Blood and AIDS: Fluid Labour of the Commercial Blood Procurement in Central China
Introduction
Blood, the fluid that transports nutrients and oxygen to our lungs, is an essential body part to sustain vitality and life. However, its meanings are distorted to carry pain under the postmodern condition that prioritizes commercialization over bioethics. A perverse biologic has dawned on us where the good life of one population can be bought by sacrificing the “bare lives” of another (Agamben, 1998). And this has demolished the vitality symbol of blood for some bodies that are legally yet unethically stripped of their bio-parts, leaving them under the shadow of sickness and social stigma, while their blood began circulating through the greedy and invisible hand of the market. As seen in medical anthropologies, bio-part trafficking constitutes a circulation of global inequality in the form of “neo-cannibalism” (Scheper-Hughes, 2004), which epitomizes the liberal discourse where individual subject’s selling of bio-parts is considered an autonomous and commercial act of free will while the beneficiaries are ethically sound with their right to good health regardless of the “bioviolence” (Moniruzzaman 2012) committed on vulnerable populations. This market exchange of bio-parts arguably inaugurates a form of labour, and in the case of commercial blood-selling, it is, namely, fluid labour (Shao, 2006).
Throughout the 1990s, in the central and southern rural regions of China, a mass population was either hunted by commercial blood collectors into participating in this fluid labour or coerced to take part in it out of financial destitution. Shockingly, this circulation of blood engendered a health catastrophe that accorded many rural regions the pejorative reputation of being “AIDS villages” (Erwin, 2006; Shao, 2006; Shao & Scoggin, 2009). This essay addresses the socio-economic factors behind the AIDS epidemic in central China caused by commercial blood transfusion and how the cultural implications of blood and AIDS were manipulated to sustain the rural residents after the “bloody business” toiled their bodies. I argue that fluid labour is a form of exploitative market labour which emerged under neoliberalism and is specifically aimed at subaltern populations lacking resources and information. I also argue that the state managed the affected populations by shifting the meanings of blood and AIDS to avoid blame and install stability.
This epidemic broke global news in the early 2000s after a series of governmental efforts to conceal it. With this epidemic's highly politically sensitive nature, few ethnographic accounts are available. In this essay, the first-hand data on rural AIDS patients are credited to Shao’s field research in Henan province (2006; 2009).
Liberalized Economy and the Emergence of Blood Selling
HIV/AIDS is transmitted through bodily fluids such as blood, semen, vaginal fluids, or breast milk. During the 1990s, in the central rural areas of China, an AIDS epidemic flamed up in the Henan province. The primary cause was commercial blood transfusion, making this epidemic a peculiar case.
The uniqueness of this AIDS epidemic lies in the ways of its transmission through blood selling during an economic transformation period in China, with the de-collectivization of labour and properties beginning in the 1980s. This movement coincides with the neoliberal process on the global scale, where welfare policies tightened, and privatized market competitions were encouraged to take the place of centrally distributed spending on public sectors such as health. In China, the rural commune system disintegrated, driving rural populations toward market labours, and shifting state responsibilities to families. Public health systems also disintegrated. With less public funding, the rural healthcare system had to rely on itself to generate the finances (Hayes, 2005, p. 14). Hospitals in rural villages had to set up “production quotas” analogous to the “household responsibility system” that promoted competition to sell services and products (Shao, 2006, p. 545). From 1980 to 2003, health expenditures grew 47-fold in billions while government spending on health experienced a steep drop. With four-fifths of rural populations not insured with health care, the expansion of healthcare income is mostly driven by private services (2006, p.546). Along with the marketization of the health industry, a plasma fractionation industry emerged with funding and support from the Ministry of Health out of a national shortage of blood products. Stations for commercial blood collections have grown especially more rapidly all over China since the state decision in 1984 to block imports of blood products from “capitalist countries” that are “potentially contaminated” with homosexuality and the health implications that come with it (2006, p.546-547).
