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July 12, 2010

Queering HIV Prevention: An Interview with Kane Race
By Trevor

kane_race.jpgThere are scant few thinkers out there publishing critically productive work in the field of HIV prevention and public health more broadly. I have long been a fan and avid consumer of Australian Kane Race's scholarship. His analyses of HIV prevention, drug policies, and public health more broadly are beautifully incisive and incredibly helpful for anyone invested in thinking critically about these complicated issues. He is a master of explicating the taken-for-granted, and making you see what before was obscured. In his latest book, Pleasure Consuming Medicine, he continues to advance his concept of "counterpublic health" -- a concept built on the work of feminist and queer scholars invested in understanding oppositional public spheres. I had the pleasure of interviewing Kane recently for this blog, and I'm thrilled to share his thoughts here. We talk about public health, HIV prevention, and his challenging concept that aims to shake up our conventional understandings of these complex phenomenon.


Question: In both published essays and your recent book, Pleasure Consuming Medicine, you've advanced a concept you term "counterpublic health" - a concept that of course borrows from Michael Warner and other scholars' work on the concept of "counterpublics." Can you talk a bit about that original "counterpublics" concept, and how you came up with the idea to adapt it to your critical work on health?

A counterpublic has a critical or oppositional relation to the public. It's a term that queer and feminist scholars are using to refer to collective contexts of discussion, debate and performance in which we forge oppositional interpretations of our identities, interests and desires. The term is useful because it references the venues, media and forms of circulation which help constitute a sense of collective political agency. It also points to the exclusions and ideological dimensions of the public sphere proper - and hence the necessity of developing alternative spaces in which critical understandings and strategies can emerge.

"To refer to these fields of public health as counterpublic health is, first of all, to register the disastrous impact of these mainstream ideological investments on the health and life chances of the groups thus stigmatized - queers, sex workers, drug users. It is to critique moralized notions of 'the public,' and think about how they affect our work."

For me the term is immediately useful for thinking about those areas of public health where mainstream investment in a moral ideology compromises the ability to respond effectively to public health needs. HIV prevention is an obvious example. Drug education and policy is another. In both of these fields we have a situation where political investment in a particular idea of public membership (e.g. family values, a drug-free nation, etc.) thwarts rational responses to public health. Ideological investment in these figures consistently obstructs efforts to conduct education (for example queer-friendly, sex-positive HIV prevention education) and institute services (such as needle and syringe exchange provision) which are known to be effective in improving the life chances of affected groups. To refer to these fields of public health as counterpublic health is, first of all, to register the disastrous impact of these mainstream ideological investments on the health and life chances of the groups thus stigmatized - queers, sex workers, drug users. It is to critique moralized notions of "the public", and think about how they affect our work.

The concept of counterpublics is also useful because it pushes us to think about the collective contexts and modalities through which alternative strategies develop. So much health work and health education today advocates individual solutions to public health problems. But if we think about the early response to HIV/AIDS, it is quite clear that much of its success depended upon creating a shared horizon of concern about the threat, as well as specific contexts of collective self-activity. Nancy Fraser talks about the journals, bookstores, conferences, conventions, festivals, lectures, educational programs, and events which make up what she calls a feminist counterpublic. I began to picture the multiple public contexts that people have activated and engaged in order to undertake HIV education and prevention - the media, working groups, drag shows, conferences, blogs, sex venues, erotic performances, public forums, dance parties, research centres, internet sites, phone-lines, bars and service organizations. These spaces of collective activity have been crucial for the undertaking of HIV prevention. They've enabled us to transform our bodies, practices, and pleasures without denying or eliminating them. In order to develop reflexive contexts around stigmatized practices like gay sex and illicit drug use, it has been necessary to create public or semi-public forums for the acknowledgment, discussion and remodeling of these practices. In his work on counterpublics, Michael Warner also draws attention to the discourse pragmatics of different spheres of public address and performance, and this opens up an important set of questions for people engaged in HIV education and prevention. Questions like, how does this particular format/venue/event engage bodies, and what possibilities does this open up for collective reflexivity about certain risks and/or practices?


