Reluctant objects

This is the introduction to a paper I am developing for this week’s HIV Social Research conference, Silence and Articulation, on the topic of Pre-Exposure Prophylaxis.  Would love to hear any input or thoughts you may have on the topic!

Update: Here is a link to a DRAFT COPY of the full paper.

To see a live version of this paper delivered as guest speaker of the CIHR Social Research Centre in HIV Prevention, Social Drivers Speakers Series on 11 April 2013 in Vancouver, visit Reluctant Objects

This is a speculative paper that attempts to make sense of gay men’s relation to Pre-Exposure Prophylaxis (“PREP”).  It emerges from a series of encounters and an overall impression, based on my participation in gay culture, of what I would venture as a surprising state of disengagement with PREP.  PREP, I will argue, takes the shape of a reluctant object: an object that may well make a tangible difference to people’s lives, but whose promise is so threatening or confronting to enduring habits of getting by in this world, that it provokes aversion, avoidance, even condemnation and moralism.  I will suggest that thinking about gay men’s engagement, or rather dis-engagement, with PREP stands to tell us much about gay men’s self-understanding as subjects of risk in the present moment of the HIV epidemic: If, for Althusser, interpellation describes the ‘hey you!’ moment when a person recognises themselves as a subject of official discourse, we might approach this topic as an inquiry into uninterpellation: the conditions in which one is led to turn away, to linger in a state of non-confrontation, to avoid recognising oneself as a subject of risk.  The object of PREP also forces us to contend with what scares us, not only about risk, but about sex: the ways in which condoms, for example, have operated in the citizenship arena not only as a latex but also a symbolic prophylactic  against the terrifying prospect of unbridled homosexuality.

By positioning PREP as a reluctant object I do not mean to suggest, of course, that PREP is an unproblematic object, or that concerns about PREP are unfounded.  It is certainly the case that PREP poses considerable challenges with regard to its effective implementation, use, and resourcing, that are by now well recognised in the international field.  The issues of non-adherence, risk compensation, unwanted toxicity, and the possible development of resistant virus in the context of sero-conversion and suboptimal treatment are real and must be addressed.  However, in this paper I bracket these concerns, primarily because these are not the concerns I have encountered when raising the issue of PREP with HIV-negative sexual partners and friends.  People outside the HIV sector haven’t even got that far in thinking about it, in my experience.  Rather, what I am attempting to understand is the affective reaction with which news of PREP is often greeted: a reaction of aversion – often powerful aversion and repudiation – among men who are otherwise familiar with, and often have sensible and well-considered approaches to, the challenge of HIV prevention.  Understanding this reaction may be useful for thinking through how to present PREP to the relevant publics, and have the added advantage of framing HIV prevention as a matter of affective attachments and investments: i.e. how people come to attach themselves to particular objects, practices, devices, identities and positions in their attempts to avoid HIV infection.


Filed under Affect, Antiretrovirals, Devices and technology, Engagement with medicine, HIV behavioural surveillance, Medicine and science, Self-medication, Sexual practice

8 responses to “Reluctant objects

  1. Geoff Honnor

    In my view, it’s an unusually well-founded speculative paper; ‘yes,’ to all of that.

    Attitudinal surveys of gay men offer significant support for your case as well – PEP good/PREP WTF? – is a pretty typical finding.

    There’s little informed public (i.e. non HIV sector) understanding of – or interest in – the evolving epidemic dynamic and that in turn has led to a remarkable persistence of pre 96 perspectives on everything from treatments (shocking, toxic) to living with HIV (a uniformly twilight world of penitential suffering with the enormous anal cancers of the NYCDOH&MH prevention campaign’s fevered imagining, a satisfactorily retributive flourish).

    We in the HIV sector have been complicit in sustaining the silence, I think for no other reason than we’ve never been able to find a way to publicly acknowledge the span of lived HIV experience without imperilling funding, advocacy and prevention imperatives.

    So the issue you identify as central – “is this all so these guys get to go back to doing the stuff that got us into this?” – resonates just as powerfully with and in gay men as it does with the public health. Too much sex is bad –apparently- and yet, unhelpfully, no-one has thought to suggest a level that might be ‘good.’

    On a more optimistic note, in ‘Dry Bones Breathe’ , the late Eric Rofes declared in a section titled ‘low risk promiscuity’ (which sounds to me about as plausible as decaffeinated coffee) that he’d personally restricted his celebration of the gay men’s tribal rite of committed butt munching to no more than four occasions per year. I note it hasn’t caught on.

  2. Cheers Geoff. For those who haven’t see the campaign Geoff mentioned, check out this link

    So much to say about this campaign that it deserves its own post. Effectively, the New York Dept of Health chucks a brown-eye at men who have sex with men and calls it health promotion.

  3. Ross Duffin

    Interesting Kane. When I first heard of PEP I had lots of reservations. It also happened when I first heard of PrEP. From talking, those reservations were wide spread and I think you could probably construct a few quite different ‘explanations’.

    Once PEP became available and widely discussed beyond the limited confines of the AIDS sector those reservations shifted. PrEP availability is slightly more complicated, and ‘threatening’, but my guess is once implemented the reservations will shift as well.

    Both PEP and PrEP are ‘endorsed’ by our medical establishment. However rapid testing is on the whole not supported – and self-testing causes ‘medical hysteria’. If we are to modernise our attitude to what HIV is (a treatable STD that’s complicated and has a lot of baggage attached to it) and get rapid testing available here then it will probably require getting gay men on board (and for a campaign to work probably making it an issue of discrimination rather than sexual freedom). Sadly, the ability of the sector to do that has proved limited – not that it’s necessarily easy.

  4. Cheers Ross. I think there are some policy reservations that might usefully be distinguished from some personal reactions/reservations to PREP among people who might stand to benefit from it. It was these latter reservations I was trying to explore in this paper – by asking how PREP appears to interfere with, or poses a threat to, other attachments that have people have developed to cope with the threat of HIV (like condoms) even when those attachments might be difficult to maintain or embody as habits. I’m interested in how difficult it might be for some people to confront themselves as subjects of risk, and also unsanctioned sex (e.g.UAI) in the mode of predictability and intentionality that PREP seems to presume. This is an issue that is raised by PREP but probably has broader significance and applicability.

  5. Pingback: @ THE WARNING: Transformer les réticences en action : positiver la PrEP | lifetripp

  6. Pingback: Provocative Objects | homotectonic

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