Health Committee on April 3rd, 2008

[Stephen Alexander]

Unfortunately, I'm not in a position to comment on how things are done in Spain or in Portugal. During the course of our discussions last spring with Canadian Blood Services, we were told that Italy had adopted a system where the focus was on people's sexual behaviour, not on their sexual orientation.

Therefore, as my colleague said, setting up a registry where people would be asked to answer questions about whether or not they had engaged in risky or unprotected sex would be an effective approach, rather than targeting one group in particular.

[Réal Ménard, Bloc, Hochelaga, QC]

Madam Chair, can the researcher...

[The Chair, Conservative, Joy Smith]

We have to go now to....

Pardon me?

[Réal Ménard, Bloc, Hochelaga, QC]

A point of order.

Can the researcher confirm whether or not this committee did in fact produce a report on a national registry?

[Nancy Miller Chenier, Committee Researcher]

I can speak to the fact that there was an organ and tissue donation report, which one of the witnesses mentioned earlier today. We studied it in 1998, and in 1999 I believe we reported on that. There was a full committee report. It was not specific to an organ registry. That was one of the issues they considered.

[Réal Ménard, Bloc, Hochelaga, QC]

I thought the committee had recommended...It didn't? All right, we will look into that.

[The Chair, Conservative, Joy Smith]

We'll check that, for sure.

Ms. Wasylycia-Leis.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Thank you.

I could jump right in on the question of a national registry. I know the committee I was part of did not recommend the registry. It has been an active issue before Parliament. In fact, I've had a bill for many, many years on this very matter.

Perhaps we could have unanimous consent from the committee to advance this bill through all stages, because it would be an important issue, an important way to deal with the issue of an adequate system of organ donations and transplantations in this country.

Mr. Plater raises a very important point here, that in fact we have discrimination built into that system so that people with HIV and hepatitis aren't eligible to receive a donation, even when they need a liver transplant. I think you're saying that; you might want to clarify. It sounds to me as if we need to deal with discrimination at both ends of this system, and that's certainly one way.

Let me give you a chance to answer that question in the context of your questioning of whether or not, if we move away from what the government has proposed and what the Standards Association has proposed, we might not be fulfilling our obligations in terms of the precautionary principle.

We have heard suggestions from many other witnesses that we are missing the boat when it comes to the true risk factors. All we're doing is building discrimination against gay men into the system. I'd like to start with you, and then I've got a few other questions.

[John Plater]

Sure. I didn't want to mislead the committee. The restriction on my getting a liver is not codified. It's just the simple fact that no transplant program in this country at the present time will do the transplantations. We've been trying to understand and respond to those reasons. Liver transplant is never a routine practice, but it is becoming available in the United States.

So there's something underlying it, and when it's not a codified thing, I get concerned that it is related to discrimination.

In terms of the changes, again the points are valid in terms of the need for constantly reviewing the regulations and the Standards Association guidelines that underlie them. But it has to be done with a full understanding. There have been some comments here today that I feel aren't completely correct.

There are women who are excluded under the guidelines as they stand. They are involved in certain high-risk activities, and in some of those cases it is tied directly to the activity, for instance, taking money for sex, having sex with an individual who's suspected or known to be infected with HIV, hepatitis C, or HBV. But that being said, you have to understand.... So women are recognized here.

The comment about the increase in the rate of infection in young women is very interesting and very telling about the problems with this discussion. Those rates are percentage increases, which are of serious and grave concern in terms of our ability to get messages through to those people, but the raw numbers are still low compared to the per capita numbers of infection in--

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I'm not so sure they're that low. I think others have made the point very effectively that the real growth in the numbers in terms of HIV and AIDS...that the whole demographic is changing rapidly.

A recent study in Manitoba showed that back between 1985 and 1995, the number of women who contracted HIV...or the percentage of new HIV infections was eight. Between 1996 and 2007, one-third of all Manitobans who tested positive for HIV were women. That's almost 500. And one-third of any new infections since 1999 have been contracted by aboriginals.

