Blood, we are frequently reminded in colorful ad campaigns, is in us to give. We are urged to give the gift of life. Although it is in all of us, flows through all our veins, it is apparently not in all of us to give. No matter how desperate the need for blood, no matter how many people could use our blood, some of us are disqualified from giving the gift of life.
I recently donated blood for the 11th time. As always, I felt good about it. I was giving of myself, quite literally, to those in need. Yet every visit to the Canadian Blood Services also leaves me feeling uncomfortable, as if, with the gift of life, I am also complicit with systemic discrimination based on sexual orientation. I feel increasingly uncomfortable with the blood donor screening process, particularly with the bottom half of the second page of the donor questionnaire.
After taking my information, then drawing a little blood from my finger to check the iron content of my blood, I was given the donor questionnaire, the top half of which I was free to fill out on my own. Thereafter, I was called into a small room, which, incidentally, feels like an interrogation room, to have my blood pressure, heart rate, and temperature checked, and also to be asked the series of 'personal' questions on the bottom half of the questionnaire.
Some of the questions are about HIV/AIDS and STIs/STDs, drug use (both medical and narcotic), surgery, and risky sexual practices. I don't have an issue with these. The two questions that concern me, and that concern many people around the world, as you'll see from a small sampling of reactions which I have linked to below, have to do with sexual orientation. Of course, they are careful not to use those words — that would sound like discrimination. It's claimed the questions have nothing to do with sexual orientation. But the message is clear: gay and bisexual men are barred for life from donating blood, and women who have had sex with gay or bisexual men are ineligible for 12 months following that sexual act. Potential male donors are asked whether they have "ever had sex with a man, even one time, since 1977," while female donors are asked whether they have "had sex with a man who had sex, even one time since 1977, with another man" in the past 12 months.
The questions do not inquire into the type of sex men who had sex with other men had, nor whether they practiced safe sex, nor whether the sex occurred within a monogamous relationship. At the same time, no effort is made to determine whether heterosexual donors have had multiple partners. The assumption is that HIV/AIDS is primarily a gay male problem and is based on prevailing stereotypes and fears surrounding gays and bisexuals that remain largely unchallenged by our society.
According to the Canadian Blood Services website, men who have had sex with men, even once since 1977, are subject to an 'indefinite deferral' (a euphemism for ineligibility, rejection, exclusion). They include men who have had sex with men under HIV high risk activities, between "people who have taken money or drugs for sex, since 1977" and "intravenous use of illegal street drugs/narcotics." Surely not all sexual acts between men are as high risk as these. It's insulting to gay men who live safely and responsibly.
In their media Q&A section, under 'hot topics', the CBS states that the basic premise behind their indefinite deferral of men who have had sex with men even once since 1977 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." They further state, and I was given the same explanation by the last person who screened me, that despite the fact that they test all their units of blood using sophisticated technology, "there still exists a brief period after the onset of a viral infection during which early signs of a virus cannot be detected," a period called the 'window period'.
The FDA in the U.S. has a similar statement, though much more detailed. They also cite increased risk and the 'window period'. And, they claim, "[n]o alternate set of donor eligibility criteria (even including practice of safe sex or a low number of lifetime partners) has yet been found to reliably identify MSM who are not at increased risk for HIV or certain other transfusion transmissible infections." The FDA bolsters its own position by stating that many European countries, despite having reexamined their deferral policy, have retained it, and that the "decision is also consistent with the prevailing interpretation of the European Union Directive 2004/33/EC article 2.1 on donor deferrals."
Still, if every pint of blood donated is tested, why the difference in treatment? If the issue is that tests cannot always detect the presence of the virus, is not then everyone's blood suspect? There are many, many heterosexuals infected with the virus. Heterosexuals are not immune. And what if gay men, bisexuals, or women who have had sex with gay or bisexual men, are simply lying to the interrogator? I had no polygraph device attached to my finger. And what if the women honestly did not know that their male partner(s) had also had sex with men?
Even if it could be proven that gay men present a much greater risk, why not work harder to find better, more effective ways of testing the blood? To me the indefinite deferral policy smacks of homophobia, and the claim that the deferral policy has nothing to do with sexual orientation is simply ridiculous. Some countries have re-evaluated and modified their screening procedures to eliminate discrimination based on sexual orientation. And there is much movement underway in many parts of the world, including Canada, and particularly from university campuses, to change these discriminatory practices.