Reflected in the rural regions, poorly managed blood-collection centers came with subpar technologies insufficient to maintain good sanitation standards. In some cases, needles could be used on multiple donors. The blood products would then be used in urban health centers for patients in need (Lu et al., 2005, p. 605). In total, more than 270 commercial blood collection plants were set up in Henan province alone (Erwin, 2006, p. 140). These collection plants were operated by both public and private health facilities, such as disease-control stations and private hospitals, located specifically in county towns to be close to rural donors who were more easily recruited (Shao, 2006, p. 547). The blood plasma collected by the facilities created a profitable revenue stream by supplying them to domestic pharmaceutical manufacturers of products such as albumin, which restores blood volumes in the circulatory system (Shao, 2006, p. 544). For the rural residents, the compensation per visit was often in the range between ¥20 ($2.4) to ¥200 ($24) (Erwin, 2006, p. 140). To supplement low incomes, some rural donors participated in selling twice a week, if not daily. After donations, the blood did not go through HIV testing and sometimes any testing for blood-borne viruses, making these products highly risky for any potential infections such as AIDS and hepatitis through circulation. To make matters worse for rural donors, they were sometimes reinjected with the pooled blood after plasma extractions of their donated blood (Wu et al., 1995).
Fluid Labour and the Commodified Blood
As the commercialized market grew to subsume the healthcare industry, bio-parts did not escape the fate of commodification. However, blood selling was never an innocently voluntary market activity analogous to the conceptual fair exchanges under a capitalistic economy.
Following Marx’s detailed analysis of labour and commodities, the blood-selling industry can be dissected along his conceptions of the capitalistic economic model (1867). To start with, commodities are finished products produced by workers’ labour. Once these products enter the market for exchanges, they become alienated from their producer as if divorced from their origin. These products are then labeled with monetary values subjected to the rules of exchanges that resemble their use-value instead of the social labour from workers. Similarly, insofar as the blood is sold on the market either as raw materials for pharmaceuticals or as a medical product ready for consumption by other patients, the “making” and donating of blood effectively constitutes a form of fluid labour (Shao, 2006).
In this case, the workers are the rural donors. The labour activity includes the continuous body functions that produce blood and the hours put in for health maintenance and blood extraction. However, as soon as the blood is extracted from its host bodies, it becomes obsolete entities separated from its previous owners. Even though at that moment, it can be traced back to the donor through biotechnologies, it quickly joins the blood pool with its distinctive identifiers of labourer or owner dissolved. However, unlike other commodities, blood products are made with raw materials from labourer’s body parts which carry significant symbolic meanings. If a person is only defined by their constituencies, such as memories and physical components, then the extraction of certain parts of it can never be reduced to purely uneventful market behavior. To put it differently, if blood is an inalienable bio-part of its hosts, then the commodification of it can always be subjected to scrutiny (Lock, 2002).
Further speaking, capitalistic exchanges presuppose workers to be doubly free, meaning they are free of means of production to subsist their own capital valorizations and that they are also free proprietors of their own labour powers. In this commercial blood collection industry, where plants were mostly set up in rural regions, the villagers were targeted precisely as they fit the definition of a ideal labourer in this “bloody business” perfectly. These rural residents are not categorized just socially but also bureaucratically determined by the household registration system passed down from the socialist era (Shao, 2006, p. 536). Being fixed by this structure of inequality, rural residents are socially stigmatized as less powerful and less educated. They are also economically ideal candidates for cheap labour in basic services of urban centers due to their lack of inherited means of production. So, the liberalized economy prefers their “free-willed” participation in market labour. Resonating on this point, some “blood heads” who were scouters on behalf of commercial blood collectors in big cities particularly recruit migrant workers on construction sites who came from rural regions (Shao, 2006, p.539-540). Overall, the commodification of bio-parts may have presented itself as a rational opportunity for cash. However, it was a ready-made industry intended to hunt down the doubly freed rural populations, echoing Scheper-Hughes’s (2004) neo-cannibalism.
The Cultural Meanings of Blood and the Social Implications of AIDS
Despite the commodified meanings of blood, it carries certain cultural meanings that imply corresponding social measures when the loss of it brings back viruses such as HIV.
