Citizenship, Identity, Blood Donation

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Citizenship, Identity, Blood Donation Kylie Valentine Body & Society  2005 11: 113 DOI: 10.1177/1357034X05052464

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Citizenship, Identity, Blood Donation KYLIE VALENTINE

Blood donation has long been known as a public act of altruism. Indeed, Richard Titmuss’s well-known analysis of donation in the 1970s argued that it is a uniquely altruistic practice. Outside the obligations and reciprocities that characterize Mauss’s gift system, and untainted by the strictures of the market, blood donation remains proof against the ‘philistine resurrection of economic man’ (Titmuss, 1997: 60). This description of donation as a public gift can also be seen in the campaigns and advertisements of blood collection systems. Blood banks in Australia, as elsewhere, appeal to the goodwill and generosity of the public in recruiting donors, and implicitly or explicitly identify donation as an act of  altruism more valuable than any other. Blood is described as ‘the most precious gift’ in these campaigns, privileging blood donation over the donation of any other resource. The more recent history of blood donation in Australia and elsewhere reveals both an apparent prescience in Titmuss’s work and inadequacies in his figuring of blood as a circulatable, universal substance. Titmuss warned against the commodification of donation, arguing that offering incentives to donors could encourage dishonesty about their health status and lead to contamination in the blood supply. Since his death, blood banks have become subject to risks beyond anything Titmuss envisioned. Yet the contamination of Australian and other blood banks with hepatitis C (HCV) and HIV occurred in precisely the Body & Society © 2005 SAGE Publications (London, Thousand Oaks and New Delhi), Vol. 11(2): 113–128 DOI: 10.1177/1357034X05052464

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conditions Titmuss recommended: donors were unpaid volunteers telling the truth. These contaminations, and later fears that blood supplies could become contaminated with vCJD, have led to changes with regard to the publics invited to donate blood. Voluntary donation has also been codified and made subject to sanction. Titmuss writes that blood donation is unique among social gift transactions because the goodness of the gift depends in part on the honesty of the giver (1997: 127). The HIV and HCV contamination of blood supplies led to all Australian states enacting legislation criminalizing false or misleading declarations on the part of blood donors. These days, the altruistic motives behind the donation of blood are more important than ever, but the nature of this altruism has changed. The conditions of blood donation remain truth-telling and altruism, but new truths need to be told, and the consequences of not telling them are newly severe. At stake is not only the moral obligation to give to strangers, but to give correctly. While altruism remains important to voluntary donation, these events present a disruption to hitherto useful models of donation and altruism. My aim here is to present a new model of donation that accounts for it as both a public and private act. Working from studies of blood donation as public altruism, I also want to argue that Jeffrey Weeks’s figuring of the sexual citizen offers a useful means for discussing the importance of intimate practices and the embodied self  to public spaces. Blood donation, traditionally analysed in terms of its public functions, emerges in the light of this analysis as the practice of an embodied self. Especially interesting here are the ways in which this nexus of private and public is known and negotiated by those with particular interests in the sphere of  donation: donors, those for whom donation is proscribed, those who receive donated blood through transfusions or other medical procedures. Weeks puts forward sexual citizenship as a corrective to ‘limitations of  earlier notions of citizenship’. He argues that sexuality needs to be included in understandings of what makes the citizen and makes up the public sphere (1998: 39). Weeks’s work extends feminist scrutiny of the often invisible gendered constructions behind liberal models of the citizen, and is indebted to feminist scholarship on the state, law and rights. This debt is acknowledged, as is the influence of another separate but connected field of scholarship, social movement studies. Also concerned with the state and claims made on the state, some social movement scholars foreground new categories of identity, and new modes of public activity. Based on practices of everyday life, and recognizing hitherto unregarded markers of identity such as dress, demeanour and speech, social movement studies examines the ways that individual and collective Downloaded from bod.sagepub.com at Universitas Pendidikan Indone on May 12, 2012

