Category Archives: HIV behavioural surveillance

Thinking with Pleasure

I’m off to Norway to give some workshops and a couple of talks about my research at the University of Oslo.  I’m excited to have the opportunity to meet researchers and students from the schools of public health and medical anthropology there.  I’ve organised the workshops around my work on pleasure, digital sex, HIV prevention and harm reduction – and I’ve attached the outline here: thinking-with-pleasure-norway-workshops.  It will be a great opportunity to workshop these pieces so I can pull them all together, as they’ll form the basis of the monograph I’m due to deliver by the end of the year: The Gay Science: Intimate Experiments with the Problem of HIV

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Filed under Affect, Antiretrovirals, Devices and technology, Engagement with medicine, Erogenous zones, HIV behavioural surveillance, Masculinities, Medicine and science, Online meeting sites, Parties, PNP culture, Policy and programs, Self-medication, Sexual practice, The statistical imagination, Uncategorized

Gay Sex and Drug Use Demand Better, Less Phobic, Forms of Attention

Review of Chemsex

(2015, dir. Gogarty & Fairman, Pecadillo Pictures & Vice Productions)

 

3 December 2015

Our relation to drugs is highly ambivalent ­– and understandably so. The Ancient Greeks captured this instability with their concept of the pharmakon, which they used to refer to those things that can function as both poison and cure: their identity is unstable.

The instability of drugs has been used again and again to condemn them. We’re much more comfortable attributing stable identities to drugs and categorizing them as either good or evil. But as Isabelle Stengers has argued, our desire to categorize drugs definitively “allows the question of the appropriate attention, the learning of doses and the manner of preparation, to be done away with”.[1] This is a problem, because the propensity for a drug to be good or dangerous depends precisely on these considerations.

 Chemsex, Intimacy and Paranoia

I was reminded of the fundamental ambivalence of drugs when I watched Chemsex, the recently released documentary that explores gay men’s use of drugs for sex in London, UK (dir. Gogarty & Fairman, Pecadillo Pictures, 2015).

It’s the dangerous end of this spectrum that the documentary Chemsex takes as its principal focus: the film sets out to investigate what it describes as a “hidden healthcare emergency” in London. We’re introduced to guys who slam [inject] the amount of crystal meth that would last most users several days in a single hit. We see disturbing interviews of men in the midst of crystal meth psychoses, or in the throes of the intense euphoria having just injected methedrone (a drug rarely seen in Australia, unlike crystal meth).

While the film presents footage of a variety of different drug practices, it’s injecting (rather than the much more common habit of snorting, or smoking methamphetamine) that features most prominently in the film, and the eerie soundtrack by Daniel Harle trains the viewer to lump all these practices together as the same, disturbingly abject and sinister, phenomenon.[2]

For those unfamiliar with gay fetish scenes, this effect would be compounded by the documentary’s graphic footage of gay BDSM activities and group sex.

For those less fazed by such practices, the participants’ openness to allowing straight male documentarians to film them is probably the real source of astonishment. But then, when people are high on psychoactive drugs, they’re prepared to do a lot of things they’d normally be reticent about, as Chemsex in general amply demonstrates.

 Relocating Partying

The topic has received a flurry of attention and alarm in British public health circles recently, but the phenomenon itself is not new: it’s been a source of concern and excitement in urban gay centres in the West for over a decade.

In the early 2000s drugs such as crystal methamphetamine and GHB replaced ecstasy as drugs of choice for a subset of gay men, while the internet replaced socializing as the most common way of looking for sexual partners. In this context, it became possible to party at home and cruise for partners without going out in public. Activities that once took place at saunas, dance parties and cruising grounds were gradually relocated to private homes and became much easier to organise and more accessible from these locations. The communal pleasures of the dance-floor gave way to the erotic intensities of sex on drugs, which – for many enthusiasts – seemed to cut to the chase at any rate.

