The World Health Organisation has affirmed ‘voluntary self-sufficient’ blood donation as the safest and most sustainable means for meeting the state’s statistical blood requirements  and together with the European Union Directive 2002/ 98/EC  has mandated that a preemptive screening of potential donors through rigorous onsite questioning and potential donor deferrals be established as a routine and permanent fixture of this process. What this has amounted to in practice is excessive and often discriminatory exclusion guidelines that centre around controversial and intimate aspects of one’s race or sexual orientation, and which work to sustain nothing more than a naturalized association between blood, risk, and security.
The aim of my Research Masters was therefore to investigate the moral and political economies of blood donor regulation in Ireland, examining in what ways the geography of global disease outbreaks from hepatitis, and later HIV/AIDS, cultivated an exclusionary and often inaccessible blood donation regimen that is still visible in the Irish Blood Transfusion service today. Using blood donor practices in the Republic of Ireland as a case study, and as a frame of reference, my research focused on the spatial tactics and surveillance techniques adopted by the Irish Blood Transfusion Service as a way in which to regulate and exclude potential donors between the years of 2015-2016 as well as the narratives, voices and opinions of non-normative donors who themselves embodied and experienced exclusion at this marginalized site of citizenship.
Since the height of the hepatitis and AIDS crisis, both gay men as well as immigrants have been central to the exclusionary logic that has at times prohibited them from contributing to the national blood supply . Racial exclusions often masquerade as travel based restrictions which target particular bodies that are believed to be located closer to the epicentre of infection. Blood transfusion services, on the other hand, typically paint a monochromatic picture of power, claiming that their donor selection criteria is standardized, fair, and in the interests of “safeguarding” a national blood supply. Exclusions on the behavioural collective ‘men who have sex with men’ MSM from donating blood have historically taken the form of either temporary or indefinite deferrals in over twenty countries including Ireland, the United Kingdom, and the US, without any scientific evidence to support it, and rather, a mounting international evidence to suggest it’s indefensibility. The most recent litigation case taken by a French citizen to the European Court of Justice as of April 2015  ruled that EU countries should seek a “less onerous” means in which to protect the national blood supply, and together with a High Court challenge by Irish blood donor activist, and student Tomas Heneghan,  it compelled the state to introduce a one year deferral on MSM, bringing it’s policy into line with international developments. While the recent decision taken by the Irish government to move away from an indefinite MSM deferral has been welcomed by many as a step in the right direction, the continued exclusion of monogamous same-sex couples which the new policy entails, has likewise been criticised for perpetuating an “inequitable risk tolerance”  between ineligible same sex partners and sexually promiscuous heterosexual men. During a time when blood donation is at its lowest rate in almost a decade , and only 3% of the eligible Irish population donate blood,  valid questions need to be asked as to whether it is indeed sustainable for us to continue meeting our national blood requirements through the presence of scientifically unsupported donor exclusions.
My research was to largely reveal that what is accepted as the most sustainable model of blood donation internationally, is still premised on the fear and mistrust of the spaces within which so-called ‘panic figures’ move . Lengthy and esoteric ‘health and lifestyle’ questionnaires are designed to confuse and unsettle potential donors from the outset, while questions addressing one’s size and weight often render implicit that the appearance of the body acts as the ultimate marker of one’s health, productivity, and thereby safety. The corporeality of the flesh remains an important visual modality in which to construct a spatial, as well as temporal geography of the body that assesses and surveills all aspects one’s moral behaviour; arms are scanned for signs of intravenous track marks, while the corporeal proximity of bodies is also often conflated with moral deterioration and given equal cause for expulsion. The ‘queer body’  had, in particular, been mapped as a space in which to project future fears of a diseased and death-ridden polity. MSM who had presented as heterosexual prior to the lifting of the Irish ‘gay blood ban’ in January 2017 feared that their identities would be outed providing they did not regulate or suppress their bodily movements within the space so as not to give away any indiscriminate cues about their sexuality. This was also true of blood drives held in community spaces where MSM who had not yet been open about their sexual practices felt compelled to donate blood as a way in which to conceal their sexual identity among unwitting family, friends or colleagues, even in the absence of STI testing. Especially striking was an Irish trans woman and avid blood donor Ms Aoife Martin, now well documented in the Irish media,  who had received an expulsion letter simply for undergoing a male- to- female gender identity transition that exemplified not only the continued inaccessibility and inequality of health care services towards people who identify as Trans  but also the way in which biological parts continued to be viewed by medical services as what Seidman (1995)  has referred to as an “authentic and unchanging space,” while gender identities are rendered a mere fictitious aberration of the former Self.
mmediate and reactionary decisions that have been taken to date by the IBTS which had excluded non-normative donors from the Irish blood donor registry throughout the research, is illustrative of the ways in which political decisions continue to be taken among objectively positioned medical services; decisions which cannot simply be reducible to scientific evidence regarding blood safety alone. What remains apparent from the research is that the act of blood donation provides geographers with a useful opportunity in which to more closely interrogate the boundary-making practices of citizenship, the regulation of the national, as well as the biological body, and ultimately, the ways in which sustainable models of blood transfusion, and of our health and development goals more broadly, must rely in equal measure on the equitable and inclusive accommodation of our increasingly socially diverse blood donor pool.
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