Negotiating risk-group categorization and the co-production of blood safety: the evolution of sociotechnical imaginaries mobilized in the public debate on the deferral of men who have sex with men as blood donors in Belgium

Abstract

To ensure safe, sufficient supplies of human blood for European medical practice, national blood establishments reconcile the social image of blood donation with technical risk calculations/deferral policies. The sociotechnical controversy concerning the deferral of “men who have sex with men” (MSM) serves as a pre-eminent case of this challenge. Drawing on the framework of sociotechnical imaginaries, we developed an interpretive case study of negotiation on the deferral of MSM in policy discourse and the public debate between the implementation of the first EU Blood Directive (2003) and the relaxation of lifetime deferral to 12 months in Belgium (2017). We analyzed recurrent arguments made by stakeholders through the High Council for Health policy recommendations, public communications of Red Cross Flanders, and the public debate evidenced in Belgian newspapers. Instances in which MSM deferral is negotiated are part of the co-production of blood- and donor safety. This process allowed to adapt the dominant epidemiological imaginary shaping blood supply risk governance practices in four phases: classic epidemiological imaginary, challenging key elements, contentious debate, and re-adjustment. Deferral became recognized as preclusion from this institutional opportunity to demonstrate high moral virtues. This sociotechnical controversy will likely resurface, as sexually active gay men continue to be deferred.