Free Blood

First off. I knew it wasn’t going to be straight forward. I don’t expect as much in health care, let alone on this, the ever exclusive club that is the blood donation process here in Canada. My last attempted donation 16 years previous had resulted in being sent away with a juice box, a cookie and a couple shopping bags worth of judgment- (I think it was based on being queer, or having had a boyfriend who had once before had boyfriends, but I don’t remember). And I wouldn’t say that it necessarily comes from the staff interactions, as I have found compassion, understanding, gratitude, apologies, and encouragement to watch for policy changes and try again from nurses on the front line. But, you know, nurses on the front line are rarely the problem, they are just left to work in the problems created by systems and their policies. 

Ideally these policies would be alive, informed by robust science, and clear enough in structure to provide ample safety and compassion for all involved in the process. In this experience, I tried to be as patient and regulated about the whole thing as I could be, utilizing my skills – developed for years as both a chronic health patient and a harm reduction educator – to inquire as to what these policies look like in action. But most of all, I just wanted to try to give blood. 

I was raised by 2nd generation proud blood donors, and while I haven’t needed a transfusion, I know that it doesn’t take long to track out through my networks to find someone who is here today thanks to blood products. I’ve watched the ads my whole life and I know that “It’s in me to give.” I have been following the gay blood ban loosening over the years, but never until it overlapped with Covid, did I expect that I would come in clear of not having had sexual contact with any queer men for 3 months. Especially since according to their criteria also includes trans women who haven’t had genital surgery (more about that later). But, low and behold, the Delta variant showed up at the same time as a cold from daycare and the “2 weeks post vaccine” date I had (at one time) marked (mentally and on my cruising app profiles) as a countdown to my expected return to hookup culture. I know some folks have kept going, or have found modifications, or ways to work around that- but I haven’t really put the work in to track down any glory holes, and keep it pretty safe with vulnerable people in my network so… I thought I had met their criteria. It had been well over 3 months, hell over 6 months, a year even, since I had had “gay” sex without a camera and screen between, gotten a tattoo, gotten pierced or left the country for any amount of time. I told the nurse, “I don’t typically lead a lifestyle that is really in line with your restrictions, but since Covid, my lifestyle is different. Well, I thought this might be the one time I could.”

The first person who signs you in at the door takes your name and asks if you have given before. I had. In 2005. Under a different name and gender presentation. I had discussed this on the phone with a nurse prior to coming in, and understood that she had already set the name to update. But, I guess they (the phone nurses) couldn’t really do that fully for some reason. And neither could the front desk. So I was asked my birth name. I responded, “I don’t wish to say it”, looking around the room so as to indicate that this is a pretty public space for me to be announcing “WHEN I WAS A LITTLE GIRL THEY CALLED ME _____”. I could have just left then, perhaps some part of me did. But I am stubborn and was really wanting to ride it out as far as I could. I scribbled my birth name onto a paper and handed it to the attendant. She found me, adjusted the name that would appear on the overhead screens, and then handed me a printed out temporary donor card barcode, with which to set the primary screening questionnaire computer on to my account. She told me that she couldn’t do a full name change and that the nurse in a screening room would be responsible for that. The woman handed me a stylus and this paper, while explaining I should use the stylus and then leave it in a jar to be sanitized. I “uh-huhed” and looked at the first on screen question. I didn’t realize until half way thru, that I was holding the stylus in one hand, touching the screen with the other one, half absent from the bizarre weirdness that was both writing out that name, and seeing it.

“Confirm that you are _____birth name_____”

I said yes. 

That’s weird. I legally changed my name in 2007, but the screening protocols are such that I am asked to confirm that I am someone, who by all legal terms, doesn’t exist- so as to access the next room where someone can adjust the name. I went through a lot of name change controversies over the years, BC Ambulance billing me as out of province, retail systems like Safeway and MEC taking years to catch up, but eventually they all had. The only other place I ever saw that name was on the duplicate voter cards that I get sent during every election, again another story for another day. It’s been 15 years since I have legally had this name, about 17 years since I have been using it full time. But here I was, interfacing with a rigid system that knew me last at least 16 years ago and wanted to pick up from there. 

The questionnaire continues. All sorts of questions, were you here at this time, did you ever spend this amount of time in this place, have you gotten tattooed, pierced, received blood products etc. 

I understood, from the conversation I had on the phone with a nurse before I booked the appointment, that I would be screened as a woman. Because I haven’t had “genital surgery”, my sexual risk criteria is screened on the F side of their flow chart. I have so many questions about this, some of which I brought up with the 2 nurses I saw in my appointment. 

I was asked “Have you in the past 3 months had sex with a man, who has had sex with another man in the previous 12 months.” 