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identities are formed and claims are made from those identities (Johnston et al., 1992). Feminism and the gay and lesbian movements are central to Weeks’s analysis and social movement studies. A particular enactment of this mobilization can be seen in the events surrounding the exclusion of gay men from blood donation in New South Wales, Australia, in 1983. Mark Cortiula (2001) provides an account of this exclusion, which was decided by the director of the NSW blood bank after he attended a seminar on the possible spread of AIDS through blood transfusions. The decision to declare a ‘no-gay’ donation policy was sudden and poorly explained. There was no consultation with community leaders around this decision, which was instead announced in the media even before many blood bank staff knew of it. It provoked an angry reaction from the gay community, already mobilized around campaigns to decriminalize homosexuality and alert to the homophobic meanings of phrases describing AIDS then in use such as ‘gay plague’. Activist groups including the Gay Rights Lobby and the Sydney Gay Solidarity Group organized much of the subsequent protest. Activists argued that in the (then) absence of compelling evidence linking homosexuality and the spread of AIDS through transfusion, the exclusion of gay men from donating represented a slur against them. Gay men picketed the Clarence Street bloodbank in Sydney, and handed out leaflets accusing the director of bigotry (Cortiula, 2001: 207–9). The mobilization of gay men around these events was an example of new realms of political claim-making and demands for recognition. Blood donation was constituted during these events as not simply an act of  altruism, but as a participatory space of belonging. Exclusion from this space became not simply an abstention from a specific act of charity, but the denial of  full participation in civil practices. In this case, donation was politicized in a claim for recognition and belonging by gay men. Donating here was constituted as a public sphere to which Weeks’ sexual minorities claimed belonging. Homosexuality functioned as an identity category in both the naming of a public newly forbidden to donate and in the reaction of that public. Beyond these specific events, it is possible to examine donation as a civil sphere in which the particularity of blood is crucial. Since 1983, other groups of people have been precluded from donating in Australia. The Australian Red Cross Blood Service, for example, advertises on its website that healthy people who are aged between 16 and 70 and weigh over 45 kilos are eligible to donate, with two provisos. First, anyone ‘who spent a cumulative period of six months or more in the United Kingdom between 1 January 1980 and 31 December 1996 cannot be accepted as blood donors until further notice’ (Australian Red Cross Blood Service, 2003). Second, unspecified ‘guidelines’ also Downloaded from bod.sagepub.com at Universitas Pendidikan Indone on May 12, 2012

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need to be met: these refer to the ineligibility of injecting drug users to ever donate, and the ineligibility of those having sex with an injecting drug user (IDU), a gay or bisexual man, or a prostitute, to donate until 12 months have elapsed since that sexual contact. Those with a history of residence in the UK are thus classified as temporarily ineligible, and specified as such. The ineligibility of  other people, which is in some cases permanent, is incorporated into the category of protective guidelines. Some identity categories, such as injecting drug users, are used in other domains; some, like ex-UK residents, were devised especially for this purpose. No one in ‘good health’ is specifically precluded from donation, although actual eligibility for donation is much narrower than that. Blood donation, then, remains a public practice at the same time that certain kinds of public are precluded from it. Blood becomes Titmuss’s public, circulatable substance while retaining traces of intimate practices and identities. Blood may no longer be seen as the origin and distillation of individual character, but it still bears the imprint of intimate practices – who we’ve had sex with and what that sex was, what drugs we’ve taken, what food we’ve eaten – and is capable of carrying that imprint to another person. This kind of double movement, whereby donating is represented as available to any healthy person at the same time that significant numbers of people are rendered ineligible to donate, is not unique to blood donation. However, the significance of altruism to blood donating suggests some interesting questions. Blood donation has become a strictly defined and finite civil sphere which promises an identity of  altruism and belonging to those who participate. What then is particular to the body of the blood donor, and how are the civic practices of this body different from those of non-donors? How do the dangers of contaminated blood supplies inflect understandings of donation as a civic practice? Who is the citizen constituted by the practice of or abstention from blood donation, and in what public sphere? It is this final question that is considered in this article, or, more specifically, the question of exclusion from blood donation. Understanding donating as a civil practice is useful in part because citizenship is always exclusionary. Benedict Anderson’s famous ‘imagined communities’ are nations with borders that set limits on who can belong to those communities, and contests in the name of  citizenship have included contests over those entitled to make claims as citizens (1983: 16). I am concerned here to examine some of the assumptions behind the imagining of the citizen-as-blood-donor, and some of the ways that understanding of that category affects those who cannot assume it themselves. The imaginative production of blood donation as a practice available to anyone who fits the category of citizen confirms the importance of the intimate and embodied Downloaded from bod.sagepub.com at Universitas Pendidikan Indone on May 12, 2012

