I finally placed my order for the highly anticipated first book from Australian cultural studies extraordinaire, Kane Race. If you have any investment in Public Health, HIV/AIDS, drug use, and conceptions of biomedical power, you must read this book. Very interesting use of the notion of counterpublics here, with Kane's "counterpublic health." Here's the book's description:

On a summer night in 2007, the Azure Party, part of Sydney's annual gay and lesbian Mardi Gras, is underway. Alongside the outfits, drugs, lights, and DJs is a volunteer care team trained to deal with the drug-related emergencies that occasionally occur. But when police appear at the gates with drug-detecting dogs, mild panic ensues. Some patrons down all their drugs, heightening their risk of overdose. Others try their luck at the gates. After 26 attendees are arrested with small quantities of illicit substances, the party is shut down and the remaining partygoers dispersed into the city streets. For Kane Race, the Azure Party drug search is emblematic of a broader technology of power that converges on embodiment, consumption, and pleasure in the name of health. In Pleasure Consuming Medicine, he illuminates the symbolic role that the illicit drug user fulfils for the neoliberal state. As he demonstrates, the state's performance of moral sovereignty around substances designated "illicit" bears little relation to the actual dangers of drug consumption; in fact, it exacerbates those dangers.Race does not suggest that the use of drugs is risk-free, good, or bad, but rather that the regulation of drugs has become a site where ideological lessons about the propriety of consumption are propounded. He argues that official discourses about drug-use conjure a space where the neoliberal state can be seen to be policing the "excesses" of the amoral market. He explores this normative investment in drug regimes and some "counterpublic" health measures that have emerged in response. These measures, which Race finds in certain pragmatic gay men's health and HIV prevention practices, are not cloaked in moralistic language, and they do not cast health as antithetical to pleasure.

Kane's prose is sometimes a bit dense, but it's often truly revelatory. Here's what my professor and mentor David Halperin has to say:

"Kane Race's Pleasure Consuming Medicine supplies what we have missed for so long: a radical but responsible exploration of both the ethics and the politics of pleasure. Exhilarating in its daring and its intelligence, startling in its originality yet completely sensible in its interpretations, the book unerringly describes the paradoxical world where we now live out the cruelties and ecstasies of human embodiment."--David M. Halperin, author of Saint Foucault and What Do Gay Men Want?

In short, what are you waiting for? Order a copy!

Via AIDSMap -- just confirming what was already widely suspected:

The two sexually transmitted infections most strongly associated with HIV acquisition in gay and bisexual men are anal warts and anal gonorrhea, Australian researchers report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

Herpes infections did not emerge as significant in this study, but men with warts were three times more likely to acquire HIV, and men with gonorrhea were seven times as likely. The authors suggest that more frequent screening for anal sexually transmitted infections in gay men should be investigated as a means of HIV prevention.

Interesting that herpes was not correlated. If you're unaware, STIs like gonorrhea can increase risk for transmission for a number of reasons. In cases where STIs cause lesions (like syphilis or HPV), these sites become more vulnerable for transmission. Also, in general, it seems that co-infection with STIs can dramatically increase your HIV viral load, thus making it easier to transmit the virus. In this study, it seems that these infections are also highly correlated with unprotected anal intercourse -- thus there's a reason men with these infections were more likely to acquire HIV.

A new study modeling results from other data sources indicates that well over half of new HIV infections in five major metro areas (Baltimore, LA, Miami, San Francisco, and NYC) among men who have sex with men can be linked to their primary partners (e.g. boyfriends, lovers, husbands, etc.).

Here's the basic 411:

Methods: We modeled HIV transmissions, using data from MSM in five US cities from the National HIV Behavioral Surveillance System, the HIVNET Vaccine Preparedness Study, and other published data. Annual HIV transmissions were estimated by partner type (main or casual) and by sex type (receptive anal intercourse, insertive anal intercourse, or oral sex).

Results: Sixty-eight percent [95% confidence interval (CI) 58-78) of HIV transmissions were from main sex partners because of a higher number of sex acts with main partners, more frequent receptive roles in anal sex with main partners, and lower condom use during anal sex with main partners. By sex type, 69% (95% CI 59-79) of infections were from receptive anal intercourse, 28% (95% CI 19-38) were from insertive anal intercourse, and 2% (95% CI 0-5) were from oral sex. The model-based estimated HIV incidence rate was 2.2% (95% CI 1.7-2.7) per year. Sensitivity analyses demonstrated estimates of transmission from main sex partners as low as 52% (95% CI 41-62) and as high as 74% (95% CI 68-80).

Conclusion: According to our model, most HIV transmissions among MSM in five US cities are from main sex partners. HIV prevention efforts should take into account the risks of HIV transmissions in male partnerships, and couples-based HIV prevention interventions for MSM should be given high priority in the US HIV prevention research portfolio.

