Sex, scandal and scapegoats: Canada’s blood donation policy for sex workers
On May 27, 2022, Canadian Blood Services—the non-profit that manages Canada’s blood supply outside of Quebec—announced that the lifetime ban on blood donation for those who have traded sex for money would be reduced to one year pending approval from Health Canada. Their questionnaire has recently been updated to reflect this decision. They claim current evidence and available testing technology do not support the lifetime ban policy.
This policy review came on the heels of outrage and criticism on Twitter in late 2021 by sex workers who had faced discrimination when trying to donate blood.
Addressing discrimination on the basis of sexual orientation
In April of this year, Health Canada announced that it was ending the policy banning blood donations from men who have sex with men beginning September 30.
Canada’s previous ban on blood donation for men who have sex with men had been criticized for discriminating against gay and bisexual men on the grounds of sexual orientation. The original indefinite deferral policies had been in place since 1992; the deferral period for having sex with another man dropped to one year in 2016. Discrimination on the basis of sexual orientation is illegal for government agencies and departments under Section 15 of Canada’s Charter of Rights and Freedoms. A human rights complaint has been winding its way through the federal court system since 2016, and was sent for a human rights tribunal inquiry in June 2021.
With an inquiry imminent, Health Canada and the federal government have been pushing forward changes in blood donor screening. A move from banning those donors who are men having sex with men (and who are protected from discrimination by Canada’s Charter of Rights and Freedoms) to focusing instead on asking all donors about their sexual activity, i.e., having anal sex with new or multiple partners.
On September 11, Canadian Blood Services (CBS) quietly implemented “sexual-behaviour-based screening.” Now, according to the CBS website, “All donors are asked if they’ve had new and/or multiple sexual partners in the last three months. If you answer ‘yes,’ you will be asked a follow-up question about whether you’ve had anal sex with any partner in the last three months. If you have, you will need to wait three months from the time you had anal sex to donate.”
Screening out sex workers
In addition, there is no longer any mention of trading sex for money anywhere in the eligibility criteria on the CBS website. Except—buried in the CBS donor questionnaire for blood, platelets and plasma used by clinic staff to screen donors—these two questions remain: under “Additional Questions,” Question 10 asks, “In the last 12 months have you had sex with a sex trade worker or anyone else who has taken money or drugs for sex?” and Question 13 asks “In the last 12 months have you taken money or drugs for sex?” Replying yes results in being banned from donating blood until the 12 month deferral period has elapsed.
Sex industry response
On July 27, Triple-X Workers’ Solidarity Association of B.C. published Sex, Scandal and Scapegoats: Canada’s Blood Donation Ban for Selling Sexual Services. In this submission to Health Canada regarding the application by Canadian Blood Services for a one-year donation deferral for people selling sexual services, Triple-X makes four demands:
- That Health Canada and Canadian Blood Services remove all questions regarding sexual services transactions as a basis for eligibility for donating blood. Sexual activity, not commercial activity, contributes to increased risk of sexually transmitted blood-borne infection (STBBI). Questions need to focus on sexual acts only.
- That Health Canada and the Public Health Agency of Canada acknowledge the very low STBBI transmission risks associated with professional sexual services provided in workplace settings.
- That the Public Health Agency of Canada remove “people engaged in the sale or purchase of sex” from the list of “key populations disproportionately affected by STBBI” in The Pan-Canadian Framework for Action: Reducing the Health Impact of Sexually Transmitted and Blood-Borne Infections in Canada by 2030 (p. 4). There is no epidemiological evidence to support such a claim in Canada.
- That Health Canada and the Public Health Agency of Canada endorse and advocate for the decriminalization of the purchase of sexual services. Occupational health and safety, and sex workers’ role in the safer sex education of their clients, are important avenues to promote STBBI prevention.
Evidence-based policies?
Canadian Blood Services claims blood donation deferral policies are based on the level of risk for having an undetected blood-borne infection being high. For bisexual and gay men, there is evidence for this based on national HIV incidence (new cases of infection within a population). In 2020, 46.6 per cent of new HIV infections were among men who have sex with men who were estimated to comprise approximately 4 per cent of the adult male population.