But many of us gays miss dancing, and the changing geography of gay partying has also given rise to new dangers – indeed, sometimes very serious ones. It’s hard to know when to ‘call it a night’ when there’s no risk of the DJ stopping playing, and drugs like crystal meth can keep you buzzing for days. Not only is crystal easy to integrate into domestic practices and everyday routines, it seems designed for repeat administration (just ask truck drivers or computer workaholics). In short, it’s frighteningly easy to become dependent on it for a range of different purposes.

Meanwhile, taking too much G can cause users to lose consciousness, become comatose and (in the worst-case scenario) die. Unlike some clubs and dance events, private homes are rarely equipped the right care and emergency services to prevent these occurrences. In their own ways, then, each of these drugs demonstrate the critical significance of “the learning of doses and the manner of preparation”, to recall Stengers’ comments.

 Sex in the Era of HIV/AIDS

There’s a lot to be learnt from Chemsex about the complexities of gay sex in the wake of the HIV epidemic, which has ravaged this community for the past 30 years. Despite the availability of effective treatment and much better therapeutic prospects for people living with HIV, gay men are still processing the traumatic effects of the epidemic and its cultural impacts on sexual desires, fears and intimacy. For at least some men, drugs seem to provide the most ready-to-hand contemporary solution to the age-old question, ‘how to have sex in an epidemic’. (But this must ultimately an indictment on the state of sex education today, which tends to be organised around reproduction rather than the practicalities of achieving sexual happiness, especially when it comes to the desires of non-heterosexuals).

For some gay men growing up in this context, drugs facilitate a process of what psychologists call ‘cognitive disengagement’ from the many fears and stipulations associated with having sex in the shadow of HIV/AIDS. [3]

For other gay men, these substances are simply valued for much the same reason that many in the wider community value alcohol: They can make sex more fun, sensual, intense, uninhibited and/or easier to negotiate.

The film does an excellent job of conveying the difficulty of fostering intimate or effective relationships when the process of arranging sex is divorced from other social contexts, as it is on digital platforms – and the dangerous effects of the isolation some men experience as a consequence.

We meet David Stuart, the founder of the pioneering program at 56 Dean St (a London sexual health clinic) that provides much-needed services to gay men who find themselves in trouble as a result their drug use for sexual purposes combined with this sense of isolation.   As Stuart reports, hook-up apps and websites have made chemsex much more visible and easier to access in the course of looking for gay friends or sexual partners in the city.

What the film neglects to mention, though, is that chemsex remains a minority practice within this population,[2] and that many app-users remain quite capable of exercising what they believe to be the best judgment.

Chemsex also provides us with rare accounts of what people enjoy about sex on drugs and the happiness and connections it has allows some men occasionally to develop. Rarely, though, does it take these accounts at face value. More often they seem to be framed as delusional. But this is it’s mistake. These ‘good’ experiences are precisely the reason that some men continue to use these drugs in full knowledge of their dangerous possibilities in some situations.

Against the idea that drug use is always the product of some state of reckless abandon, there is fascinating footage in the film of the careful lengths some men go to arrange group sexual encounters that are consensual, pleasurable and free of unwanted dangers.

One fellow organising a sex party at his home even goes to the trouble of drawing up a detailed timetable to schedule his guests’ G consumption as a way of ensuring their safety. Indeed, the film could have said much more about the techniques and ‘manners of preparation’ some gay men have devised to occasionally enjoy the pleasures of drugs, while keeping themselves and their partners relatively safe from harm. Indeed, these techniques are much more interesting and important to their practitioners than the film seems prepared to give them credit for.

 Unconstructively Moralizing

Unsurprisingly, normative morality about both sex and drug use is centrally at play here. Chemsex is framed in such a way that the many pleasures associated with illicit sex and drugs are only ever allowed to emerge as dangerous. The spectacle of non-normative sex and illicit substance-use gives the film an ominous tone that works against a more constructive treatment of its subject matter.