So in this one covid special circumstance where my singular cisfemme partner and I have been functionally monogamous, with my transfemme partner far away and only boning over video, and my cruising cancelled until further notice- I could answer no! It’s felt like a long ass time since my last visits to Steamworks in Vancouver in January and early March of 2020. Over the past year and a half + those nights live on as memorable personal legends. I felt I had just started to get into feeling into my confidence and able to chase my pleasure in such spaces. I had looked forward to returning after having had top surgery. But no. 

So if I can’t be slutty I should be able to give blood right? Maybe… more screening. 

Of course within a rigidly binary system, there is always a question of what counts as “MEN”. The blood service’s genital surgery requirement, is beyond the federal requirements to change a passport, or the provincial requirements to change a birth certificate or drivers licence. I told them I was planning to be having genital surgery later this year, and I wanted to know, what is included in “Gender conforming genital surgery”? Do they count phalloplasty? Only? What about meta, release or partial clitoral reconstructions? What if you retain a vaginal opening? What if the end outcome is not a binary conforming set of genitals? Then what? What is the requirement based on? Is there science that shows disease transmission risks stratified across different genital surgeries? Of course not, such science doesn’t exist and folks who are having genital surgery don’t need another thing to be put under a microscope over. If ‘women’ are categorized differently because it’s about the risks involved with having a vagina, a penetrable orifice, that can hold sexual fluids amongst mucousal tissue- then trans men who have vaginas would be assessed by that metric. At which point, your categories are not Men and Women, but genitals. What someone has, or doesn’t, also cannot be neatly sorted into binary categories- and the deeper we get into asking these qualifying and classifying questions- We have to ask WHY? It is not based in science, it is based in homophobia. It is about excluding men who fuck men. Which really could more accurately lead to including trans guys who present and fuck as men, regardless of genitals, as men- if it is about population, proximity, or dating pool prevalence. Stigma remains from the era of the AIDS crisis. It should be noted, that gay men (or MSM, GBT guys, however you wanna say it) have been historically, but are not currently a key population where HIV is spreading. It has been traditionally more prevalent, but has also become more culturally integrated in how we go about things. Everyone has their own protocols, whether that include PREP, regular screening, condoms, or closed arrangements- but talking about HIV is culturally much more normalized than I think it is amongst het folks. That being said, I know that there is still a lot of mistreatment of our poz community members, which is fucked up. But as a community, or network of communities, we have been living in this pandemic for longer than I have been alive. 

I worked in harm reduction for years, I have known lots of people who have or had HepC, HIV, and sat in meetings of interdisciplinary Blood Borne Illness service providers. I know more than most about these viruses, how they spread, how they are screened and what they look like in the body, with and without treatments. So I honestly want to know, what increased risk do I have as a “man” with a surgically constructed or supported phallus or microphallus than today with years of hormones, top surgery, and social transition? I don’t believe that there could be any science behind that, but their policy states that genital surgery should be followed by a 3 month deferral after which time the donor is screened as the “confirmed” gender. So as of January 2022(I mean maybe… surgeries aren’t really getting booked these days), if I wanted to try and donate, I would instead be asked, “Have you had sex with any men in the last 3 months?” Remembering of course that any non-binary, trans femme partners who have a phallus from birth would be counted in that (which, I will say right off- No thanks- I don’t want to do that to my partners even if it is just a thought exercise). In further reading I am understanding that trans fem folks who have had genital surgery cannot donate at all ever either. Which there surely is another whole separate rant about the problematism in that, but I will pin it for now.

I was expecting all that to some degree. Luckily, the senior nurse came in to help,  as I think my questioning was really tripping up the newly trained nurse I was patiently confusing. She was kind, but also was flipping through this big binder that holds all of the sub-criteria. 

Like a 5 inch thick manual 

IF THIS→ THEN → _______

IF THIS → THEN → ________

Checking medications, medical conditions. So what was that exactly? And was that resolved? Asymptomatic as of when? And so on and so on. 

They ask you to be as honest and thorough as you can be. So we talk through all the various things. 

And then they get to this question. Which I learn, probably should have alerted the system that it had a “you shall not pass” flag attached to it, but somehow hadn’t. So I had spent about an hour going through my medical history first. 

“Since 1977 have you ever received drugs or money in exchange for sex?”

I had answered “I don’t know.”

I have been sex work adjacent for many years. I have made content for the internet, been a driver and security for full service workers, and had taken a brief and snowed out foray into full service hotel work that ended up being a whole line up of no-shows. I am now training in Somatic Sex Education, which comes from a lineage of sex work and sacred sexuality work, and has roots in embodied and harm reduced erotic expression tools. Joseph Kramer, considered a founder of Somatic Sex Bodywork, was initially motivated to develop tools to help nurture sexuality while the AIDS crisis cut so many off from that part of ourselves. 