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self to the public sphere, but it also re-inscribes the boundaries of civic belonging and exclusion. This article is based on interviews conducted for a study on blood awareness and hepatitis C prevention.1 The following two sections will examine the responses of interview participants to questions about blood donation – including questions about the imagined impact on blood donating if payments were offered to donors, and how participants might feel about receiving blood in conditions where donors are paid. The section following that, ‘Exclusion’, examines representations of drug users as blood donors: representations that reflect both the attribution of moral derangement to drug users and the exclusion of some drug users from donating. Charity The altruism of blood donation has been compared to other altruistic practices, especially the donation of labour or money. When asked about similarities between blood donation and charitable donation, a number of responses across all categories placed these practices as proximate. However, about as many responses – again from donors, recipients and IDUs – nominated blood donation as not just different from, but ‘more’ than charity, either in terms of the value of  the resource donated, or the effort of the donor, or both.2 A few of these spoke to the difficulty of the process of donating – for example, Bill (IDU): ‘It’s such a personal, intrusive thing again. A hard thing to do physically. It can be distressing and it can be unpleasant.’ A few others spoke to the exactness of the exchange between donor and recipient: ‘you can actually save someone’s life. Directly’ (Jane, IDU). In one instance, blood donation was contrasted with the political environment of social welfare charities: ‘Like money can only do so much. It’s like putting money in a bucket for the homeless, it’s solving a temporary issue and there’s a whole lot of social, political obligations behind that’ (Trudy, donor). Most, however, privileged blood over other forms of giving because of the substance itself. Responses to other questions in the interview, around incorporation of blood into the body after transfusion, and whether blood in some sense still belongs to the donor after donation, did not reveal any strong proprietorial or symbolic attachment to blood (Waldby et al., 2004). Here, however, blood is represented as something other than a disembodied resource, and donation of it as something ‘better, stronger’ (Jane, IDU) than other altruistic acts. Fiona, a blood recipient: ‘I don’t think it’s the same as giving money to charity, anyone can give money. When you give blood, it’s not like more, but it’s like they care.’ Bob, a donor: ‘Blood donating you’re actually giving a bit of yourself literally. I Downloaded from bod.sagepub.com at Universitas Pendidikan Indone on May 12, 2012

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mean it’s human tissue, stuff that you’re donating. So again, I think it is a bit special.’ Several responses contrast blood donation with other acts of charity with a description of giving blood as giving the self. Ryan, a donor: ‘But when you give blood you’re giving away something of yourself, your own blood, so it’s more personal to you. Like it’s part of you that you’re giving away.’ These responses correspond to the language employed in recruitment and advertising campaigns of blood banks. In contrast to money or other gifts, blood is seen as an urgent, immediate, life-saving gift. This may be attributed in part to scepticism over the uses to which other resources may be put by social welfare charities, and perhaps to the difference in cultural meanings between medical emergencies and, say, poverty. Yet the value given to blood donation here reveals an investment in blood and the donation of it that is not always shown in other responses. Most responses nominate blood donation as equivalent to or more significant than charitable donations; in contrast, only a small number of  responses put forward blood donation as ‘easier’ than other donations, because of the relatively short time commitment involved and, in one case, absence of  contact with the recipient. The fact that blood is ‘the most precious gift’ only under specific conditions, that money or other resources are far more valuable and possibly life-saving under different conditions, and that blood is used for ongoing, routine procedures as well as in emergencies, is not visible in the majority of responses, which reveal meanings invested in blood donation beyond the instrumental. While blood is not sacralized, a strong sense of donation as giving the self, in contrast to the donation of impersonal resources, is evident here. These discussions of blood donation disclose it as both a public act and an intimate practice. Outside considerations of the social or cultural meanings invested in blood sui generis, blood donation can be considered in the light of  theoretical models of the embodied subject and analyses that demand recognition of corporeality as important to selfhood. Like many other interventions, the process of donation itself disrupts any interpretation of the donor’s body as a closed system. It pierces the skin, introduces the technical apparatus of collection into seemingly enclosed circulation systems. An act of the embodied citizen, blood donation makes literal the place of the private self in the public space of  the blood bank, of the public uses of the private body. Blood donation also concretizes the specificity as well as the commonality of the donating bodies. A repeated, universally applied series of bureaucratic and clinical procedures, the implementation of criteria for donation is nonetheless necessarily individual and personalized, and is experienced as such by donors. Downloaded from bod.sagepub.com at Universitas Pendidikan Indone on May 12, 2012

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But I’m always conscious of when I’m walking down the hallway that the nurse in that booth is going to find something on my file that is some kind of flag that there’s something wrong. I don’t know why. I have no idea why I think like that, because there is nothing wrong with me but there’s always that little nagging thing in the bac kground that they’re going to say sorry Sally you can’t give blood today . . . are they going to say oh I’m sorry you’ve just been penalized you’ve got to leave. (Sally, donor)

