Hiding Homophobia Behind Healthcare

by Ace Mann (they/them)

Love unites us all and gives us a global cause, but history has not always been kind to the rainbow community, and we’ve often been judged for the way we love. Yet, there’s another topic that unites us all where our community finds itself being judged—this time something no one can deny we all share, no matter our differences: blood.

The rainbow people have long since known of the “homophobic blood ban” that began to ostracize our community under the guise of healthcare. In the 1980s, human immunodeficiency virus (HIV) emerged and spread across the globe, leaving the acquired immunodeficiency syndrome (AIDS) epidemic in its wake. Before standardized blood testing was commonplace, thousands of transfusion recipients were unknowingly infected with a tainted supply of HIV+ blood. This tragedy caused the blood ban of 1992 to be written into Health Canada regulations. These restrictions stated that no person who was a man who had sex with men (MSM) could donate blood if they had engaged in such sexual activity even once since 1977, effectively ruling out all gay donors at the time.

Canadian Blood Services (CBS) is a Canada-wide system that facilitates the collection and distribution of blood, plasma, stem cells, organs, and tissues. They are the most common—but not the only—blood donation bank in the country and are regulated by Health Canada, despite operating separately from the federal government.

In 2013, CBS relaxed their rules to allow the MSM community to donate blood if they had been celibate for five years. In 2016, the abstinence period dropped to one year, and again to three months in 2019. While the CBS website insists they are “working with LGBT groups” to provide long-term, science-based solutions for donation, there is a lot of work left to do before these regulations are not discriminatory.

Trans* Eligibility and Discrimination

While CBS insists that they are hard at work to improve the blood-donating experiences of LGBTQ2S+ people, they seem to be forgetting that MSM is just one small portion of the rainbow. People who consider themselves part of the trans* umbrella face a different form of discrimination: not just who they love, but who they are versus how they were born. We spoke to a local transgender man—let’s call him Nick—about his very recent experience with CBS, and he wanted to spread this message to all trans* siblings: “Know what you’re getting into before you go.” A staunch advocate of mental health, he believes donating blood is important but says the experience is “rife with triggers.”

Our transgender friend made an appointment to donate for the first time in a decade, his first visit since transitioning. When he gave the nurse his ID, his new name wasn’t in the system, and the nurse began to initiate a profile for a “new donor” before remembering to ask if he had donated in the past. He answered honestly and said that his information would have changed since the last time—as had his gender marker. This immediately became an issue, and the nurse refused to give him more information about changing his information in their system until he had answered some general health questions about donating. The nurse handed Nick a sheet of paper with his female-coded deadname emblazoned across the top next to a gender marker reading “F.” Trembling, he answered the standard questionnaire about pregnancies, surgeries, MSM screening, etc. before being taken to a private screening room where the nurse abruptly turned to him and asked him, point-blank, about his genitals.

Thinking—and hoping—the nurse was simply inquiring about gender-affirming surgeries, the dates of which could affect his donation eligibility, he tried to illustrate his history when he was interrupted: “No, your genitals, I said.” All nurses at the CBS are required to screen donors based on their genitals and only their genitals. The nurse went on to claim that this policy was in effect for Nick because of the previously mentioned MSM regulations, demonstrating that CBS staff are not equipped with the basic knowledge of what it means to be a transgender person—never mind treating them with respect. While the website says that questions will be asked based on whether the donor has had lower gender-affirming surgery, what the website doesn’t say is that the information on file will not be changed, and trans donors must deal with it and be given an 8×11 printout of their own worst triggers to carry like a scarlet letter.

“I felt completely invalidated,” Nick says. “The government allows me to change my gender marker because it’s who I am, but then CBS doubles down that it’s my genitals that make me who I am. It was gut wrenching.” When asked if he wishes there was anything he had done differently, Nick replies, “It sounds awful, but I almost wish I had lied… I also don’t think people understand how expensive and time-consuming gender-affirming bottom surgery can be. There are so few places that can do it—and do it well—that it’s almost inaccessible.” For context, in Canada, phalloplasty is generally only attempted at one hospital in Montreal. Even if you have the means to get there and afford it, there are other hidden costs; the hospital in Montreal advises electrolysis prior to the surgery to attain hairless skin to be used for the grafting process. Gender affirmation depends on the body you’re born with and the body that makes you feel authentically you. It is not a one-size-fits-all procedure, and it can be very different for every person, including whether it’s right for them.

BloodWatch.org is a Canadian not-for-profit that advocates for safe and voluntary donations of blood to CBS and CBS only, but they aren’t afraid to push back on CBS policies. Kat Lanteigne, the executive director and co-founder of BloodWatch.org has stated over and again that it is behaviours, not groups, that should be screened. She says, “Whether they are MSM or trans or a single woman or a married person [they should be] asked the same questions and are deferred based on their behaviour.”

