screening is based on people’s sexual orientation is because of the limits of the existing testing methods,” said Evan Wood, a research scientist at the British Columbia Centre for Excellence in HIV/AIDS.

“If a gold standard test became available that could say with certainty whether a blood product that was going to be derived from any individual was safe then that would be great.”

Wood said unknown emerging infections, as was the case with HIV 20 years ago, provides further justification for screening blood donors from high-risk communities, including men who have sex with men.

“[T]here is often co-infections in addition to HIV – such as Hepatitis C, Hepatitis B – that raise additional concerns.”

Rick Galli, chief technical officer of bioLytical Laboratories in Richmond, B.C., where the INSTI kits are developed and manufactured, said that it took eight years to develop the technology for the test.

But now tests for other diseases can be developed in significantly shorter amounts of time using the same technology.

“It’s changed the whole landscape of testing,” said Galli.

Listen to an interview with Rick Galli explaining how the INSTI rapid HIV test works:

[audio:https://thethunderbird.ca/html/wp-content/themes/WpAdvNewspaper/audio/Rick%20Galli.mp3]

Time for change

HIV/AIDS researcher Wood said the blood services’ policy is meant to protect the public, but he recognizes there is pressure for amendments.

“Now recently there’s been a movement in the community, and I think it’s a reasonable one, because there are many gay men that are in long term, stable relationships, or always use condoms, et cetera, that are relatively low risk and those people want to be able to contribute to society and give blood.”

The students’ federation proposes that changes to the policy should adhere to the following principles:

• The Canadian Blood Services’ policy should strive for clarity and simplicity.
• The Canadian Blood Services must adhere to its responsibility in the broader public to pass along accurate messaging, in the interest of public health and not propaganda.
• The blood supply must be kept safe through explicit donor screening that is based on behaviours, not demographics.
• The Canadian Blood Services principle of striving for non-discrimination should be adhered to when drafting and enforcing policy of the organization.

Olson said that advancements in testing should affect the screening criteria for donors. He said countries like Spain and Italy have changed their deferral criteria and that their blood supplies have not experienced increases in detected infections.

With all permanent deferral criteria in place – this includes men who have sex with men, intravenous drug users, people from certain African countries and people who lived in the UK between 1980 and 1996 – only one in two Canadians are eligible to donate blood.

Currently only three per cent of eligible people donate.

“We want [the policy] to change because it’s the right thing to do, and we want to have the research to be able to change that and make that happen,” said Canadian Blood Services’ spokesperson Poon.

She said changing the current policy simply to give previously deferred groups the privilege of donating blood is an example of “tokenism,” and not the goal of the blood service.