Thank you very much, Madam Chair, and thank you to the standing committee for the invitation for the Canadian AIDS Society to be present at this table and in these discussions.
The Canadian AIDS Society is a national coalition of over 125 community-based AIDS organizations dedicated to strengthening the response to HIV/AIDS across all sectors of society.
While we appreciate the need for ensuring the safety of organs and tissue for donation, we are nonetheless concerned that the guidelines in the safety of human cells, tissues, and organs for transplantation regulations have been changed into a law in which, despite the exceptional distribution clause, gay men and other men who have sex with men have been targeted as a specific population banned from organ donation. It's a law that seems to be based on the assumption that all homosexual and bisexual men are at high risk for HIV, and it's a law that perpetuates homophobic prejudices by equating sexual orientation with sexual behaviour.
This new regulation seems focused on stereotypes of gay men and other men who have sex with men, and it's based on an unproven belief that allowing the gay and MSM population to donate would increase the risk of HIV transmission to transplant recipients.
It's been well established within the field of epidemiology that certain conditions need to be met for HIV transmission to occur. There must be the presence of HIV in bodily fluids, such as blood, semen, vaginal secretions, or breast milk; as well, there has to be a route of infection--for example, specific types of unprotected sexual activity; mother-to-child transmission; sharing of needles or syringes and other paraphernalia used in piercing the skin; or receiving transfusions of infected blood or blood products, transplanted organs, or donated sperm.
The new regulations for organ donation do not define the type of MSM sexual activity that can lead to HIV transmission. Thus, an MSM relationship that is monogamous still can be subject to a ban, while a male having sex with a female can engage in unsafe practices or have safer sex with multiple partners and still be allowed to donate.
Dr. Gary Levy has already told this committee that:
...new testing modalities for HIV, including third-generation serology, which measures antibody responses, RNA and DNA PCR, provide transplant practitioners with enhanced tools to screen potential donors and organs. Properly used, they make the transmission of HIV exceedingly unlikely.
Understanding that risk of transmission of HIV by organ donation would occur almost exclusively during what is called the “window period” suggests that with the use of current sensitive enzyme immunosorbent assays and data on HIV incidence among transplant recipients, the risk of HIV transmission through organ transplantation is one in a million.
Canada's organ and tissue donation rate is one of the lowest in western industrialized countries. Donation rates have levelled off at 14.5 donors per million at a time when the need for transplants has increased by 50%.
Identifying high-risk groups of people rather than high-risk activities works to eliminate a lot of people who could be safe donors, and while the argument to target the gay and MSM population continues to base itself on scientific and empirical data, the HIV and AIDS in Canada Surveillance Report to December 31, 2006 by the Public Health Agency of Canada demonstrates the persistence of trends among women documented in previous surveillance reports. The positive test reports among women continue to increase, and they reached their highest level yet in 2006, at a total of 27.8% of total positive test results. That is a notable increase over 1997, when women represented only 11.1% of total positive test reports.
The PHAC report goes on to state that women account for a substantial proportion of positive test results among young adults and that in 2006 young women between the ages of 15 and 19 represented 63.8% of all positive test reports in this age group. Although MSM accounted for the largest proportion of positive test results in 2006, the heterosexual exposure category continues to account for a significant number and proportion of positive test results.
By using the same logic of incidence and prevalence that excludes the gay male population, the question remains whether there will be more increases in exclusion criteria that will further diminish the already small donor pool.
The Canadian AIDS Society urges the Standing Committee on Health to work toward providing a set of criteria that is equitable to all populations and will allow donor agencies to continue the policy of screening based on individual behavioural risk, rather than a blanket policy of exclusion based on sexual orientation, thus ensuring greater access to organs for transplantation.
Thank you.