I gave blood yesterday. It got me thinking. First, let me show a few screenshots:
Let me interject here I’m using the terms Male and Female based on the criteria I selected in the American Red Cross’s Fast Pass screen. More on why I make that distinction further on. But first two more screen shots.
Now, on the face of it, this second set of questions especially almost seems to make sense: I mean if I answered Male early on in the questionnaire, why by asked about a pregnancy? But what I’m asked at the beginning is about my gender, not my actual child-bearing capability. Let me quote from Merriam-Webster:
2-b: the behavioral, cultural, or psychological traits typically associated with one sex
Or from the World Health Organization:
Gender refers to the roles, behaviours, activities, attributes and opportunities that any society considers appropriate for girls and boys, and women and men. Gender interacts with, but is different from, the binary categories of biological sex.
Who can be pregnant?
So above, really what the Red Cross is asking isn’t about my gender, but really my ability to be pregnant. Now, this is a valid medical concern. There are risks they want to avoid in regards to pregnant women, or recently pregnant women giving blood. So their ultimate goal isn’t the problem, but their initial assumption might be. A trans-man might still be able to get pregnant, and a trans-woman might be incapable of getting pregnant (as well as a cis-woman might be incapable.) And this is why I had the caveat above about using the terms male and female. I’m using the terms provided which may not be the most accurate.
Assumptions on risk factors
The first set of images is a problematic in another way: it is making assumptions about risk factors. Now, I think we can all agree that keeping blood borne pathogens such as HIV out of the blood supply is a good one. And yes, while donated blood is tested, it can be even safer if people who know they are HIV or at risk for it can potentially self-select themselves out of the donation process.
Let me show the actual question:
This is an improvement over the older restrictions that were at one year and at one point “any time since 1977”. Think about that. If a man had had sex with another man in 1986, but consistently tested negative for HIV/AIDS for the following 30+ years, they could not give blood under previous rules. By the way, I will make a note here that these rules are NOT set by the American Red Cross, but rather by the FDA. So don’t get too angry at the Red Cross for this.
The argument for a 3 month window apparently was based on the fact that HIV tests now are good enough that they can pick up viral particles after that window (i.e. at say 2 months, you may be infected, but the tests may not detect it.)
Based on the CDC information I found today, in 2018, male-to-male sexual contact resulted in 24,933 new infections. The 2nd highest category was heterosexual contact (note the CDC page doesn’t seem to specify the word sexual there.) So yes, statistically it appears male-male sexual contact is a high-risk category.
I know a number of gay and bisexual men. I don’t inquire about their sexual habits. However, a number are either married or appear to be in monogamous relationships. This means if they want to give blood and not lie on the forms, they have to be celibate for at least 3 months at a time! But hey if you’re a straight guy and had sex with 4 different women in the last week, no problem, as long as you didn’t pay any of them for sex! I’ll add that more than one gay man I know wants to give blood and based on their actual behavior are in a low risk category, but can’t because of the above question.
Why do I bring all this up at the end of Pride Month and what, if anything does it have to do with database design (something I do try to actually write about from time to time)?
As a cis-het male (assigned at birth and still fits me) it’s easy to be oblivious to the problematic nature of the questions on such an innocuous and arguably well-intended form. The FDA has certain mandates that the Red Cross (and other blood donation agencies) must follow. And I think the mandates are often well-intended. But, there are probably better ways of approaching the goals, in the examples given above, of helping to rule out higher-risk donations. I’ll be honest, I’m not always sure the best way. To some extent, it might be as simple as rewording the question. In others, it might be necessary to redesign the database to better reflect the realities of gender and sex, after all bits are cheap.
But I want to tie this into something I’ve said before: diversity in hiring is critical and I think we in the data world need to be aware of this. There are several reasons, but I want to focus on one for now.
Our Databases Model the World as We Know It.
The way we build databases is an attempt to model the world. If we are only aware of two genders, we will build our databases to reflect this. But sometimes we have to stop and ask, “do we even need to ask that question?” For one thing, we potentially add the issue of having to deal with Personally Identifiable Information that we don’t really need. For another, we can make assumptions: “Oh they’re male, they can’t get pregnant so this drug won’t be an issue.”
Now, I’m fortunate enough to have a number of friends who fall into various places on the LGBTQIA+ (and constantly growing collection of letters) panoply and the more I listen, the more complexity I see in the world and how we record it.
This is not to say that you must go out instantly and hire 20 different DBAs, each representing a different identity. That’s obviously not practical. But, I suspect if your staff is made up of cis-het men, your data models may be suffering and you may not even be aware of it!
So, listen to others when they talk about their experiences, do research, get to know more people with experiences and genders and sexualities different from yours. You’ll learn something and you also might build databases. But more importantly, you’ll get to know some great people and become a better person yourself. Trust me on that.