If you want to get a sense of how moral fears about gay sex are being exploited to frame our emotional responses to Chemsex, imagine setting the film’s creepy music as the soundtrack for a documentary about the activities and excesses associated with popular mainstream events like Melbourne Cup, or St Patrick’s Day, or Anzac Day. I guess it would make a good comedy. But most garden variety, casual drinkers just wouldn’t take it seriously. Nor should they.

By treating the drugs it deals with as inherently bad, and stabilizing the pharmakon in this way, Chemsex ultimately fails to find an appropriate “register of attention” to deal with its subject matter. For this reason, I worry that the film runs the risk of doing more harm than good, by further marginalizing the vast majority of occasional users (not to mention casual sex enthusiasts).

This is a great shame, because people’s emotional and social circumstances change, making them much more vulnerable to some of the situations the film deals with, which are undoubtedly concerning.

Despite the (presumably) good intentions of the directors, what Chemsex demonstrates most powerfully is that the complexities of gay sex and drug use demand much more careful, creative, open and intimate forms of attention.

Ultimately, Chemsex sells gay men out and deprives gay drug users of even the slightest sense of agency by portraying them as inevitable victims of their own – “pathological” – sexuality.  In this sense, the makers themselves put it best: “It’s a horror story”.

 

****

The original, truncated version of this review was published in The Conversation

Footnotes

[1] Isabelle Stengers (2015) In Catastrophic Times: Resisting the Coming Barbarism. Lüneburg: Meson.

[2] Rates of injecting are much higher and have increased much more steadily in London compared to Sydney gay men, among whom they have remained stable at around a third of the 11% of gay men who have used crystal meth at all in the last six months in community samples for some years now. In 2014, only 4% of gay men surveyed report regular use of crystal meth (defined as ‘at least monthly’). The findings of these surveys are presented here.  Some experts attribute the higher rates of injecting among gay men in London to the availability of the drug mephedrone, which is much more painful to snort than most other uppers, but rarely a part of chemsex practices in Australia.

[3] See Race, K. (2009). Pleasure Consuming Medicine: the queer politics of drugs. Durham: Duke University Press, Chapter 7.

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Filed under Affect, HIV behavioural surveillance, Masculinities, Online meeting sites, Parties, PNP culture, Police, Policy and programs, Self-medication, Sexual practice

The Gay Science

Intimate Experiments with the Problem of HIV

I’m in the throes of preparing my manuscript for Routledge on gay sex and HIV prevention in the pharmaceutical and digital context

And I think my aha! moment has finally struck me.  My key wager is that science and related knowledge practices should both be guided by, and promote, an embracing of the pleasures some seek in sex.

Because science, too, is best when it feels the risk of its involvement – but also acknowledges its investment in – being transformatively affected by its encounters, experienced as events.

The determining question is the range of feelings one activates in response to such events.

I’m using this proposition to frame a range of social scientific and gay male sexual responses to HIV/AIDS in our digital times. What happens when we treat the sexual and social practices of affected groups as situated experiments and consider how they get articulated with the problems HIV science and policy put forward?

My thinking derives much of its energy from bringing the later work of Foucault on problematisation and ‘bodies and pleasures’ into conversation with A.N. Whitehead’s adventurous definition of events.

For an early experiment with this, see my piece ‘Reluctant Objects’ in the first edition of GLQ this year, 2016.

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Filed under Affect, Antiretrovirals, Books, Engagement with medicine, Eroticism and fantasy, HIV behavioural surveillance, Medicine and science, Parties, PNP culture, Policy and programs, Random thoughts

Reluctant Objects, out now

My piece on PREP and sexual pleasure has now been published in the first ed of GLQ this year.  Linked here for those who can’t access through uni libraries.  Hope you enjoy!

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Exceptional Sex

How does crystal meth participate in the continuing experience of HIV among gay men, and how have responses to HIV shaped gay men’s crystal meth use and surrounding practices?  The topic recurs with surprising regularity in gay community discourse:  We’ve had a number of excellent community forums on this issue in Australia in the last few months alone – and seen the production of some useful resources locally and internationally – yet some of the themes, findings and positions taken in these forums have persisted for a decade if not more.

