Canada’s forthcoming “drop your pants” trans* blood donation policy

In addition to reducing the required wait time between having sex and donating blood to one year for gay men, Canadian Blood Services is poised to release its first-ever guidance on how CBS personnel should respond to potential trans* donors: if it’s in you to give, then drop your pants.  While the policy has not yet been released officially, it was leaked to Buzzfeed, and is being corroborated by the health organization’s representatives on Twitter.

Oh, you don’t have to literally drop your pants. Canadian Blood Services doesn’t actually want to see your junk — they just want to know what’s there. Because that’s not invasive at all.

That is, I assume that no one is checking your junk. But it depends on whether voluntary information is sought by CBS, or some other proof. Identification doesn’t help verify genital status, because most provinces allow ID changes prior to surgery.  Requiring surgery proved to be discriminatory, prohibitive and created significant hardships for lengthy stretches of trans* peoples’ lives, if not indefinitely. [There is an interesting historical fact about that: surgery-based ID policies followed a precedent set by Sweden, where lawmakers in the early 1970s deliberately chose that benchmark, because it would ensure that sterilization occurred.]

The reasoning to the new CBS policy is that if your partner is male and you’re a pre- or non-operative trans* woman, post-operative trans* man, or a not-medically-inclined-at-all gender diverse person who has a penis, then CBS considers you to be a man who has sex with men (MSM). Besides seeming very reminiscent of ultra-conservative judgments about what constitutes a “real” woman or man, it also makes presumptions about one’s partners — i.e. insisting that a straight male who dates a trans* women is actually gay — and other judgments that are potentially shaming in nature.

It does raise some questions, though. For example, why would it take a year following genital surgery to become safe enough for trans* women with male partners to donate blood (by contrast, genital surgery would be immediately disqualifying for trans* men with male partners)? And if a potential trans* donor has slept with trans* partners, does the surgical status of everyone need to be disclosed?

The change follows a similar policy enacted for gay men in the U.S. last year, although that policy honoured trans* peoples’ own self-identification and considered their self-disclosed sexual history, rather than demanding intimate medical information.

Incredibly enough, this is actually an improvement over the previous situation with Canadian Blood Services, in which the ability to donate blood was mostly dependent on the subjective decision of clinic staff, and often saw trans* people of either and / or neither gender automatically classified as “MSM” — and sometimes, the sex of their partner(s) or whether they’d been sexually active at all were considered altogether irrelevant details.

Probably nothing better illustrates just how arbitrary and regressive abstinence-before-donating policies and adherence to narrow-sighted MSM classification are.  The change is also very poorly-timed, following the shocking massacre at Pulse Nightclub in Orlando, Florida, which saw the community hardest hit by the violence — predominantly Latinx LGBT people — unable to donate blood to help their loved ones and siblings-in-spirit (despite some misinformation circulating at the time).

Now, to be entirely fair to the Canadian health agency, this mode of thought didn’t originate with Canadian Blood Services.

For example, “Men who have Sex with Men (MSM)” terminology originated with the Centers for Disease Control (CDC) and other early public health organizations. It was ironically intended to be more inclusive than only focusing on gay men, but had the (theoretically unintended) result of invalidating trans* peoples’ gender identification. For the longest time, though, international health NGOs resisted acknowledging the existence of trans* people, and stubbornly insisted the classification was adequate… which only reinforced the impression that the invalidation was deliberate.

In fact, “MSM” language, thinking and subsequent HIV activism and education (aside from whatever mitigation occurred at the grassroots level) has a history of alienating trans* people, and confounding safe sex initiatives, outreach and data-gathering among trans* populations — a tragic situation for a community in which infection rates remain significantly high.  Even LGB(t) organizations perpetuated the problem, although this gradually improved around the start of this decade. [I first wrote about this (albeit with imperfect terminology, too) back in 2010, after being excoriated by an LGB(t) organization representative collecting data, who launched into a tirade saying that by declining to push a horribly-phrased survey on trans* people, I’d be “‘guilty of the murder of’ every transsexual woman who perished from HIV who might have benefited from the study.”  Yes, things have not always been amiable.]

Canadian Blood Services came into being specifically because of the scandal raised in the 1980s and 1990s resulting from screening failures of NGOs like the Red Cross during the AIDS crisis.  Its policies are directed by Health Canada.

Being fair to CBS also requires one to acknowledge a few further facts:

  1. There is a short window of time (roughly a couple of weeks in most cases, but sometimes up to a few months) in which HIV still evades detection, and
  2. Penile-anal intercourse (PAI) remains a high-risk mode of transmission.

Of these, penile-anal intercourse — the premise on which the “MSM” policy is premised — notably also occurs with some frequency among heterosexual partners, while not all gay men engage in it.  On the other hand, targeting specific communities instead of activities has created an inherent bias, and allows homophobic and transphobic organizations and figureheads to perpetuate stigma.

The number of sexual partners one has had in the previous year is also a crucial factor, which “MSM” screening on its own fails to account for.

Before forming government, the Liberal Party had petitioned to end the blood donor deferral policy altogether. When the one-year deferral policy for men was released, Health Minister Jane Philpott was quoted as saying:

“The desire is to be able to have those deferrals based on behaviour as opposed to sexual orientation.” 

This statement, of course, is the right direction.

The new practice, on the other hand, is destined to be an embarrassing anachronism.

As incremental as it may be, the policy that has been issued for (non-trans*) gay men fails, exactly because it continues to fixate on who is donating, rather than what their specific sexual history and risk factors are.  And when the attempt is made to extend that same policy to trans* people, its shaky logic disintegrates altogether.

(Crossposted to rabble.ca)

  1. i am o positive but won’t be going to give blood.anytime soon. i am waiting for surgery i am a woman !

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