The specificities of the donating body are integral to the donating process conducted by the blood bank, and are felt as such by the donor. Blood is particularized even as it becomes part of an anonymous pool of disembodied resources; the body and intimate practices of the donor are subject to scrutiny even as that body is presented as public.3 The Donor as ‘Anyone’ Prompted to discuss the real or imagined motives for donation, some donors and non-donors nominated reasons of self-interest as well as altruism, such as imagined or anticipated receipt of blood by the donor. Both donors and nondonors, reflecting Healy’s (2000) argument that attention should be paid to systems of blood collection as well as individual impulses, also proposed a kind of absent motivation behind the practice of real or imagined donation, including habit or family tradition. However, in most responses donors were discussed in moral terms: either positive (for example ‘just to help other people’, ‘be a good boy scout’) or very positive (for example ‘very compassionate’, ‘friendly, lovely, good, generally wonderful people’, ‘legend’). These correspond roughly to the two main representations of blood donation above as either more valuable than other kinds of donation, or as similar to other kinds of donation. Blood donation is seen, then, either as an act confirming or enabling membership of a collective identity; or as the practice of an individual with a greater sense of altruism than others with that collective identity. In the main, donors are discussed by donors and non-donors in language invoking moral superiority, rather than, say, membership of a different community, or attachment to a different identity. Donors are seen as more caring, compassionate, and generous than non-donors, and blood as equally available, or even more available, as a gift than money or other resources. The universality of blood is implicitly, and sometimes explicitly, equated with a universal possibility of donating it. Kelvin, nondonor: ‘I mean they could be anybody or anywhere. Just saying citizens, it doesn’t mean male, female or otherwise. Colour, creed or anything.’ Imaginative representations of donors as anonymous and divested of race and other markers of individual identity recall Titmuss’s argument that blood is ‘a Downloaded from bod.sagepub.com at Universitas Pendidikan Indone on May 12, 2012

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bond that links men and women in the world so closely and intimately that every difference of colour, religious belief and cultural heritage is insignificant beside it’ (1997: 61). But blood is not a universally donatable substance, which is both Titmuss’s point and a highly visible outcome of recent history. This history reveals that while all blood regarded as unsuitable for donation is regarded, from the point of view of blood banks at least, as alike, there are differences of import and impact between the categories of exclusion. Narrowings of eligibility criteria for blood donation after 1983, most notably the ineligibility of those who have lived in the UK because of the theoretical risk of the transmission of vCJD through blood transfusion, have not generated the same controversy as the exclusion of gay men. This is doubtless attributable in large part to the impact of HIV and HCV transmission through blood supplies. Public recognition of blood as an anonymous, disembodied resource now also accommodates blood as an individualized substance. The politics of these eligibility criteria, so visible in 1983, have been largely transformed to the apparently neutral framework of health. However, while the response of gay men 20 years ago to being excluded from donation should be understood partly in terms of  changing meanings attributed to blood, this is not the full story. Exclusion from public practices is a political act for those forced to struggle for rights and public recognition, regardless of the reasons for that exclusion. Different responses to exclusion by different groups reveal the political identity and repertoires of those groups, and the meanings given to that exclusion. In 1983 a politicized community, made up of individuals with a strong attachment to homosexuality as an identity, recognized exclusion as political and responded through innovative use of available resources. In contrast, the exclusion of ex-residents of the UK was not directed at an identity group belonging to an active social movement, and was not recognized as a political gesture. Gay men reacted to exclusion in ways that reveal the existence of homosexuality as an identity category as well as the political mobilization of that category. In contrast, the non-response of one-time UK residents reveals not just the politically neutral meanings given to blood by that group of people, but the weakness of that category as a social identity. While it is not possible to pursue this issue here, the variation in responses to the exclusion of a social category from blood donation has the potential to throw light on the ways embodied identity is formed and understood. In particular, the third category of ‘healthy’ people excluded from blood donation in Australia – injecting drug users – occupy a social space somewhere between these other two. The forces producing ‘drug user’ as a social identity, the strength and extent of a movement based on that identity, and the means for political claim-making by that movement, are less Downloaded from bod.sagepub.com at Universitas Pendidikan Indone on May 12, 2012