At other times in my life, since 1977( I was born in 85 so…), I can also honestly ask- were those drugs shared with me because there was sex involved? When a sexual partner helped pay my rent cause I was short, and we joked about “Paying back with blowies”, which likely would have happened if the money hadn’t been exchanged, but would the money have been exchanged if the sex wasn’t? Did that person buy me a drink because they wanted in my pants? Did I stay here for free and now you’ve given me some cab fare just because we fucked? I don’t feel like I would be alone in having these questions. I said, “I don’t know that my experience of transactional sex is really much more than the average hetero woman. I just have a different perspective I think.” My neurodivergent tendencies want to have implicit statements made explicit, and to have murky things clearer than the allistic standard dictates, in this situation, that inclination delivered me to a road block.

The nurse explained, that if someone answered “I don’t know”, that meant that the nurse would be prompted to have a conversation with the donor- but that there is no way to change a Don’t Know, to a no, even if you got into the semantics of it and found 

an image of a hand, holding a pencil over a multiple choice answer sheet.

Cash exchanged? no

With specific parameters pertaining to sexual exchange? no

P-in-V? no

Oral? no

The screening questionnaire can’t change an “I don’t know” to a “yes” or a “no”. The nurse can’t change it. By stating that there is any ambiguity, whether it be that you don’t want to speak to the intentions of someone who was a generous date many years ago, or that you weren’t sure what the blood service counted as sex. Or, perhaps, you believe in a feminism that sees domestic and emotional labour as valuable labour, devalued by the patriarchy. And that as such, so is sexual labour- and that far too often the exchange of sex leaves women and femmes short changed. I was raised in a religious context where a part of “wifely duties” would naturally include the sexual labour as dictated by the husband and culture- this of course is my looking back reframe- but I can’t unsee a justice lens on labour and exchange in the home. 

The policies aren’t based in science. They are based in the patriarchal moral code. They conveniently ignore that all blood is screened for BBI pathogens, quarentined and screened again. The rationale given to back the policies over reach is always the “1988 controversy” in which the Red Cross gave blood tainted with Hep C to people across Canada (because at the time they didn’t know much about it, how it was transmitted or screened.). Because it was a virus that is more concentrated amongst IV users and sex workers, it wasn’t getting any attention. Until it was “innocent” transfusion patients, nobody was paying attention to Hep C. I wasn’t in the field back then, but I have seen the ways that the medical system (as a system – #notallnurses)  continues to treat folks with addiction, complex mental health issues and poverty as garbage.

As I was given my “lifetime deferral”, a recognition was made that “sometimes these rules change, keep an eye on them in the future, maybe you will become eligible again”. Which after getting a “lifetime deferral” feels like an acknowledgement that the “rules” are unjust or arbitrary and likely to someday change. I was offered a juice box and snack even though I left with all the blood I had come in with, but it felt like the best I could get to make up for what I had just endured. I saw all the people sitting hooked up to the bags eye me in my “GAY 4 DATA” shirt, being wished well on my way before ever getting up to the draining floor. I am sure that there were judgments cast, I could feel them. But similarly, I wondered if the people being drained had ever felt empowered agency over their sexuality. 

And as I walked out, I saw the sign out front. As I have seen for 15 years- encouraging donation, I wondered if the blood service spent a small amount of the resources they spend on marketing, instead on developing science backed policy, they would probably be able to address shortages better. I wonder how many people get selected out based purely on these stigma driven policies, and how many people don’t want to bother being subjected to that level of scrutiny. I imagine the ongoing and ever-coming climate apocalypse. Or a zombie plague. Or god-forbid, another pandemic, maybe a microbe melting out of a glacier. Treating it requires massive amounts of blood products, and the nature of the crisis forces CBS to move into a new policy, and fast. Would they be able to? Where would they turn?

After leaving I went shopping, made food, spread post-its of how this relates to 100 other ideas brewing in my head across the floor, went to school, made crafts and otherwise leaned into the scroll holes. One of the algorithms prompted me with an invitation to complete the Sex Now Survey. I have been participating in this survey for many years, and was pleasantly soothed by the opposite experience of stigma and judgment. Community based research writes a very different sort of questionnaire that the Blood Service could learn from. Throughout the whole survey, my identity was affirmed and validated. My practices were investigated without being pathologized. My relationships were validated and my risks calculated. When it all comes out, they will be who gets’ my blood. The survey came with 3 at home HIV tests, and the irony of the whole thing.

Thank you for reading my observations and musings about this world of ours and all it’s cracks, failings and potentials. If you want to support my work and ensure you get advance notice about upcoming talks, workshops and events as well as accessing patron exclusive content, please consider becoming a patron:

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