So the demographics have changed, yet the criteria have not changed. I think what we're trying to do today is figure out a way to be honest with the precautionary principle consistent with scientific facts.

So I want to ask Mr. Alexander and others this question. What are the options? We can recommend that we change the list of exclusionary criteria, or we could go back to the system that existed, which had clear testing and all kinds of measures in place to screen out high-risk behaviour, or we can do what they've done in the United States, where they have some exclusionary criteria, but they're not regulations. In fact, they are not exclusionary; they're just there as guidelines.

What would your advice be in terms of where we should end up as a committee on this matter?

[Stephen Alexander]

Going back to what was originally there prior to December, or January of this year, it was a set of guidelines where there were questionnaires and surveys for the donor, if living, or if it was cadaveric, of the family, and it went through all the scientific and empirical testing for disease. If it was found to be tainted and not usable, it went through the exceptional distribution clause and there was physician and recipient informed consent.

I think a measure of those three together would give us something that is safe and equitable.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Mr. McCutcheon, do you want to add your views to what a new system should look like?

[Laurent McCutcheon]

I believe the focus must be on people's behaviour, not their sexual orientation. The same regulatory framework must apply to both homosexuals and heterosexuals. Risky behaviour is not a function of sexual orientation. That is what we need to focus on.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Okay, and let me ask--

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Wasylycia-Leis.

Mr. Tilson.

[David Tilson, Conservative, Dufferin—Caledon, ON]

Thank you very much, Madam Chair.

I'd like to enter into some dialogue with Mr. Alexander on the topic of the comment that these regulations may have homophobic prejudice. I can't remember who mentioned that, but I believe it was you who mentioned that you'd had some communication with the Canadian Blood Services.

I knew someone in my riding who died a number of years ago and it was eventually determined that he had AIDS. He acquired this through receiving a blood transfusion. Someone had donated blood and he'd received it. Of course, shortly after that time there was this tainted blood scandal. It was awful. It was quite a few years ago. It has to be 20 or 25 years ago. It was a terrible thing. People died and it was awful. It was quite a while ago.

After that time, when you went to give blood it was made much more difficult. I believe there are provincial regulations and there are national regulations. I just went on the website and got part of the questionnaire that you have to sign, from the Canadian Blood Services.

And you read some of the questions that are asked. It's very similar to the regulations. Just read some of them. Do you have AIDS? Have you ever had a positive test for HIV or AIDS? Male donors: have you had sex with a man even one time since 1977? Female donors: in the last 12 months have you had sex with a man who has had sex even one time since 1977 with another man?

There are a whole bunch of questions about drugs and a whole bunch of questions about other diseases. In the past six months have you had sex with someone whose sexual background you don't know? Were you born or have you lived in Africa since 1977? Those are rather controversial questions that you have to sign. Unless you sign them, you can't give blood. And then there's something else.

I think it was you who said you'd had some discussions with the Canadian Blood Services. My question is this. Is what's going on with this--when you give blood--any different from what goes on with organ donations? Is the philosophy with trying to protect the recipient because of these questions and these statements any different from trying to protect the recipient with respect to organ donations?

[Stephen Alexander]

The philosophy of ensuring a safe blood supply and a safe organ supply remains the same throughout. The philosophy of using the gay population and targeting them as vectors of disease, however, drastically needs to change.

In a day and age where the gay fight has come from being viewed as a mental disorder to where we now are supposedly equal people in society can be vastly undermined by such targeted exposure and criteria that really put a negative slant on being gay.

You will notice that Canadian Blood Services in 2005 did a revamp of their criteria and what were criteria that would exclude five to ten years got changed. Gay men are still excluded for life from ever giving blood.

The whole point is that not all gay men take part in risk activity. There are heterosexual people who take part in risk activity. We don't want to say it, but anal sex is one of them. And if you're going on a basis of risk behaviour, then you have to include all risk behaviour in all categories of people and not just exclude it to gay men.

Safety is paramount, yes. We really need to find a way where safety can be had without the prejudice against gay men.