We've known for sometime that a great deal of HIV transmission risk can be located not just within anonymous partners (as the sex panic around HIV would indicate), but also within their primary relationships. I talk to many men who engage in short-term, serial monogamy and opt out of condom use very quickly in the relationship. I didn't find it in my quick read of the article, but it's not immediately obviously how "main partner" got defined as they use it -- e.g. how long a relationship would qualify.

Also of note here is the grave disparity between RAI (receptive anal intercourse) risk and IAI (insertive AI) risk -- 69% of infections were the result of RAI, while 28% were the result of IAI. Obviously, reporting is a concern here (stigma may push some to report IAI instead of RAI) -- but it's worth noting the chasm between the two. Although as someone mentioned in the discussion on CHAMP's listserv, this disparity isn't as a gross as we might expect it given the data we generally rely on that says that the risk disparity is more like a factor of 10 difference.

In any case, we should seriously consider implications for this data in the way we approach prevention in the US. Australia started doing couple prevention eons ago (the famous "Talk. Test. Test. Trust." campaign), and the US is quickly catching on -- there are numerous efforts being developed or already underway. But data like this highlights that the epidemic doesn't neatly fit many people's preconceived notions that link STI's with unabashed promiscuity.

If you have journal access, you can find the article here in the journal AIDS.

New research out fo the University of New South Wales in Australia supports what many HIV/AIDS researchers had suspected for years now: circumcision reduces the risk of contracting HIV for gay men who predominately "top" (e.g. are the insertive partner in anal sex). Obviously, this does not impact us bottoms.

Here's the news:

Sydney - Circumcision can help protect gay men from contracting the virus that causes HIV/AIDS, researchers in Australia have found. "We have shown for the first time that men who predominantly take on the insertive role in sex are less likely to contract HIV if they have been circumcised," David Templeton, from the University of New South Wales, told an international gathering in Perth.

The Sydney-based researcher said his team studied 1,426 HIV-negative men, two-thirds of whom were circumcised, and tracked their HIV infection over four years.

While circumcision did not reduce the HIV risk overall, the study found men who predominantly took the insertive role had an 85-per-cent reduced risk of contracting HIV if they were circumcised.

Templeton warned against any notion that circumcision provided protection, noting that most HIV infections were contracted in the receptive role, not the insertive role.

Circumcision provides some protection because it removes the foreskin which is prone to lesions, which in allow the virus to enter the body through the penis.

Now the question is, do we want to sacrifice 1000s of nerve endings, better orgasms, and pleasure in the face of this data? I'm not so sure.

And State funded, by the way! The message: "When we play, we live the sensation. By using condoms and testing regularly for STIs, and remembering that the more partners we have the more often we should be tested, we reduce our risk so we can give into the moment."

Sexxxy!

After I posted a photo of a quite sexy Brazilian prevention campaign here a few days ago, my friend Michael -- who is a wonderful researcher from Australia -- sent over a few examples from Australia. They were all provocative, but I thought this one in particular was quite striking for its use of interactive media on the internet - and for its thoughtful design.

Check out the image below. It's a screenshot I took of the page featuring "Michael's Story" -- which includes several really interesting sections -- "Panic Attacks"; "Mega Slut"; "Jewish & Gay"; "Euphoria"; etc. What I like here is the complexity allowed for in gay men's lives. The fact that two of the predominant themes -- religion and promiscuity -- can be featured alongside each other without any seeming contradiction. It's really quite an interesting site -- even if it had nothing to do with HIV! Ch-check it out!

I have the great privilege of writing from my hotel room in Philadelphia, PA where I'm attending the 2007 LGBTI Health Summit. This was an annual organizing event and, really, political movement that Eric Rofes worked hard to put together year after year. In his absence this year, there's a great deal of rumbling over what the future has in store for this conference, and the movement for LGBTI health as a whole (gay men's health, in particular of course).

I also had the great privilege of spending a great deal of time getting to amazing, wonderful, and inspiring activists and thinkers like Tony Valenzuela, Michael Hurley, Bill Jesdale, the French activists from WARNING, and Amber Hollibaugh. These folks made this summit one of the most academically rich and thought-provoking weekends of my life. I owe them a great deal. If America had just one HIV social science researcher like Michael Hurley from Australia, we would be a much better place. His thoughtful presentation on gay men's intensive sex culture was mindblowing. What a treat!

I also was honored to present my thesis work here at the conference under the title "HIV Panic and Young Gay Men: Preliminary Results from an Exploratory San Francisco Study." It really turned out to be a lot more about gay communities, sexual shame, and then of course about fear of HIV for young gay men. I was really pleased with how my presentation came together - I kept making changes in the days during the conference before my own workshop was scheduled. Add some sex here - a bit more about desire there. The feedback and support from my colleagues was nothing short phenomenal. I hope I can post the slides from the presentation here soon!

Anywho, must sleep. More conferenceing tomorrow! Then back home to SF tomorrow night.