Question: How is this concept of "counterpublic health" useful in your own work, and how do you hope others will take it up?

I think it helps define a broad field of public health practice and understand the conditions in which certain public health initiatives operate. This field is characterized by a tension between public morality and what I like to call practical ethics of public health. One of the first lessons of health promotion, for example, is that education works best when it is couched in terms of the values, vernacular and practices of the group in question. But when it comes to HIV prevention or drug harm reduction, this necessarily involves an acknowledgement of practices that are difficult to acknowledge (without scandal at least) in the conventional public sphere - practices like gay sex or substance use. Paradoxically, public morality makes those initiatives which are most likely to connect with the relevant groups in effective ways most at risk of political intervention.

"The concept could be used to describe any public health work that discovers that it is necessary, as part of its project, to challenge hegemonic ideas of average personhood and create new collective contexts for the airing of otherwise stigmatized practices."

The scenario is familiar. An educational campaign or service which is explicit about drug use or gay sex gets picked up by a tabloid newspaper. Moral outrage ensues and the story dominates talkback radio for a couple of hours. The minister's office panics and condemns the organization that produced the resource. It's a constant possibility. And it is very damaging because it compromises the ability of health promotion practitioners to engage people at the level of their concrete embodied practices.
Counterpublic theory is useful here because it understands this dynamic as a product, in part, of the mass media's mode of address: the presumption of the reader as a member of an imaginary national family unit that is white, heterosexual and drug-free. This is the ideal with which we are encouraged to identify our deepest interests at the hands of this form of address. But it's a fiction, in the sense that it is based on untested presumptions about the average reader or listener or voter. So while many readers may not actually organize their lives in this way, this image of the public takes on a forceful reality which counterpublic health practitioners must contend with all the time. Counterpublic theory provides a useful handle on these dynamics and encourages us to think about the constraints and possibilities inherent in different scenes of circulation and modes of address - and develop new ones. The concept could be used to describe any public health work that discovers that it is necessary, as part of its project, to challenge hegemonic ideas of average personhood and create new collective contexts for the airing of otherwise stigmatized practices.


Question: I met you back in 2006 for the first time at the "Against Health" conference here at Michigan. Should we be against health? Does the concept of "counterpublic health" help answer that question?

One of the things that conference did well was highlight the use and abuse of the term health. Health is tricky like that: it's just as likely to evoke moral criteria as practical criteria around wellbeing. But "morality" does not always amount to healthiness, and frequently moralism has distinctly unhealthy effects. I think it's unfortunate that, because the term is so frequently abused, many of us find ourselves in a situation where we start believing that we are, indeed, "against health". To be sure, health is only one concern among many, and it is not always the most pressing one. But I agree with the conference organisers that our efforts to live longer, happier, more pleasurable lives would be greatly enhanced by bringing some critical force to bear on the ways in which the term 'health' is exploited to pursue other agendas. Counterpublic health may be a useful concept here, because it describes the situation of doing public health work in a context where hegemonic ideals of sexuality, personhood and citizenship are loaded against you. I don't think we are or should be against health, but frequently queers are constituted in precisely that way.


Question: There is a long history of both collaboration and tension between public health practitioners and HIV activists. They've been the best of friends and the worst of enemies at times. I wonder how you see that relationship evolving today, both in Australia where you work and more globally?

I think that today most HIV activists work within the frameworks and institutions of public health, and they do some very good and very important work there. Certainly this is the case in Australia. But I wonder how well the discourses and paradigms of public health are able register the importance of critical sex education, which has been a crucial component of the community response to HIV/AIDS. I think we need more than the professional frameworks of public health are able to offer if we are to sustain effective forms of HIV prevention. We need to promote literacy and reflexivity around sexual practice, and this is not necessarily something that public health specialists are particularly well trained to do, or that is easy to register within the professional frameworks of the field. Sexual practice is infinitely more complex than is recognized in public discourse, and the risks it gives rise to are often disguised or distorted by our desire to identify with normative forms. There's a critical literacy around sex, health and stigma that has developed within communities responding to HIV/AIDS that is worth sharing with people who are new to gay life. I don't know how you argue for a critical focus on heteronormativity as part of HIV education within official institutions of public health, but I think that's an important dimension of our work.

