Too much information?

Last winter a friend of mine died of leukemia. Just before she died I signed up for the Unrelated Bone Marrow Donor Registry, a database of potential donors made available to medical institutions around the world for patients in need of a transplant. I knew that my chances of being her match were next to impossible, but it was one of the only things I could do. It was a way to feel less helpless as she slipped away. She was 26.

This month I got a call from the registry. I had been identified as a potential match for a stranger somewhere in the world and was I willing to take the next steps toward donation — an in-depth interview concerning my medical history and a confirmatory blood test?

I was dreading the interview and when the nurse asked the inevitable questions I realized I was holding my breath. Had I ever accepted money or drugs for sex? In the past 12 months had I had sex with a man who’s had sex with a man since 1977?

I answered truthfully, suspecting that either answer would instantly disqualify me. The nurse conducting the interview was similarly concerned. She didn’t book me for the confirmatory typing. She told me (as if I didn’t already know) that I wasn’t eligible to donate blood under the current Canadian Blood Services (CBS) policies. She thanked me for my honesty.

The CBS policy, which excludes sex workers and men who have had sex with men since 1977 from donating blood, is all about sexually transmitted diseases like HIV and hepatitis. The argument goes that although all donations are tested before they enter the blood supply none of the tests are without a margin of error, therefore it’s desirable that the pool of donors be as risk-free as possible. The CBS has long defended the policy as nondiscriminatory because it doesn’t restrict gay men from donating per se, just gay men who’ve engaged in the supposedly risky behaviour of having sex with another man. Since 1977.

In place since 1983, when the blood supply was still controlled by the Canadian Red Cross Society, the policy restricting men who’ve had sex with men from donating blood is now under review. Improved detection methods for HIV and hepatitis, notably nucleic acid amplification testing, have narrowed the margins of error, but it’s unclear if it’ll be enough to shift the policy, especially with organizations like the Canadian Hemophilia Society arguing in favour of the status quo.

What frustrates me about these policies is that they acknowledge that it’s behaviours that increase risk, not orientation, but they don’t take the next step. They don’t ask the important questions about behaviour: What kinds of sex have you had? How frequently and with how many partners? What do you know about your partners’ sexual histories? What protection do you use, if any?

Maybe the answers to these questions are just too much information. Maybe it’s easier to rely on assumptions. But it doesn’t make sense that a gay man who has only ever engaged in oral sex and used condoms every time would be considered a higher risk than a straight man who has had unprotected vaginal sex in a series of one-night stands over a period of years. Call me crazy.

As for sex work, the same logic applies. Hundreds of handjobs aren’t the same as a handful of unprotected fucks, though in all fairness I have yet to meet a single sex worker who barebacks on the job. There’s nothing like turning sex into an occupation to counteract all the reasons people give themselves to justify risky behaviour (just think, “we’re really in love so it’s okay to skip the condom,” etc). Hell, it may be that Canadian sex workers are, on average, having safer sex than the general population.

Of course, since sex work is criminalized in Canada (not by the letter of the law, mind you, but by a number of corollaries that make the practice of sex work illegal, like the law against communicating for the purposes of prostitution), it’s difficult to know anything for sure about the comparable risks of sex workers.

As it happens, the Unrelated Bone Marrow Donor Registry is a little more sophisticated than the blood donation system. During my interview, the nurse did ask for all the relevant details and I was eventually judged to be an acceptable risk to go ahead to the confirmatory typing stage. As anyone facing a terminal illness will tell you, it’s better to have risky options than no options.