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visible than in the case of gay men and ex-UK residents. The non-response of the latter group resembles, at first glance, the absence of an organized protest around the exclusion of IDUs. However, as we will see, there is a marked contrast between the absence of political meaning attached to ex-UK residents and the identification of drug users as a social category and individual identity. Exclusion The identification of blood donation with altruism is reinforced by responses to the imagined impact if payments were offered to donors. Four indicated a neutral response, and five a positive, encouraging response. Mostly, however, hostility was expressed to the prospect of payment. Overseas examples of payment systems were nominated as a troubling precedent, echoing Titmuss’s analysis of  private blood banks in the United States. The impact on the resources of blood banks, in terms of both finding the revenue required to pay donors and the necessity of additional screening processes, was raised. A number of responses connected payments to donors with a privatized blood banking system – for example, Isaac, a blood recipient: Oh definitely it would change it altogether because then you’d have to pay to have it. Like the amount of money I’d have to, you wouldn’t be able to afford it you know. Like I wouldn’t be able to afford [blood products]. Like how much is a bag of blood going to cost you?

In some ways, the imagined devaluing of blood donation by its being accorded a monetary value corresponds to the non-commercial value of other altruistic practices, such as unpaid labour for charities. A strong sense was evinced by several participants, with different experiences of donating, that donation should remain outside the commercial sphere, that altruism should be preserved in the practice of donating and the identity of the donor. To be honest I think it would actually cheapen the donation. It would make it feel less worthwhile. Once you put a value on something like that then you probably couldn’t afford my blood anyway so I wouldn’t be giving it. (Derek, donor)

The value of altruism to the person performing the altruistic act is suggested here, as is the value of practices deliberately excluded from any assessment of commercial value. Yet negative assessments of the impact of blood donation were not only about maintaining the altruism of donors, or what Titmuss called the value we accord people by giving to strangers. When asked to identify what changes in donation practice would be brought about by payment, a number of different kinds of  people, some ineligible to donate, some not, were identified as likely to become Downloaded from bod.sagepub.com at Universitas Pendidikan Indone on May 12, 2012

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donors if paid. Several responses indicated poverty – due to unemployment or unspecified reasons – as a motivation for donation. However, the single largest group identified as donors likely to be motivated was drug users. People in poor health and people who have ever injected drugs are ineligible to donate. But the identification of drug users as likely to donate were payment offered reveals something more than recognition of the technical requirements (the Red Cross’s ‘protective guidelines’) precluding some people from donating. Homosexually active men were not identified as likely to be responsive to payment, and nor, with one exception, were those who have lived in the UK. It is not always evident whether or not participants knew of the criteria for eligibility as a blood donor, and whether their identification of drug users as undesirable was based on some drug users not meeting that criteria. Instead, the moral value accorded to blood donors is reversed here in implicit and explicit associations with drug users and some impoverished people as of degraded ethical standing.  Aldo (blood recipient): People who need the money, like drug people from Kings Cross [an inner city suburb of Sydney with an active drug market and numerous services for injecting drug users] they don’t care, they just want the money, they’ve got all these drugs in their system, and they are the kind of people we don’t want. I mean I don’t want blood from them. Carl (blood recipient): Yeah it would. You’d get every drug addict in the western suburbs [of  Sydney], every drug addict around here that needs a couple of dollars. You know, that’s the way they are. Like and they will be trying to get money. You know. Maxine (donor):

I don’t think you would get people doing it for the right reasons, they would be just doing it for the money, and the blood wouldn’t be as safe, that was just something I read. Like if you pay people for blood you get like minority groups.

Interviewer :

Like what groups?

Maxine:

Poor people or drug users, or something like that.

Interviewer :

And there’s a high risk of disease?

Maxine:

Not poor people, but maybe homeless people, like drug users.

The sharing of self practised by blood donors becomes, in the context of people getting paid to donate, the presenting of an inappropriate, unwanted self. Those who would donate if paid should not donate – at least in part because they are the kinds of people who are willing to give their blood for money. Aside from responses specifically about drug users, more general comments about the character and quality of potential donors characterize some of the

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responses – although others explicitly disavow moral judgements about donors or potential donors. Trudy (donor): I think you’d get juniors that come in that just want their $20 to go out and spend. And I think you might get a lot more less desirables in the community. Interviewer :

What categories are you thinking there?

Trudy:

People that need the money that don’t care how they live or where they live and don’t take care of themselves. Like I won’t turn around and say homeless because I don’t think the truly homeless will come in to get the money. I’m thinking the late night partiers, the people who don’t care, the people that really are just the ‘Hey man, free money, I don’t care’, that sort of thing. It’s hard to explain but I don’t believe, as I said, it’s a charity work but if, I think you’d just get those two sorts of people. You would get more people but I think you’d lose a lot more blood in the testing. Yeah.

