As part of an ongoing series investigating the research CBS claims to have in support of their new policy, you can follow the progress of my communications with related parties here (list updates with every new related post):
- One Step Forward, Two Steps Back
- That’s Not The Question I Asked
- You’re Like, Halfway There
Canadian Blood Services has now posted an information page specific to trans folk, which is an improvement over inserting us as a foot note under the “men who have sex with men” policy. You can check it out here. There’s a few pieces I will draw your attention to.
The first:
We are also working on updating our computer system so that donated blood components can be processed to reduce the risk of transfusion-related acute lung injury (TRALI) without donors having to be identified as female.
Credit where credit is due, I suppose. As aggravating as CBS’ announcement has been, it’s still progress to acknowledge that trans men generally don’t want to be called women. TRALI is an elevated risk in blood from people who have at some point been pregnant. Under a cissexist system, this means any women who have been pregnant have their blood flagged for additional screening–this policy appears to redress the fact that trans men can also have pregnancy somewhere in their history, which still justifies flagging their donations as a TRALI risk, but without forcing trans men to suffer the indignity of misgendering in order to donate. As I observed previously, the correct risk factor is “has been pregnant,” not “was assigned female at birth.”
Things still crash and burn elsewhere, even if this policy is a good start.
The second:
Canadian Blood Services is dedicated to providing the safest possible blood to transfusion recipients. Donor criteria that affect recipient safety should be based on available scientific evidence. And, these criteria must be approved by Health Canada, our regulator.
I’ll also draw your attention to the word “available.”
There is little information available on the safety of subgroups of trans* individuals and blood donation.
That’s practically an admission they drafted policy this policy without accurate data.
There is very little information available on the risk of HIV in trans* individuals in Canada, as they are not included in a separate risk category by the Public Health Agency of Canada in their annual reports of HIV and AIDS in Canada.
However, in a review of available studies,
The same ones that lump sex workers and needle-sharers in the same risk category as monogamous MSMs?
As with all of our donors, eligibility is not based on an individual risk assessment, but rather on assigning donors to a risk category.
Except that the studies CBS cites state the “risk category” is not gender variance per se, but socioeconomic discrimination.
New blood donation eligibility criteria
Donors who have not had lower gender affirming surgery:
Donors will be asked the relevant questions for their sex attributed at birth and will be accepted or deferred based on these criteria. For example, trans* females will be asked whether they had sex with a male, and if the response is yes, they would be deferred for one year after their last sexual contact.
Donors who have had lower gender affirming surgery:
Given the complexity of screening donors according to both their sex attributed at birth and their affirmed gender, donors are instead deferred from donating blood for one year after their surgery. As the longest deferral period for sexual partner risk is one year, donors will be screened in their affirmed gender one year after their surgery. For donors with female sex attributed at birth, a code will be added to the donor’s file to decrease the risk of TRALI.
“Donors will be asked the relevant questions for their sex attributed at birth and will be accepted or deferred based on these criteria.”
“As the longest deferral period for sexual partner risk is one year, donors will be screened in their affirmed gender one year after their surgery.”
Still waiting for that evidence that bottom surgery has anything at all to do with HIV infection. On the contrary, one’s socioeconomic does not improve simply because one has bottom surgery.
The third:
What evidence are the criteria based on?
Unfortunately, there have been few studies on the trans* population in Canada. The CDC’s “HIV Among Transgender People” (April 2016), which summarizes information from the U.S. and European countries, states that studies reveal HIV prevalence rates of 22 per cent to 28 per cent among trans* women in the U.S. and other high-income countries. The fact sheet, “What are transgender men’s HIV prevention needs?”, prepared by experts from the Ontario Gay Men’s Sexual Health Alliance, and “What are transgender women’s HIV prevention needs?”, prepared by experts from the University of Minnesota, provide recent, clear summaries of what is known about HIV risk in these population groups.
“What is known about HIV risk in trans women,” according to the fact sheet THEY PROVIDED:
It is important to note that not all transgender women are at risk for HIV. Like many populations, those at greatest risk are more likely to be poor, homeless, young, people of color and sex workers. There are many transgender women who do not face the same degrees of risk.
“The risk profile is not the same across the entire gender demographic,” says the University of California San Francisco. CBS defers all pre- or non-operative trans women who have had sex with men, even if it’s monogamous and protected. Oh, and while we’re talking risk profiles, remember that these only exist in the first place because of discrimination.
And the CDC, also provided above?
Transgender-specific data are limited. Currently, many federal, state, and local agencies inaccurately collect data about individuals’ sex and gender. Using the two-step data collection method of asking for sex assigned at birth and current gender identity can help to increase the likelihood that transgender people will be accurately identified in HIV surveillance programs.
Translation: “We had to guess because our sources don’t consistently identify trans women as their own epidemiological category.”
This is your idea of a compelling data?
What’s next?
CBS has been responding to my emails, so I’m currently being referred to specific folks and areas other than the probably underpaid email clerk. I will collaborate with CBS on how much I can disclose. Certainly we ought to be concerned with some of the glaring inconsistencies between their policy as stated and the citations they say support their policy.
I haven’t yet contacted the LGBTQ lobbyists–CBS, to their credit, appears to be sincere so far in putting me in touch with their policymakers, so I might be able to make my case for a distinct epidemiological category for trans women myself.
-Shiv
That might be a little more believable if they bothered to ask women whether they’d ever been pregnant. Just like the talk about high-risk sex would be a little more believable if they also asked how many sexual partners straight people had.
Although the questionnaire at present assumes you’re female in order to answer the question, it does in fact ask about pregnancy: https://www.blood.ca/en/blood/record-donation
Valid point on the straight people’s risky behaviour, though. No questions there on how many people you’ve boinked or whether you used protection–just if it was with a MSM.
Jesus. I really admire your persistence, here’s hoping all your work manages to make it past a few thick, policy-making skulls.
That’s odd, they never asked me if I’d ever been pregnant. It’s been a few years since I’ve been able to donate, so that question must have been added. To be honest, they spent more time examining my arms for needle tracks than asking about my sexual history.
I hope you’re successful in convincing them that individual risk patterns do not equal population risk patterns, especially in a diverse population of trans people.