[David Tilson, Conservative, Dufferin—Caledon, ON]

Someone over here made the statement that there are new screening tests or processes. I think it was you, Mr. Plater, or one of you. It was also acknowledged—at least I got the impression, from the new screening, the new testing—that science has improved over the years, but it's still not perfect. So if one acknowledges that issue, then one asks this question, and I'm going to ask it to all of you: is Health Canada's primary duty or responsibility to the recipient or to the donor? Anybody?

[Laurent McCutcheon]

Health Canada has a duty to all Canadians. If measures are taken to deprive recipients...We know that there is a shortage of organs. Any policy must therefore take into account the overall situation.

I understand that the current policy is based on concerns for safety. We are all aware of past problems with blood donations. The emphasis has shifted to policies where safety is the primary consideration. In the process, if recipients are not receiving organs, then I think the policy and the regulations need to be revisited. All facets of the problem must be considered.

If I were a public decision-maker, it would be in my best interest to make a decision that would not leave me open to possible legal action. We saw what happened in the past, after the Krever inquiry. I would want to opt for very safe policies too. However, as a result of this approach, the list of people waiting for a transplant is growing and the shortage of organs available continues to be a problem. Public decision-makers are protected from prosecution. While they have carried out their duty to protect the public, they have failed to ensure that people awaiting a transplant receive the organs they need. The waiting list is long, but few organs are available.

[The Chair, Conservative, Joy Smith]

Mr. McCutcheon, I'm sorry to interrupt you, but we have gone over time. I thank you for your comments.

We're now going into the second round. It's five minutes per person, and we'll begin with Ms. Kadis.

[Susan Kadis, Liberal, Thornhill, ON]

Thank you, Madam Chair.

Welcome to all our...[Technical difficulty--Editor]

In your view—all of our witnesses—is there adequate scientific evidence to justify any of the exclusion criteria? I know we've been focusing on one particular one, but we have an array there that is set out in the standard. Do you feel the case has been made and that there is a scientific basis for the new regulations, the new exclusion?

[John Plater]

Yes, there is, in my opinion. There's fine tuning that needs to be done. Some parts of it are not as clear-cut as others.

One of the particular issues is the amount of time from the behaviour to the date of the proposed transplant, but obviously my position is to err on the side of caution and inform the recipient of the best knowledge available, so that they can make the decision about receipt. But essentially, yes.

It gives me a quick opportunity to respond to the point about the increase in women. Of course, there's an increase in women, a very concerning increase in women. How many of those women are not women who have used intravenous drugs or had sex with someone infected with HIV, hep C, or hep B, or are at serious risk of that? The numbers again go lower. If the day comes when the prevalence of women as a population who have sex with men or with women increases to a significant rate, then there may be room to add them to the list.

I always envisioned a country where we were working towards reducing the infection rates in all of these populations and getting people to understand the importance of safety in sexual encounters, in drug-use encounters, etc., so that we could lift the ban on everybody. Unfortunately, the stats tell us we're not headed that way. We're actually in a reverse trend, where we're going to be adding more people to these lists and not removing them.

[Susan Kadis, Liberal, Thornhill, ON]

Mr. McCutcheon.

[Laurent McCutcheon]

We continue to come back to the same point. I believe that we can justify excluding some people based on the level of risk. However, do we need to target a particular group of people, or persons of a certain sexual orientation, or should the focus be on behaviours? I see no problem with listing in the Annex behaviours that are deemed risky, with stating that if a person has engaged in a certain type of behaviour for a certain number of years...However, I cannot accept the regulations as they now stand. Currently, if you are a man who has had sexual relations with another man, even though you used proper protection, as you were taught to...Health Canada does educate people on proper prevention and protection measures. All of Health Canada's policies must be consistent. I would be fully in favour of drawing up a list of exclusions based on behaviours.

[Susan Kadis, Liberal, Thornhill, ON]

I would like to hear it from all witnesses.

Mr. Alexander, are the exclusions we're talking about justified, in your opinion, on a scientific basis?