 Jill (IDU):

Because I know that if people were getting paid to give blood you’d get all the dodgy people of society, you know myself included, you would. At least where it is now you only got, you know like, do-gooders, like you know, wanting to do it, but you know.

Interviewer :

And why would that matter?

 Jill :

Because in my eyes do-gooders are cleaner. Do you know what I mean? There’s less, they have a less risky life so there’s less chance of, you know.

Again, the moral valuing of the donor as a compassionate and more generous citizen than normal is reversed in assessments of the potential, paid donor. Such potential donors are undesirable donors because they may indulge in riskier practices than current donors, or they may be in poor health. These render people ineligible to donate – but many people are ineligible to donate. What is significant here is that the imagined donor is willing to expose other people to harm, is willing to practice a donation that is not just not altruistic, but dangerous. Not all drug users are ineligible to donate, only drug users who have injected. It is therefore not always clear if the identification of drug-users and others as potential paid donors is an explicit assessment of these groups as willing to lie – although some responses do name paid donors’ dishonesty about their ineligibility as likely. However, whether an explicit attribution of risk or dishonesty is made or not, most participants indicated disagreement with the prospect of  donors being paid, and expected payment to encourage people to donate who shouldn’t. These responses reveal – in line with the valuing of donation and the donor – an investment in blood as a personal and specific substance unlike other donated resources. Unlike money, blood bears the mark not just of the donor, but the motive of the donor. Privileging donors’ motivation imbues blood with the properties of its source, and the process of its donation.

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Hannah (IDU):

Because it’s to help someone. It’s to help to live again to see another day. Not to see another $100 bill. I mean money’s plastic. I mean to a lot of people money talks every language. I know that but not my language. I talk from my heart, I speak from my heart. Not from my pocket. My pockets don’t talk for me. It’s from my heart and my mind, what’s in my head.

Sally (donor):

And all of them all doing it for the wrong reasons. There’s got to be an alternative reward other than money and we just haven’t found it yet.

Lisa (blood recipient): [I]t would be like the needle exchange, you’d walk to the, you’d see them all hanging around outside with their cups of methadone and you know, no, it’d be awful. I can just see it now. What it would be like. And I think I’d rather die probably. Interviewer :

Do you really mean that or . . .

Lisa:

Oh I’d be very unhappy about accepting their blood. I wouldn’t be happy at all.

 Judy (recipient):

I would hope people would, if I needed blood, people would give it to me because I needed it. They think the same as I do. Not because they’d been paid to do it.

Gordon (donor):

I like to think that the blood I am receiving has come from people who gladly volunteer it and not from people whose financial situation necessitates it; on the other hand it might swing more people to do it. Like you might be teetering on the edge, I might do it, or I might not, but I like to think that all the people who give blood are happy to volunteer it.

Interviewer :

Why is that?

Gordon:

It seems like the fundamental way it should be done, it should just be people doing it without seeking a reward.

These responses also reaffirm affirmations of donors as people with a higher moral capacity than non-donors. The universality of blood connects easily and intuitively with an assessment of those who voluntarily donate blood as belonging to the same social group as those who don’t donate but possessing a greater moral capacity. However, as the responses to questions about paid donation indicate, blood is not a universally donatable substance to public blood banks. Equating blood donation with moral superiority is obviously beneficial in terms of the recruitment and valuing of donors, and matches well with both common-sense and theorized ideas of donation as altruistic. However, it elides the specificity of criteria for donation. It can also be assumed to have an impact on those who cannot donate. As noted earlier, the response of gay men to exclusion in 1983 is one proof  of this impact. The responses of interview participants in this study is another.

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It was in the era when people were getting their licences marked with donations and stuff like that with the organs, I did mine too. I thought that was quite cool. And I’ve felt really awful, now I can’t give blood. I can’t get my little badge and say I’ve done the right thing. I’ve got no status symbol. I feel as though I’ve been cut off in a way. Like I’m now not good enough.

 Angela (IDU): Yep, I’d donate blood except for the fact that I use, and you know, as a young girl, I don’t know, I think it’s just a good Samaritan thing, you know for a lot of people, and for myself it would be just like something that I could do to help others, but it’s something that I can’t do so I don’t even really go there. I’m actually a bit sad about that. You get that. Mary (IDU):

By the time I sort of got to that age where I started thinking about that, I had hep C. So I couldn’t. But I really, that’s about the one thing that upset me the most about having this disease, was not being able to give blood or give my organs when I die. That was about the most emotional part [of diagnosis].