"How do we equip people to think flexibly and creatively and astutely about their sexual practice and intimate lives? What forms of pedagogy can be developed to this effect?"

In some ways, the concept of counterpublic health is my response to this situation. It is designed to conjure a critical "outside" to given institutions of public health while recognizing that most of our HIV activist talent is now fully immersed within these institutions. I want the concept to signal the practice of connecting with subcultural knowledge and queer critique, and to convey the importance of keeping that connection alive. How do we equip people to think flexibly and creatively and astutely about their sexual practice and intimate lives? What forms of pedagogy can be developed to this effect? I think these are crucial questions.


Question: In one of your forthcoming articles, you talk about the "risk of HIV prevention." Can you talk a bit about what you mean by that?

I use that phrase in my paper "Engaging in a Culture of Barebacking: Gay Men and the Risk of HIV Prevention", which first came out in 2007 and is being reprinted this year in HIV Treatment and Prevention Technologies in International Perspective, edited by Mark Davis and Corinne Squire. The article is concerned with the way risk is measured in the prevention sciences, and the effects of the mismatch between gay men's HIV prevention practices "on the ground" and what's identified as risk within the science. Barebacking is the case in point. I was amazed to discover that most of the initial articulations of barebacking in the US media from 1995 were made by HIV positive men, speaking about unprotected sex with other HIV positive men. There's no risk of newly infecting an HIV-negative individual with HIV in these circumstances. And in fact this strategy is even promoted today in some US contexts as serosorting. But these men were denounced as deliberate risk-takers at the time because they were talking about breaching the condom code. In the moral panic that ensued, the concerns around HIV prevention that were actually informing the practice got lost. I'm interested in the extent to which mainstream behavioural science was complicit in this process.

"In failing to attend to the cultural categories and practices according to which gay men are organising their sex lives, behavioural science misses innovative HIV prevention practices and mislabels them as risk."

The risk of HIV prevention which the title refers to is the risk that, in failing to attend to the cultural categories and practices according to which gay men are organising their sex lives, behavioural science misses innovative HIV prevention practices and mislabels them as risk. This promotes an image of gay men as intentional risk takers, irrespective of the precautions and conditions that actually animate their sexual practice. I think this is what has happened in the case of barebacking, and the effect has been to produce unprotected sex without condoms as a thrilling transgression of public health norms. When in fact it needn't be, and in some contexts it is actually quite safe.

More broadly, I think there is a related risk that current practices of HIV prevention, including social scientific practices, can't quite grasp the relationality of liminal practices like sex and drugs, and end up reifying the idea of the rational choice-making individual as the subject of these practices. Sometimes we overemphasize the intentionality of sexual actors, when it seems to me that part of the appeal of sex and drug practices, at least on some occasions, is a certain losing sight of the self. I think there's something important about the focus on relationality and liminality in these approaches that needs further elaboration. We need to develop better ways of accounting for sex and risk which take this dimension of erotic experience into account, without pathologizing it. I'm hoping that grappling with this problem may produce some new and better ways of doing practice-focused sexuality research. But this is an ongoing project.


Question: What do you think needs to change about the way public health approaches HIV prevention?

Well, that's a difficult question to answer, because public health approaches HIV prevention differently in different contexts. But I think this would be one area. We need knowledge practices that are better attuned to the cultural categories according to which people are organising their sex lives and which are better able to account for the relationality and variability of sexual practice. Sexual practices, drug practices and prevention practices change - in the context of new technologies, new environments, and new circumstances. I think HIV prevention needs to keep in touch with these changes if it wants to remain relevant and responsive to those groups that are most at risk. There is a lot of emphasis in the international field today on determining the predictability of interventions. I think this emphasis is misguided, given what we know about historical and cultural change. Instead we need research methods and pedagogies that promote both individual and public responsiveness to the unpredictable situations that inevitably emerge.