The “ABCs of eligibility” page on the CBS website lists a myriad of legitimate issues that may preclude someone from being an eligible blood donor. These include, but are not limited to allergies, birth control, cancer, general health, and other medical issues. Under each section, a brief description of the condition can be found along with what makes or breaks eligibility based on science, healthcare, and potential “risky” behaviours. Only one section takes a step further and includes a community: HIV/AIDS. This category only mentions the MSM community and takes no time to distinguish whether these individuals have one or more partners, have used protection, or have had recent clean sexual health tests.

The Science

HIV is a virus that circulates in the bloodstream and bodily fluids of its host. It is transmitted from one person to another when fluids come in contact with each other. Contamination can happen by contact with contaminated needles, through sexual intercourse, from parent to child during pregnancy, etc. The real risk in getting infected involves what’s called a “mucous membrane,” which is where the body generally acquires the virus and is able to transmit it to the bloodstream. This is why anal sex is considered a high-risk activity by the CBS; however, they seemingly are considering all sex, all men, and all bodies to be the same. If two cis men engage in anal sex, the receptive participant is thirteen times more likely to become infected from a partner than the insertive participant. The main function of the mucous membrane in that part of the body is to absorb liquid in the intestines, making the risk factor higher. This tissue can also be thin and delicate, making small tears a possibility and giving the virus direct access to the bloodstream. The risk factor in anal sex remains higher than vaginal sex exclusively because the receptive tissue performs different biological functions.

But all sex and all bodies are not created equal. Receptive partners are more at risk than insertive partners of anal sex, and both participants can mitigate their risks further by taking precautions before, during, and after intercourse. People who believe they can be at risk for acquiring HIV may be able to take a pre-exposure prophylaxis (PrEP), which can reduce infection risk by 75%. Condom usage can reduce infection risk by up to 99% when used correctly. Regular testing for people engaging with multiple partners can keep participants informed and able to take action as early as possible should infection occur. In addition, highly active antiretroviral therapy (HAART) can be taken to drastically reduce an HIV+ person’s viral load to the point of making them effectively unable to transmit the virus.

With all this said, CBS does test all accepted blood donations. Introduced in 2001, nucleic acid testing (NAT) is a highly sensitive and accurate way to test donations for many viruses at once by scanning for specific portions of the viral genetics. (Interestingly, this is the same test used currently for COVID detection.) While the CBS website states that they can detect HIV in the bloodstream as soon as nine days after infection, many studies state that this is about three times longer than the average.

Blood Testing

We spoke to a communicable disease expert from Manitoba who wishes to remain anonymous for this article. He acknowledges that all blood is tested when collected, regardless of screening questions. “It doesn’t negate the screening but adds an extra layer of protection to the system,” he explains. “The point is that we need donated blood, and effectively turning down donors because CBS refuses to work with and respect them is baffling. Why not describe specific ‘risky’ behaviours instead of lumping a whole community in together? The MSM policy doesn’t even begin to touch on trans men who have sex with cis men, and how they do it. The issue is physical biology, tissues, transmission, etc.—not gender.”

Blood gets two category markers: a letter type (A, B, and O) and Rhesus (Rh) factor (positive or negative). Letter types are based on antibodies, and we inherit one letter type marker from each parent, giving us four possible blood letter types: A, B, AB, and O. Because “O” is actually a zero—meaning no antibodies—it is the most sought after for donations. The Rh factor is based on whether the blood carries a specific protein; you either have it, or you don’t. This protein can harm blood cells that are Rh-, making Rh- donations the most sought after. While other chemicals, like hormones, are involved in blood, their concentration is low enough that sex doesn’t play into who can receive and who can donate.

He points out the CBS page on HIV key facts, saying, “The NAT testing was introduced in 2001, so why did it take so long for the policies to reduce their timelines for [MSM] abstinence? [CBS] boast[s] zero blood-borne infections since 1998. The screening questions are helpful to them, but if they act as a disrespectful deterrent to those who are willing and able to donate this life-saving blood… can they not see their way to finding a less inflammatory way of asking about behaviour while educating the public about why it’s done? Many people are able to deal with consequences if they know why the rules are in place.”

The science says that there are “risky” behaviours that could potentially lead people to have a higher likelihood of disease. But, as scientists are known to say, “correlation does not equal causation.” If we are going to all move forward to prejudice-free healthcare, we need to work together, without judgement. Honesty is imperative—lives are on the line—but respect is the first step to bringing us together for the good of us all.

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