However, there are no national HIV incidence statistics for people selling sexual services in Canada. There is no evidence that selling sexual services presents high risk for sexually transmitted blood borne infections in this country. Furthermore, in the UNAIDS 2022 Global AIDS Update, figures for “new HIV infections by population group” in Central and Western Europe and North America show that only 0.4 per cent of all new infections in these regions were sex workers.
Section 15 of the Charter guarantees that every individual in Canada have equality under the law and freedom from discrimination, including based on race, ethnic origin or nationality, colour, religion, sex, age, or mental or physical disability, and courts have recognized sexual orientation as an additional prohibited ground. The courts have not recognized type of employment as a prohibited ground of discrimination under this section. So, unlike gay and bisexual men, people are not currently protected from discriminatory government policies based on selling sexual services.
Government policies continue to target exchanging sex for goods or money as both a public health threat and a menace to public safety. Canadian criminal laws define commercial sex transactions as inherently exploitative, causing social harm. Our public health policies addressing sexually transmitted infection treatment and prevention define commercial sex transactions as “behaviours” that are inherently high risk for transmitting disease.
These laws and policies about selling sexual services are baseless and prejudicial assumptions. They needlessly create barriers to public health goals for STBBI and HIV prevention, and discourage sex workers from accessing sexual health services.1
Keeping the blood supply safe
Requesting approval from Health Canada to implement a new screening policy based on a donor’s occupation—selling sex—is indefensible. Selling sexual services is not a “behaviour.” It’s a commercial enterprise—a business, a profession, a job—with long-standing workplace practices that keep sex workers and their clients safe.2 Blood donation eligibility policies that require individuals to not be compensated for sexual services are oppressive, because they imply that sex workers must leave the sex industry in order to be socially acceptable.
However, if Canadian Blood Services has evidence that having “new and/or multiple sexual partners” in the three months prior to blood donation increases risk for undetected infection, and it applies to all donors with the result being a three-month deferral, then so be it.
While sex workers may not enjoy specific protection under the Charter, Health Canada and by extension Canadian Blood Services must not base policies on their moral perceptions of sex workers and their clients. Government policies designed to protect the public’s health should be based on scientific evidence, not prejudice. All questions regarding sexual service transactions as a basis for eligibility for donating blood must be removed to end this stigma.
#EndTheBloodBan.
Andrew Sorfleet is an activist who has been involved in the sex industry since 1989. Andrew is president of Triple-X Workers’ Solidarity Association of B.C. He currently resides on Lasqueti Island in the Salish Sea.
Photo credit: Bill Powers
End Notes
- The 2014 Working Paper by Cecilia Benoit et al from the Canadian Institutes for Health Research reported that 40 per cent of sex workers said their healthcare needs were not met in the prior year, compared with about 12 per cent of the general population. In addition, “A sizable proportion of sex workers did not seek healthcare that they needed because they were concerned they would be judged negatively by the healthcare provider (21 per cent).”
“Contexts of vulnerabilities, resiliencies and care among people in the sex industry: A “working paper” prepared as background to Building on the Evidence: An International Symposium on the Sex Industry in Canada,” Cecilia Benoit, Chris Atchison, Lauren Casey, Mikael Jansson, Bill McCarthy, Rachel Phillips, Bill Reimer, Dan Reist & Frances M. Shaver. Institute of Gender and Health, Canadian Institutes of Health Research, November 18, 2014
- “In fact, a sex worker study conducted in Victoria (n=201 adult sex workers aged ≥ 18 years, including 160 female, 36 male and 5 transgender individuals) has shown that condom use with clients among sex workers exceeds 90 per cent, indicating that professional sexual services are performed safely in an occupational setting.”
Estimation of Key Population Size of People who Use Injection Drugs (PWID), Men who Have Sex with Men (MSM) and Sex Workers (SW) who are At Risk of Acquiring HIV and Hepatitis C in the Five Health Regions of the Province of British Columbia Final Report, B.C. Centre for Disease Control, October 5, 2016. p. 13