"I think sex education needs to be a central part of HIV prevention education, and it needs to go beyond biological descriptions of anatomy and risk to provide opportunities for reflection on the dynamics of specific sexual contexts and relations if it wants to equip people to protect themselves and each other effectively."

I've talked about the need for critical sex education as a feature of HIV prevention programs. There is a great deal of resistance to this internationally. Indeed, one of the drivers of official enthusiasm for very expensive trials of Pre-Exposure Prophylaxis around the world at the moment seems to be the promise PREP holds out of avoiding difficult public discussions around sexual practice, drug use, and gendered relations. I think sex education needs to be a central part of HIV prevention education, and it needs to go beyond biological descriptions of anatomy and risk to provide opportunities for reflection on the dynamics of specific sexual contexts and relations if it wants to equip people to protect themselves and each other effectively. The same could be said for drug education. We need a less moralizing approach to drug education and service delivery that de-pathologizes people's desire for pleasure and proceeds pragmatically from that point.

I also believe that public health needs to resist current trends towards criminalizing HIV transmission. Sex is a relational practice. It takes place between two or more people. In criminalizing HIV transmission and non-disclosure of status, the criminal law produces a sense of HIV-positive individuals as exclusively responsible for HIV infection, and this in turn promotes a false sense of security and protection for HIV-negative individuals. So while one may well find willful or reckless transmission ethically troubling, there is a technical and practical question here about whether criminalization is an effective way to promote public health (not to mention a shared response to HIV). There is already a wealth of knowledge in the field about the negative public health effects of punitive strategies. Punitive strategies constitute individuals as stigmatized subjects; make them less likely to access services; promote evasiveness and disavowal; and reduce people's capacity to care for themselves. They also promote a climate of distrust, suspicion, hostility and fear - the very opposite of an enabling environment for public health. I believe public health needs to continue to insist on HIV prevention as part of its ambit, and not a matter for the criminal code.


Question: Many scholars today have trouble with the notion of social change, in part because both the foundation for advocating for that change and the notions of "progress" and "justice" have been so thoroughly challenged and at the very least made slippery. And yet, of course, many of us got involved in academia with some hope of our scholarship actually making some kind of impact on the world around us. How do you approach this problem?

Hmm. I think social change is already happening - sometimes very rapidly, sometimes quite slowly, always with complex implications - and the challenge is to work out how it is happening, and intervene in ways that you think will be productive. We have a habit in the HIV field of separating the concept of "science" from "intervention", but as someone who has been involved in the HIV field in various ways for almost 15 years now, I am utterly convinced that knowledge practices matter: they are performative - which is to say they are intimately involved in the production of certain realities over others. I've seen this happen. Science is intervention, whether we like it or not. So for me your question is a qualitative question. That is to say, if scholarship is already having an impact on the world around us, then what sort of impact is it having and how could things be improved?

"To me, to articulate and teach critical theories of sexuality is to develop one counterpublic space among others."

And for me this raises methodological questions. I'm attracted to fields like cultural studies because they provide models of embodied scholarship and a context for reflecting on practices of embodied scholarship which I find more promising, politically and ethically, than research methods which require you to cloak your subjectivity at the door as a condition of entry. I find it bizarre for example that we have so many people working in the HIV field (and also the drugs field) who are participants in affected communities but who are blocked if not actively discouraged by the professional or scientific frames within which they work from reflecting, as part of their work, on their experience in any structured or sustained or critically informed way. We need to be producing spaces and contexts for this to happen! In the mainstream field, it now seems as though "research" and "community" are conceived as entirely distinct domains, the first completely disembodied, the second increasingly tokenistic. We should refuse this binary. We need participants of affected communities to be engaged in critical reflection and research about the conditions and details of their experience, and for the knowledge they produce through this process to be taken seriously as part of policy debate. For the past couple of years I have been putting most of my energies into developing a large undergraduate course in sexualities here at the University of Sydney. There is nothing more exciting than seeing a student begin to pick up the tools of queer studies and cultural theory and start to use them to understand their world and their experience of it. I think the new generation of sexuality researchers will be critically astute, engaged with social policy, and produce work that is both conceptually innovative and empirically informed, and grounded in their experience of the world. Certainly, these are attributes I hope to foster in my teaching.