These three respondents have injected drugs, and drug users, as noted above, were named more often than any other single category as likely donors were payments made. Their accounts describe emotional reactions to the recognition of ineligibility of donating, of exclusion from the community or identity of  donation. This exclusion of drug users operates on three levels. First, IDUs are excluded at a technical level: their blood cannot be utilized by blood banks. Second, they are excluded from identity categories of altruism and moral superiority, of what can be called good citizenship. Third, and particularly, they are excluded from these moral categories because their motives are suspect and their ethical standards deranged: they would do harm rather than good if money was involved, and so become the reverse of the altruistic blood donor, a bad citizen. Other people are also excluded from the blood donation in the first two senses, but drug users are morally devalued twice: in their ineligibility to assume the identity of the blood donor and in their imagined willingness to assume it dishonestly. Drug users are thus not only remote from but threatening to the existing, valued figure of the blood donor. Conclusion Recently, Lifelink, a network of health organizations responsible for coordinating all (deceased) organ donations that take place in New South Wales and the Australian Capital Territory advertised the expansion of eligibility criteria for organ donation to people with hepatitis C. It is now possible that a hepatitis C infected but reasonably healthy liver can be transplanted into someone who already has hepatitis C (Hepatitis C Council of New South Wales, 2003: 37). This is obviously a positive move at a number of levels. First, it will add to the stock

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of limited resources available. Second, the marginalization of those with hepatitis C will be addressed and countered by the identification of the hepatitis C infected body as nonetheless useful and available for sharing in the same way that other, ‘healthy’ bodies are. It is now possible for some people with hepatitis C to adopt an altruistic identity previously denied them. At another level, if organs can be circulated among people with hepatitis C, then our understanding of what constitutes public altruism can be refined. Organs emerge from this invitation as individual donations with uses to particular groups. People with hepatitis C can publicly donate their organs, but to a particular public, constituted by other people with hepatitis C. This too suggests further uses for recognition of these particularities and communities, and for our thinking around blood. As the study conducted here shows, blood is recognized as both universal and individualized, and blood donation as both universally available and vulnerable to appropriation by those who are not meant to do it. These polarized understandings have the capacity to marginalize further individuals and identities already assailed as morally suspect, as not quite citizens. Accounting for intimate and individual corporeality in models of citizenship broadens and enriches our understandings of the way private and public intersect. However, the imaginative construction of the altruistic, embodied citizen as blood donor seems also to risk a corollary of the bad or non-citizen, the donor who is not altruistic and who endangers the public sphere through inappropriate occupation of it.  Jeffrey Weeks writes that sexual citizenship accommodates newly complex questions about citizenship raised by HIV/AIDS, ‘especially about the degree to which the execrated and threatening person with a life-threatening syndrome who nevertheless fails to engage in “safer sex” can be fully included in the social’ (1998: 44). AIDS has inflected sex with not only political but civil obligations, imposing a need to balance individual needs and responsibility to others in a community of identity. A homological shift is revealed in the case of blood donation, an ostensibly civil practice constituted by intimate, embodied agents. Mostly without a political identity, drug users are nevertheless subject to the same questions of inclusion in the social, and their representation as damaging to the socius is mostly unchallenged. Sexual citizenship has been discussed extensively in the context of political mobilization, belonging, and moments of transgression and citizenship; the research conducted for this project discloses the tensions of belonging and identity in a context where these elements are absent or incipient. Alternatives to such tensions are possible: in the active recognition of blood donation as available to some people at some times and not others, and of blood Downloaded from bod.sagepub.com at Universitas Pendidikan Indone on May 12, 2012

