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June 1, 2009

How did I get here?
FILED UNDER: "Our So-Called Lives"
TAGS: Daniel Reedersgay men's healthHIV PreventionMichel FoucaultsyphilisTed White
By Daniel Reeders

How did I get here!? Not writing on Trevor Hoppe's blog - for that I have Michael Hurley's introduction and Treviana Hoppington herself to thank - but sitting on a panel in Sydney, at a national forum about gay men and syphilis, asking myself this question.

Here's the concise version: I do social marketing and policy analysis at a PLWHA organisation in Melbourne, Australia. I joined an AIDS Service Organisation as a refugee from law school, having decided that really wasn't how I wanted to spend my life. I left the ASO after a year -- it was not a safe place for someone who cannot help but question -- but I was hooked on HIV, and before long I was back, working for a different organisation and a manager who encourages me to ask difficult questions.

Two main themes have bookended my time in the role -- syphilis and stigma -- and in my presentation to the forum I managed to combine the two. I argued we should not shy away from targeting "sexually adventurous" men with messages in honest language about their greater risk of exposure to syphilis -- even if that's ultimately thinking the issue in risk groups rather than risk practices.

The risk practice for syphilis infection is touch, so that's not a useful approach. For the "Other STI", we normally talk about "regular" testing and treatment, and recommend testing "more often" if you have "lots" of partners. But that's begging the question. How long is a piece of string? With syphilis in Australia, not enough men are at risk to justify asking every gay men to test every three months, so we end up talking about a subset anyway.

Apart from law, I trained in cultural studies, so I'm comfortable talking and thinking about sexually adventurous subculture, and I was arguing we need to look for 'cultural markers' in enhanced surveillance to guide our campaign, testing and treatment strategies.

Moments later, my former manager stood up to declare the concern with sexually adventurous men is really deficit thinking driven by moral panic about the 'Sexual Outlaw' and in fact men of 'every stripe' dip in and out of sexual adventurism. I have to summarise his argument from memory, as he reneged on his offer to provide me with a copy of the presentation, saying it remained embargoed.

It's a classic culturalist argument about the contingency, fluidity and dynamism of identity practice, and it got me thinking about a quote Trevor posted a few weeks back, about my beloved Michel Foucault:

Of course the social world includes the cultural, it includes the realms of discourse and symbolic representation, but the cultural is not all there is to the social. The distinctively social has to do with questions of social structure but also situated social practices. [my emphasis]

That's a glorious piece of exposition, alright. And it summarises everything that (for me) went wrong in the Nineties liberal arts obsession with identity and labels and representational politics. They only considered the cultural half of the equation.

Coming back to that forum, it's just implausible to posit a cultural reaction against sexual adventurism that doesn't generate possibilities and constraints for social interaction and identity practice. It's also a huge mistake to overlook the social rituals and barriers that make it difficult or impossible to 'dip into', say, crystal-smoking sexual networks.

To the extent we routinely describe this stuff as 'fluid' and 'dynamic', I would suggest that's true only in relation to the glacial pace of social research. One of my key informants now teaches fisting classes, and he points out he didn't go out one night and decide to sit on a fist -- he took nine years to learn how. It took my own social network several years to adapt to the introduction of crystal meth in the chemical repertoire of some of our number, and for a while there it got pretty ugly, with the suspension of our normal rules of care and hospitality according to who felt uncomfortable smoking what in front of whom.

And those are the fault lines across which knowledge transmission does not occur, leaving a core of identified players with expert knowledge (and the distortion of risk perception familiarity creates) and a loose fringe of occasional visitors unaware of what they don't know. It's not deficit thinking to point out the informational asymmetries and inequities, or to identify the power relations inherent in them, or the potential for HIV transmission. It's our job as campaign and health promotion strategists to do that.

(On this point I'm in furious agreement with Yale epidemiologist and cultural theory skeptic Ted White's recent contribution [registration required] to the Gay Men's Health Summit forum. I just differ in thinking you should do the research to map those fault lines before you start building interventions across them.)

So how did I get here? Funny story. It was a first-year law subject, a mandatory History & Philosophy of Law subject, that introduced me to cultural studies, critical theory, queer theory - it was heaven on a plate. You know the type of subject where they try to inoculate you against the intellectual blinkerage of professional socialisation? In HPL (pron: "hipple") this was called Learning To Think Like A Lawyer. And blow me down, it worked. I maintained a critical distance, a Foucaultian skepticism, all through my law degree, culminating in a flame-out in my final, research year. Inoculation is bad, y'all. So now I fly interstate to present on syphilis, and my parents wonder where it all went wrong.

PERMALINK | Posted at 10:11 AM | Post a Comment (2)

2 Comments

A lovely piece, dear! Very helpful linkages to the cultural constructionism bit. You should explore that more in a lengthier piece perhaps for publication in an academic journal. I think you've pointed to an interesting division of knowledge and power that certainly relates to Michael Hurley's recent work on intensive sex party subcultures.

I think what your coworker was trying to do was to make sure that the stigma of the subculture could not easily adhere to a known group of players, and his best method of diffusing that stigma was to claim that there was no such core group that we could acknowledge as a coherent, relatively static (or at least momentarily tangible) entity. But as you say, this may indeed prove false if we actually bothered to map those divisions in a meaningful way. I believe Hurley has already been up to some of that, no? In any case, it's certainly an important practices that we need to advance. I'd imagine ethnography would be the method of choice here, but I suppose you could get at the knowledge in other ways (and the IRBs in the US would have a conniption at the idea of an ethnography of sexual subcultures).

I, for one, am increasingly moving towards turning the eye of research back on public health rather than keeping it focused on gay men. But that's for another post, another day.

Author Profile Page Trevor User Profile | June 1, 2009 1:37 PM


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