Comment: Sex, blood and the status quo
While Northern Ireland continues to drag its feet on lifting the lifetime ban on blood donations from gay and bisexual men, recent developments in Great Britain are no great victory. Since early November, queer men in England, Scotland and Wales are permitted to give blood so long as they have refrained from homosexual activity for a year. But although the exclusion of sexually active queer men has been tackled by a multitude of commentators, they are not the only people barred from blood donation because of who they sleep with.
Despite the recent change in regulations, it remains the case that a woman who has had sex with a man who has ever had sex with a man must wait one year before she can donate. This means, in practice, that while John may be eligible to give blood once a year has passed since his last sexual contact with a man, his girlfriend Sally is excluded until a year after the end of their own sexual relationship. Assuming, if we will, that they are monogamous and that their relationship lasts for years, the ban on her participation grows ever more ridiculous with the passing of time. John’s blood donation is not problematised, but Sally’s donation, purely because of her association with John, is.
According to the FAQ – which is buried fairly deeply in the Blood Service website – Sally may be able to get around this if she and John attend for blood donation as a couple and his blood is satisfactorily screened. No other potential donors appear to face such a round, and John would bypass it altogether if he were single or if his girlfriend did not intend to donate. The FAQ elaborates that when John and Sally attend to discuss the situation, the Blood Service will need “to establish that no further higher-risk sexual activity (such as anal or oral sex between men) has taken place”, which suggests the couple may have a needlessly repetitive discussion to look forward to, given that John’s abstention from sex with men is the reason why they are there in the first place. However, they’re unlikely to get this far anyway, since the default checklist maintains a blanket ban on women in Sally’s position, rather than inviting them in to discuss the issue further.
One curious aspect of these guidelines is that sex is only defined when it takes place between men. The Blood Service is so concerned about queer men’s sex lives that they’ve left no room for doubt that any man who has had oral or anal sex with another man, with or without a condom, may not give blood until sufficient time has elapsed. There is no distinction between sexual activities for the rest of us, let alone any hint that perhaps condoms might magically dissolve when you’re with the wrong partner. For queer men, the definition of sex needs to be spelled out; for anyone else, it’s assumed that we all have the same interpretation. Since I’ve frequently heard heterosexual people making a distinction between “sex” and “oral sex”, this appears not to be the case. Does this mean, then, that depending on their specific sexual activities or on the presence or absence of condoms, some women who have sex with queer men could perhaps still be eligible to give blood? (When I called the Blood Service a few years ago to ask, the person I spoke to sounded rather flustered, said he’d get back to me, and never did.)
One reason given for discriminating between queer and straight donors is that “the introduction of extensive donor questions regarding sexual behaviour could lead to a loss of existing donors who may find the process intrusive.” Translation: the risk of offending straight people outweighs the benefits of levelling the playing field and asking questions that better assess individual risk. (Despite this sentiment, the Blood Service has demonstrated some willingness to both consider individual risk and to ask questions that may be interpreted as intrusive, if we refer back to John and Sally.) Although statistically more potential blood donors may be heterosexual, this strategy points to a culture in which heterosexuality remains normalised and its practitioners privileged. The risk of offending them is seen as greater than the risk of receiving contaminated blood, while the inverse applies to queer men.
Another group which remains barred from donating blood – but with little to no public outcry – is sex workers. While their partners and clients may resume giving blood a year after sleeping with them, anyone who has ever “worked as a prostitute” is asked to refrain from donating.
Those who have no links to the sex worker population – or at least think they don’t – are liable to shrug at this exclusion, but again it’s a case of tarring an entire population with one brush, and here it’s not just to do with assumptions about condom use or condom failure. In discussing the ban on sex workers, the well-hidden FAQ rushes to reiterate that “permanent exclusion remains in place for any individual with a history of intravenous drug use”. It goes on to state that “[c]hanging the criterion for sex workers could potentially cause confusion and possibly lead to individuals who do not meet with selection criteria because of previous drug use donating in error”. The assumption here would seem to be that sex workers have less capacity than the general public to read a form and tick the appropriate boxes. And given that injecting drug use is common only among street-based sex workers, a distinct minority within the overall sex industry, this conflation of all sex work with drug addiction appears to rely on stereotypes and is liable to cause offence to many.
Ultimately, the blanket exclusion of these groups comes down to a kind of shorthand, no doubt convenient for policy-makers dealing with large numbers of people. However, there is also no doubt that perfectly healthy blood fails to make its way to the Blood Service because the drafting of these guidelines has devoted no space to individual nuance. Concurrently, heterosexual, non-sex working blood donors are welcome to continue with far more risky sexual practices, for fear of upsetting them by asking “intrusive” questions. This strategy promotes erroneous assumptions about certain sexual practices and identities, persists in Othering queer men and sex workers, and reinforces the heteronormative status quo. In this day and age, it’s hard to imagine widespread outrage should the Blood Service ask donors a few simple questions like “Have you had unprotected sex or experienced a condom burst in the past year?”, and perhaps even outline which sexual practices it’s referring to. But as long as everybody involved is heterosexual and there’s no financial transaction taking place, actual assessment of risk takes a back seat.
Nine is a former LGBT editor of The Skinny magazine. She spent several years delivering harm reduction services to sex workers until she was made redundant due to funding cuts, and since mid-2010 she has been travelling on a low budget and one-way tickets.