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as neither wholly public nor wholly private. The moral capacity of blood donors should be recognized and valued, but so too should their membership of a particular community. Donors are not morally superior in a kind of generic way – they are located in particular networks of blood collection and processing, and the donating body is possessed of particular characteristics. Non-donors belong to a different set of networks and the non-donating body may be possessed of  different characteristics. It is not necessary to evacuate recognition of the altruism of blood donation to recognize these different categories of donors and non-donors. Theories of the self, and our intuitive understandings of what blood donation is, emphasize the embodied individuality that is inseparable from acts of public participation. The motives of blood donors cannot be subsumed under a single category of altruism, and public recognition and gratitude for donation need not preclude examination of the intersection of the public and private forces behind these motives. Equally, abstention from donation is not simple. Singling out drug users as threats to the category of the altruistic donor collapses distinctions between those who are not invited to donate and those who are invited but do not. But even these distinctions do not take account of the particularities of  the public and private spaces occupied by different non-donors. The convenient fiction that members of the public can and should donate to a public blood bank sits in tension with the recognition that the public is not singular, that donation is not always possible, and that normative judgements about donation vary and polarize according to the category to which donors are imagined to belong. Persisting with this fiction may reward those who donate, but at some cost to those who are not invited to donate – and to our understandings of the ways private and public are imbricated in blood donation. Notes 1. The study recruited 78 participants with different relationships to blood: ex- and current injecting drug users; blood donors; blood transfusion recipients; those with haemophilia and thalassemia; those with high occupational exposure to blood (ambulance officers); and those with hepatitis C acquired through means other than injecting drug use. The study was funded by the National Health and Medical Research Council to research the range of understandings of blood among these groups of people, and to use this knowledge in the formulation of hepatitis C prevention strategies and materials. The interview was semi-structured and took about one hour to complete. All interviews were taped and transcribed. Participants were de-identified and aliases were ascribed. Analysis of data was facilitated by the use of NVivo software. Codes were developed based on a sample of early interviews and adapted as the interviews progressed. Coded data were then sorted and retrieved according to the research question. This article focuses on the parts of the interview concerned with blood donation. The article makes clear if participants were donors, people who have received blood in a transfusion, or injecting drug users, although their status as current or former IDUs is not specified. Participants are identified as donors, non-donors, or injecting drug users, for

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while people in the last group are obviously either donors or non-donors their drug use, as we will see, is identified as important. 2. Cf. Healy: ‘We can think of blood donation as a special kind of volunteering that involves more than just money or time . . . the physical and symbolic nature of the gift of blood is what makes it attractive as the perfect example of altruistic giving’ (2000: 1641). 3. Kath Weston analyses media coverage of the 1997 blood drive for Betty Shabazz in New York and argues that the altruistic community response to that blood drive was predicated on an ignoring of the particularity of blood, made possible through the technologies of blood banking: ‘It is this warehousing of blood in an intermediate stop between bodies that allows blood transfers to be resignified to represent a timeless, depoliticised, universal solidarity’ (2001: 165).

References Anderson, Benedict (1983) Imagined Communities: Reflections on the Origin and Spread of Nationalism. London: Verso and NLB. Australian Red Cross Blood Service (nd) ‘Your Guide to Giving Blood’, URL (consulted April 2003) http://www.arcbs.redcross.org.au Cortiula, Mark (2001) Banking on Blood: A History of the Australian Red Cross New South Wales Transfusion Service. Walcha: Ohio Productions. Healy, Kieran (2000) ‘Embedded Altruism: Blood Collection Regimes and the European Union’s Donor Population’, American Journal of Sociology 105(6): 1633–57. Hepatitis C Council of New South Wales (2003) ‘The Most Precious Gift’, The Hep C Review 40(March): 37.  Johnston, Hank, Enrique Lanaña and Joseph R. Gusfield (1992) ‘Identities, Grievances, and New Social Movements’, in Hank Johnston, Enrique Lanaña and Joseph R. Gusfield (eds) New Social  Movements: From Ideology to Identity. Philadelphia, PA: Temple University Press. Titmuss, Richard (1997) The Gift Relationship: From Human Blood to Social Policy, expanded edn edited by Ann Oakley and John Ashton. New York: New Press. Waldby, Catherine, Marsha Rosengarten, Carla Treloar and Suzanne Fraser (2004) ‘Blood and Bioidentity: Ideas about Self, Boundaries and Risk among Blood Donors and People Living with Hepatitis C’, Social Science and Medicine 59(7): 1461–71. Weeks, Jeffrey (1998) ‘The Sexual Citizen’, Theory, Culture & Society 15(3–4): 35–52. Weston, Kath (2001) ‘Kinship, Controversy, and the Sharing of Substance: The Race/Class Politics of  Blood Transfusion’, pp. 147–74 in Sarah Franklin and Susan McKinnon (eds) Relative Values: Reconfiguring Kinship Studies. Durham, NC and London: Duke University Press.

kylie valentine is a Research Associate at the National Centre in HIV Social Research and at the Social Policy Research Centre, both at the University of New South Wales. She is the author of Psychoanalysis, Psychiatry and Modernist Literature, published by Palgrave.

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