If you've ever exchanged money for sexual services, you're barred from giving blood in the UK—forever. Sex workers explain why the ban is unjust.
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"I'm technically barred from ever giving blood again," says Priya. "I've donated blood before when I was younger and always been really enthusiastic about it. I know I could donate blood, but now I can't."
Priya, like 80,000 other people in the UK, is a sex worker. Part of a workforce that is roughly the same size as the population of the English market town of Burnley, she belongs to a group of employees that—in spite of their numbers—face prejudice, imprisonment, or even violence because of the stigma that surrounds their work.
In this case, Priya is frustrated by yet another problem in the constellation of complex issues faced by those in her industry: Under current legislation, sex workers are still not allowed to give blood.
In spite of the ongoing battle for gay and bisexual men to donate blood, men who have had sex with men can only give blood if they haven't been sexually active in the last 12 months.
But tucked with little explanation at the bottom of the UK's banned donor list is another prohibition on those who "exchange sex for money or drugs."
Even though concerns could be justified if the research was available to prove the potential risk, the decision appears to be based on presumption rather than medical justification.
"The Food and Drug Administration guidelines currently suggest that all individuals who have ever exchanged sex for money are not allowed to become a blood donor," says Dr. Rupert Critchley, a medical journal editor.
"This is largely due to lack of studies or data available to recommend safety from blood borne infections such as HIV," Dr. Critchley explained.
That means that if you have ever engaged in sex work that involves direct physical and sexual contact with a client, you are barred from giving blood in the UK—forever.
However, the same does not apply to those who have purchased sexual services, as Dr. Critchley points out: "An individual who has had sex with a sex worker is allowed to donate, providing this is not within a 12 month period."
According to a British Association for Sexual Health and HIV study, female sex workers report extremely high rates of condom use in commercial exchanges, at a level that is much higher than the general population. According to the last Office of National Statistics report, 46 per cent of men and 51 per cent of women use condoms, but researchers at St Mary's Hospital Medical School in London found that the use of condoms during penetrative sex with paying clients was almost 100 per cent.
"It's not payment that makes sex more or less risky—it's whether a condom is used," says sex worker and activist Molly Smith.
"So rather than sorting people by whether they're being paid for, or paying for sex, it would make more sense to sort people by asking them when they last had unprotected sex, and go from there."
Alex Feis-Bryce is the CEO of National Ugly Mugs, a charity which saves the lives of sex workers by allowing those in the industry to anonymously report dangerous clients who may pose a risk.
He believes that the blood donor list is based on a lack of understanding around the nature of sex work.
Your 'lifestyle' and sexual activity is not approved of and you're permanently given the label of having dirty blood.
"The main issue with is that [the ban] is completely not founded in any evidence whatsoever," he says."In the UK, all the research and evidence shows that sex workers are more likely to look after their sexual health in the UK. According to a British Medical Journal study, 32.5 percent of sex workers obtained contraception from GUM clinics when they visited the sexual health centres, whereas 10.6 percent of non-sex workers did. Actually, they are less likely to have things like HIV or any other illness that can be transmitted through blood.
"There are a lot of people who generally just have casual sex, and a lot of people from every walk of life have casual sex. It's a misinformed decision and is perpetuated on stigma, and it's based on a stereotype of sex workers, rather than any evidence of a link between sex workers and poor sexual health."
Although these measures are in place to stop donors from passing on blood-borne diseases like HIV, Hepatitis B or C, Give Blood notes that every sample is tested for these diseases before the blood is supplied to the person that needs it.
"I offer only protected services, so why should I be more at risk to transfer anything over people who go out at the weekends and have one-night stands unprotected?" asks Charlotte Rose, an English sex worker.
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Lee Brooker, a sexual health outreach worker at the Terrence Higgins Trust, a leading HIV/AIDS charity, agrees. "In our experience working with sex workers, we find that their sexual health is often better than most people's, as their income depends on their sexual health and so they're more likely to go for regular check-ups," he says. "Many of the sex workers we support do therefore feel that the full lifetime ban on former sex workers giving blood is discriminatory and not evidence-based."
So if there is little evidence to show that sex workers are not any more likely to pass on blood-borne diseases than other donors, why is the ban in place? Abby* from the English Collective of Prostitutes, a sex worker-founded activism group that campaigns for the decriminalization of the industry, believes that it is linked to the lack of support most sex workers encounter in the health system.
"You can't come forward and say you're a sex worker to your GP because if you have children, you're worried that social services are going to get involved or the school's going to find out—or you just don't want your GP to find out for many reasons—so you are not getting the proper care you need, because you have to silence a big part of your life," she says.
Instead, Abby says, many sex workers have to cover up their real occupation and are forced to "make up some strange story to make up for the fact that you have a partner and a child, but you've slept with five other people... but all you want to do is tell the truth, and there be no repercussions from that."
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"I think [this] stigma flows, definitely," she adds, "in not being able to give blood donations."
Feis-Bryce agrees. "There's a lot of myths and stereotypes about sex workers. A lot of people believe the mythical thing that sex workers are a street-based sex worker that they have driven past," he said. "But actually, your typical sex worker is probably a neighbour who you don't know is a sex worker, or a carer who is looking after one of your parents in a care home or a teaching assistant."
Gail Miflin, Medical and Research Director for NHS Blood and Transplant, said: "Ensuring donor and patient safety is at the heart of what we do. The processes we follow at our blood donation sessions are in line with blood donor selection criteria set by the Department of Health on the advice of independent experts.
"The donor selection guidelines state that we cannot accept donations from anyone who has ever received money or drugs for sex. The guidelines are not intended to be discriminatory and we appreciate that it can be disappointing if you want to give blood but don't meet the criteria. The Department of Health Expert Committee is currently reviewing a number of the donor selection rules including those relating to sex workers."
For sex workers like Priya and Charlotte, this response simply isn't good enough.
"Putting sex workers and men who have sex with men on the barred list marks them [both] as dirty and diseased," Priya, who volunteers at Umbrella Lane, a sex worker's project in Glasgow, argues. "Your 'lifestyle' and sexual activity is not approved of and you're permanently given the label of having dirty blood."
"I'd always want the option to be able to save a life, and I want to give blood for that reason," adds Charlotte.
"I shouldn't be penalized because of my job title."
* Name has been changed.