Queering Foucault: biopower in MSM tissue donation policy

By A.W.Sully

This essay was originally written for the CHID class Biofutures. It was readapted and published online in Graphite Publications in Montreal. 
Michel Foucault, a French social theorist and historian of ideas, lectured on political power schemes. In feudal aristocracy and absolute monarchies, kings and dictators muzzle a limited power: “le droit de faire mourir ou de laisser vivre” (1) Sovereigns exercised their power by threatening and inflicting death. For example, Hammurabi’s ancient code mandated the execution of any caught robber.
Biopouvoir or biopower departs from and contrasts this medieval structure. The modern Western nation-state controls bodies, and subsequently populations, with the prerogative “make live and let die” (2) Regulation promotes health and productivity in the society and more importantly the workforce. For example, certain vaccinations are mandated in both public and private professions. (3)
The positive influence of biopower cannot be understated. I do not worry that coughing and spreading my cold will result in my beheading! But regulation of specific populations conceals oppressive sentiments, enters an area of bioinformatically-justified control, and seizes a false security.
Forms of oppression emerge from the implementation of biopolitical policy. This can, paradoxically, hinder the goal of biopower to promote life. The exclusion of men-who-have-sex-with men (MSM) in tissue donation policy in Canada and the United States acts as a paragon of this paradoxy.  
The disuse of MSM tissues primarily functions as a scientific measure for maintaining and cleansing the tissue and blood supply. The United States Food and Drug Administration (FDA) indefinitely deferred any male donor who has had sex with another man until this year (4) The policy’s installation occurred in 1983, when prevalence of HIV/AIDS surged and the virus’ origin remained misunderstood (5). After the adoption of tissue screening, MSMs remained barred from donating in the US. Likewise, the Canadian policy recently revised in 2013 limited donations for MSMs to five years after last intercourse.
Biostatistical information base and justify the exercise of power over MSM tissues. In 2010, gay and bisexual men accounted for an estimated 63% of new HIV infections in the United States (6). In a study of sexually transmitted disease (STDs) prevalence rates in heterosexual and homosexual men, the latter have higher rates of gonorrhea and syphilis (7). This likely results from a larger average number of sexual contacts and more potential sites of infection. With this epidemiological information, the policy continues to restrict MSMs from donating as a form of risk regulation.
Tissue and blood testing is not necessarily perfect and human error during tissue handling may occur. However, critics of the tissue policy argue the medical concern is no longer valid, as rigorous testings for known viruses are performed. It seems that the regulation superficially stands on potential risks and foundationally on politics.  
The exclusion of MSM donors does not necessarily promote life of the population. In “protecting” the tissue banks, the system of giving and selling tissues loses valuable blood, organs, semen, etc. from healthy individuals in the MSM group. With tissue scarcity, the exclusion of a population from this economy curtails the benefits for the general population. For example, the gap between tissue donors and individuals waiting for tissues grows and the blood banks empty (8). Yet, MSM donors have tissues rejected based on the population risk for HIV/STD infection. The application of population statistics on the individuals within that population limits the goal of biopower.
Although the US Food & Drug Administration and Canadian Ministry of Health ultimately control MSM policy, the power over the tissue and blood donor system is exercised from innumerable points. U.S. medical groups including the American Association of Blood Banks, and American Red Cross recommended that the policy be overturned. As one example, the New York City Council passed a resolution in April 2010 calling on the FDA to eliminate the ban on giving blood specifically, stating “This ban was based on prejudice, a knee-jerk reaction, and misunderstandings about the HIV/AIDS disease. Given the constant need for blood, it does not make common sense to prohibit donations from an entire population.” (9). The United States just adapted the ban in December 2014 to a one year waiting period for blood donation (10). Some European countries have instituted lifetime bans on blood donations from MSM (11).
The Canadian Blood Services justifies a five-year deferral period to maximize time – and amplify stigma – in identifying infectious disease. They argue that testing does not prevent disease transmission, citing the “window” of undetectable infection, lack of tests for agents like herpes virus type-8, and a case of HIV/hepatitis infection in four Chicago transplant recipients in 2007 (12).
Activists argue the policy should be more individualized, like Italy’s, in which potential donors are interviewed to screen for higher-risk donors, like people with multiple sexual partners or who report sex with intravenous drug users or prostitutes (10). This approach eliminates the paradox, limits oppression, and promotes life while honoring the reality of risk.
The use of biostatistics and bioinformatics, in this case, the population differences in rates of STDs, colludes with other forms of institutionalized oppression of the LGBTQIA+ community. By rejecting a population from this system of exchange, the bodies from the MSM population serve no productive use and hinders the intent of biopower. The example of MSM donation policy should resonate in other forms of biopolitical control, but more importantly, it should remind us of one last paradox: we must fight fire with fire, bioinformation with more bioinformation.


Works Cited

  1. Foucault, Michel. The History of Sexuality. Trans. Robert Hurley. Vol. 1. New York: Pantheon, 1978. Print.
  2. Hendricks, Christina. “Foucault on Beheading the Sovereign.”Prezi.com. 21 Apr. 2015. Web. 26 Oct. 2015. <https://prezi.com/wlkxwdtx97zn/foucault-on-beheading-the-sovereign/?utm_campaign=share&utm_medium=copy>
  3. Cole, Jared, and Kathleen Swendiman. “Mandatory Vaccinations: Precedent and Current Laws.” Congressional Research Service, 21 May 2014. Web. 26 Oct. 2015. <https://www.fas.org/sgp/crs/misc/RS21414.pdf>
  4. Consumer Affairs Branch (CBER). “Blood Donations from Men Who Have Sex with Other Men Questions and Answers”. Fda.gov. Retrieved 2012-07-20.
  5. U.S. Food and Drug Administration. “Questions about Blood.” Blood Donations from Men Who Have Sex with Other Men Questions and Answers. N.p., 19 Aug. 2013. Web. 24 Oct. 2014.
  6. “HIV Among Gay and Bisexual Men.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 21 May 2014. Web. 21 Oct. 2014.
  7. Aral, S.O., Kevin, A.F., and King, K.H.. “Sexually Transmitted Diseases in the USA: Temporal Trends.” National Center for Biotechnology Information. U.S. National Library of Medicine, 26 Dec. 2005. Web. 24 Oct. 2014.
  8. “Want To Give Back This Thanksgiving? Canada Still Needs Blood.” The Huffington Post. Web. 26 Oct. 2015. <http://www.huffingtonpost.ca/2014/10/09/canada-blood-supply-donations_n_5961404.html>
  9. “Legislative and Community Report”. New York:New York City Council. 30 April 2010. page 2.
  10. Tavernise, Sabrina. “F.D.A. Easing Ban on Gays, to Let Some Give Blood.” The New York Times. The New York Times, 23 Dec. 2014. Web. 26 Oct. 2015. <http://www.nytimes.com/2014/12/24/health/fda-lifting-ban-on-gay-blood-donors.html>
  11. Wilson, Kumanan, Katherine Atkinson, and Jennifer Keelan. “Three Decades of MSM Donor Deferral Policies. What Have We Learned?” International Journal of Infectious Diseases: 1-3. Print. <http://www.sciencedirect.com/science/article/pii/S1201971213003081>
  12. “MSM Policy.” Canadian Blood Services. Web. 26 Oct. 2015.<https://www.blood.ca/en/msm>


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