As discussed in the earlier section, blood is an inalienable bio-part to its host that renders its commodification and implied alienation coercive. A similar understanding could be found in classical Chinese medicine, where blood and qi are both essences of health conditions. While qi can freely travel inside the body and around its field, blood is to be contained within the body. Blood loss then is considered to harm vitalities, such that women during menstruation are always regarded as in a stage of frailty (Erwin, 2006, p. 145). This concern for a potential loss of energy leads to reluctance when it comes to blood donations. Erwin’s urban interlocutors, educated Shanghainese, hesitated to give their blood away (2006, p.146). Similar sentiments are also found in Hong Kong, where blood is treasured to be essential in signifying kinship relationships (Holroyd & Molassiotis, 2000). However, under this broader cultural context that attributes kinship and health significance to blood, rural residents are still targeted for blood procurement, constituting the unequal structure in medical aid distributions which sources from the powerless to support the powerful.
To contain and justify the commercial plasma collection campaigned in rural areas, a shift of mindset is required. By encouraging rural residents to sell blood and plasma to supplement agricultural income, the state has manifested itself as a “custodian of life” (Shao & Scoggin, 2009, p. 31) that manages the population for profit. To cope with the blood product shortage, the liberalized economic ideology must be reinforced to transform the inalienability of blood to its host as an energy source and cultural symbol into the freedom that is presupposed in rational individuals to dispose of their bio-assets for capital gains. Once the AIDS epidemic broke out, it was then an understandable stance that the government took to hide the news for as long as it could. Because this epidemiological tragedy was not induced by any particular risky behavior of the individuals but the policy-level influences and the failed safety measures (Shao, 2009, p. 33).
From the denial of the epidemic and the shutdown of all commercial collection plants in 1995 to the public disaster management operations in the early 2000s, the state continuously manifested new ideological tools to contain its failures. Very interestingly, Shao’s interlocutors in one of the most severely impacted AIDS villages in Henan identified their infection of HIV as distinctively different from other cases. In short, they did not contract the virus from sex. Molecular epidemiology also confirmed this conception among villagers who proudly identify their contraction to be from blood contamination and not other sources. Specifically, plasma donors were infected with the viral strain, subtype B’ of HIV Type 1, which was predominantly discovered in HIV-positive drug users living near the borders of Yunnan province in the early 1990s (Shao, p.33). The villagers also further confirmed the distinctiveness of their infections through the media, where the HIV virus was depicted to be prevalent among homosexuals in the west and some drug users in southern China (Shao, 2009, p. 31).
This identification of AIDS to be wholly different from other countries implies a moral incentive that eases certain anxieties among rural patients. Even AIDS activism in China continued to reinforce this recognition of the epidemic to be political instead of morally corrupt. Instead of promoting contraception among the already infected rural populations, the focus was still centered on the “blood plague” (Shao, 2009, p. 39). One of Shao’s collaborators also claimed proudly that he continued to have sex without condoms because his partner believed condoms were only needed for commercial sex (2009, p.32). After all, the use of exceptionalism to cope with the consequences of AIDS was to substantialize stability through nationalistic sentiments. The villagers were enabled by the public discourses to gain moral assurance, largely through the othering of different kinds of AIDS infections in foreign countries, therefore achieving a certain degree of consolation by forming local solidarities on the uniqueness of blood transmissions.
Conclusion
The AIDS epidemic in the 1990s of China started under the liberalizing context that introduced market labour to rural populations and privatized the healthcare sector. Under the process of commercialization of bio-parts, blood procurement among rural regions emerged at the intersection of the unequal structure of resource allocations that extracts from the peripherals of urbanities to enrich the center and the liberal discourse in the capitalistic economy that presupposes doubly free workers. Nevertheless, the AIDS epidemic in China is highly political, with its stems from policy changes that nourished the industry for commercial blood products. In response, the state continued to conceal its failures and managed the consequences among rural residents by maneuvering the connotations of blood selling and AIDS to be economically rational, morally acceptable, and nationally exceptional.
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