UK Blood Donation and Homonationalism

A discussion of the end of the 'gay blood ban' by NHS England and why it risks further marginalising Black and immigrant would-be donors, by Chase Ledin

On 14 June 2021, NHS Blood and Transplant (NHSBT) – a health policy body that oversees UK-wide transplant policy and England-specific blood donation services – announced changes to blood donation eligibility, which included a reorientation to focus on sexual practice rather than wholesale sexual identity. The policy seeks to re-position perceived risk of HIV and STI exposure to focus on ‘individual circumstances surrounding health, travel and sexual behaviours’.

Framed as an ‘inclusive’ health policy, the changes allow donations from individuals who have had the same sexual partner for the last three months or from people who have had casual partners but no anal sex, no known recent exposure to an STI and no recent use of the HIV medicines pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP).

These changes were adapted by blood services in Scotland and Wales and received favourably among HIV and sexual health charities. The National AIDS Trust and Terrence Higgins Trust, for instance, welcomed the new individualised risk assessment criteria.

But in a joint letter to Matt Hancock, Health Minister at the time, these organisations urged further clarification of vague language in England’s blood donation criteria that generalises and makes ineligible a large demographic of individuals ‘who have, or you think have been, sexually active in parts of the world where HIV/AIDS is very common [including] most countries in Africa’.

Drawing from evidence produced by the FAIR steering group – a group of scientists, public health experts, charity organisers, patients and community members – the letter foregrounded how such a new and ‘inclusive’ health policy neglected systemic changes to blood donation policy which, in vaguely claiming ‘countries in Africa’, sustains mistrust of the NHS among Black communities.

According to NHSBT, only 1% of current blood donors in England are Black, despite a call for increased priority of ‘finding people from all backgrounds and communities’ – including Black African populations who are more likely to access treatment for sickle cell anaemia.

The blanket exclusion of African countries has been removed from donation eligibility in Scotland and Wales, the One Voice Network note. However, it’s important to note that the Scottish National Blood Transfusion Service and the Welsh Blood Service do not collect BAME demographic statistics; thus the absenting of such data collection raises different questions about donor inclusion.[1]

Focused on the English context, these changes reinforce frustrations about the lack of consideration of Black African populations who access NHS England. As the letter writers suggest, there is a significant need to address social barriers to accessing healthcare more broadly for Black African populations in England and across the UK. The blood donation policy is key to making the necessary healthcare reforms for Black African populations as well as BAME populations largely.

This problem is rightly cast as a social determinant of health – that is, a barrier to healthcare services based on larger social and institutional factors. But it should also be seen as a problem of homonationalism entangled within ‘progressive’ health policy. Commonly understood as the alignment of gay liberation politics with institutions in power, homonationalism is used to justify racist, xenophobic, and anti-poverty social perspectives (Puar 2007, 86) by focusing too closely on a queer demographic and away from entrenched social inequalities in order to signify social change.

Read exclusively in terms of including gay and bisexual men’s ability to contribute to the national blood supply, whilst neglecting to discuss the language that excludes most countries in Africa, the policy changes for English blood services signify a ‘liberal’ and ‘inclusive’ alterations that absent critical conversations about migration. Consequently, such changes intensify rather than mitigate the problem of inclusion. This absenting ultimately reproduces ideas about populations that are ‘easily captured’ by public health bodies largely designed for white and northern European citizens.

In the context of the ‘gay blood ban’ in the US and UK, Ben Weil (2021) has argued that ‘[as] white, middle-class gay men work to assert their potential as disease-free candidates for admixture into the national blood supply, their rhetorics cast doubt on the somatic viability of a range of other individuals—to name but a few: the non-white immigrant, the sex worker, the intravenous drug user, those who take risks, those who are HIV-positive, those who are not buoyed by class and racial privilege—all deemed beyond the pale of full-blooded citizenship’.

The problems following from this policy reform are thus expanded to include issues of right to care for anyone who has anal sex – especially sex workers – and an inability to capture the nuances of migration and citizenship using a global health framework.

In short, whilst the policy change targets a new demographic of blood donators, it neglects the challenging and intersectional contestation of – and resistance to – ‘mapping risk’ on an entire continent. It positions blood donation as a highly localised endeavour outwith a global health framework. Thus, in the English context, it creates a narrow politics that serves only the white Northern European paradigm.

Short of a radical critique of the sustained absenting of Black donors’ lived experiences, the policy change raises questions about how blood donation practices will continue to evolve: how do we have conversations about right to care, how do we address social determinants of health, and how do we expand blood donation policy to better integrate a global health approach?

As activist Lisa Power writes, in order to create equitable and accessible blood donation strategies and healthcare practices broadly, ‘equality means [including] all of us’.

References

Browne, Deryck, Deborah Gold, and Ian Green. 2021. Open Letter to Matt Hancock Concerning Blood Donation Policy. 14 Jun.

Gold, Deborah. 2021. Statement: Blood Donation Rules Still Include Exclusionary Criteria. National AIDS Trust. Blog post. 14 Jun.

NHS Blood and Transplant. 2021. Landmark change to blood donation eligibility rules on today’s World Blood Donor Day. Press release. 14 Jun.

NHS Blood and Transplant. 2021. Why Black, Asian and minority ethnic donors are needed. Website. N.d.

One Voice Net. 2021. Confusing and conflicting blood donation rules obstruct Black blood donors in England. Blog post. 14 Jun.

Power, Lisa. 2021. Blood Donation Rule Changes. Tweet. 14 Jun.

Puar, Jasbir. 2007. Terrorist Assemblages: Homonationalism in Queer Times. Durham, NC: Duke University Press.

Weil, Benjamin. 2020. Out for Blood. The Baffler. 25 Jun.