To me, to articulate and teach critical theories of sexuality is to develop one counterpublic space among others. And many need to be developed. Like other cultural researchers, I try to work at various interfaces and engage with multiple publics - some academic, some pedagogical, some policy-related, some popular, some subcultural - where the aim is to participate in debate and develop new ways of understanding, and therefore acting upon, experience. It's true that academic work has a quite specific field of circulation, but it connects to many others. One would hope that by identifying and giving weight to certain under-articulated or hidden forms of experience, new spaces for thought and practice - and new possibilities of responsiveness - open up.

PERMALINK | Posted at 11:58 AM | Post a Comment (4)

4 Comments

thanks! this is an awesome interview!

Author Profile Page Scott User Profile | July 12, 2010 3:12 PM

Great interview! Thrilling to read ... Thanks Trevor and Kane. I miss you both.

Tony

Author Profile Page Tony Valenzuela User Profile | July 13, 2010 9:49 PM

I had never heard of counterpublic health before. Important oppositional concept. Thanks.

BTW one of the reasons that public health workers are discouraged from reflecting on their experience as targets of public health campaigns may originate in the class nature of the 'noble' professions 'helping' the 'downtrodden masses'.

Author Profile Page Sean McShee User Profile | July 25, 2010 5:26 PM

We came to a simple-minded habit of binary thinking, here in 'the Western technological world', by many paths. Insightful discussions of 'embodiment' and 'subjectivity' attempt to overcome binaries of reason and emotions, mind and body, etc. Phenomenological insights and techniques attempt to overcome binaries, and other inauthentic divisions, of human reality (gender, age, wealth, etc) and life with the world (species, well being, etc). Bentham helped propel modernity toward utilitarian configurations of society to manage - in his view - the 'two masters' (yet another binary) of humanity - pleasure and pain - which we often conceive as internal states, to achieve, or to avoid. And, so, lots about our economy and society (broadly conceived, or conceived in segments and sub-segments - e.g. a particular urban gay male society ) have become oriented toward achieving pleasure, and avoiding pain. Pursuit of health is also often handled in this way. The author's (and interviewer's) discourse, here, help highlight the troubles with these binaries - which is a wonderful service! - while not thoroughly unraveling or exploding the binaries, or shining a light very far down the path to move us forward (but then, that is not for only one or two people to discern). A new pedagogy about sexuality is very much needed, queers might substantially agree; and this is one example of a 'counterpublic' strategy ( defined anecdotally as "doing public health work in a context where hegemonic ideals of sexuality, personhood, and citizenship are loaded against you"). One (among many) helpful possibilities of this concept may be to re-conceive the binary of pleasure and pain, as communal rather than individual, and reflections about This would be a superb existential project for queer folks to undertake, if we are able. But, reflections upon pleasurable self-actualizing embodiments of 'a gay community' in a dance party through changed self-consciousness, may not offer the suffering world - including suffering queers around the world - much to thrive on. At a recent opening of a rural Virginia center for popular education - very much influenced and supported by queers - a speaker from SONG - Southerners on New Ground - related an important question realized during SONG's year long 'listening tour' among queers in the American South: why do many gay Southerners struggle for months, or even years, to save money to go to a 'big city' Pride, or Circuit party; to enjoy themselves 'as gay', for so brief a time? One response of SONG has been to employ an analysis that attends to longing for local community, accessed through the 'tools' of speaking of one's desire, vision, and dreaming, and hearing these voices from the many intersections of gay community, with special care to include those usually not heard - rural gays, gays of color, poor and working class gays, gays across the age spectrum, etc. This is a moral adventure that may help describe pleasure communally: as self-regarding, other-regarding, and world-regarding. We'll see what happens.

Author Profile Page edwardnvirginia User Profile | July 30, 2010 10:21 PM


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