Exceptional Sex was an attempt I made in 2007 to make sense of the evolving construction of “the Tina epidemic”, or whatever you’d like to call it – #WiredPlay, #Chemsex, #PNP, the “double epidemic”.  Each of these terms have tried to do the work of naming, in different geographical contexts, what nevertheless seem to be some common patterns and emerging forms in urban gay scenes internationally.

I’m sharing Exceptional Sex here because I think the analysis if offers remains topical, but the text itself is hard to access in electronic form.  (You can always buy the book  hint hint – Pleasure Consuming Medicine (Duke UP 2009), where the essay was later published).

But I’m also curious – what’s changed?  what’s stayed the same? what’s missing? where do we go from here?

What can we make of this issue?

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Filed under HIV behavioural surveillance, Masculinities, Online meeting sites, Parties, PNP culture, Policy and programs, Self-medication, Sexual practice, The statistical imagination

The Difference Practice Makes: Evidence, articulation and affect in HIV prevention

This paper considers the difference that a conception of sex as social practice has made to the relations articulated in HIV social research in Australia.  In defining sexual practice as “fluid, embedded in specific social formations, and involving the negotiation of meaning” (Kippax & Stephenson, 2005), social researchers put their own research categories and questions at risk by constructing situations in which their objects of research were given occasions to differ.  Taking this risk produced sharp insights about the evolving dynamics of the sexual and prevention fields and produced distinctive, interesting findings.  It enabled the articulation of the practice of “negotiated safety” and later strategies of HIV risk reduction emerging from gay men’s practice, for example.  I draw on Latour’s (2004) concept of articulation to make sense of these innovations and query some of the key distinctions that organise the field of HIV research:  qualitative/quantitative; social/biomedical; subject/object; human/nonhuman; interpretations/evidence.  In the present context, I argue that keeping HIV prevention effective, engaging and interesting will require ongoing attention to the embodied articulation of HIV relations.

[This post is the abstract of a paper of mine just submitted to AIDS Education & Prevention.  Should be of interest to HIV prevention geeks and potential prevention geeks mainly ; )]

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Provocative Objects

Things are moving fast in the world of HIV prevention and sexual practice, with the introduction of new techniques such as Treatment as Prevention and Pre-Exposure Prophylaxis (billed as ‘a pill a day to prevent HIV infection’) being purposed for prevention purposes.  While the latter is not yet available in Australia, it has been the subject of a whole lot of controversy as well as some very provocative and creative cultural production in North America, including the My Life on PREP series by blogger Jake Sobo, who gives a fascinating account of how his perceptions, experiences, practices and theorisations of risk change as he starts using the drug for HIV prevention.  He really accounts for himself as a sexual subject “in process” and the result is both fascinating and informative.

promiscuous

If that wasn’t creative enough, check out this recent  Youtube clip, “The Key” adapted from one of Jake Sobo’s blogs, that positions PREP as an intervention into the forms of shame, sexual judgement and aversion to stigmatic identification that circulate in gay male domains like the online world and which could be seen to hamper effective HIV prevention.  Most of us know the territory, but as far as confronting these things, it’s been a while since I’ve seen an intervention this bold.  There’s much to admire about this clip – the funky  beats, the uncompromising confrontation of online dynamics and interaction, and the sharp analysis of how investment in normative ideals of intimacy can precipitate forms of self-deception around risk and sexual practice.

What I am less sure about is the invocation of PREP as THE key  – as though an exclusive – way of solving this problem of sexual stigma, shaming and aversion. I have huge admiration for this intervention, and I  have also been very interested in the provocative powers of PREP,  but I’m  keen to hear people’s responses to this clip.  How well does it handle your concerns about PREP?  What does and doesn’t it deal with?  What else might one need to know to consider engaging with this preventive strategy?  What issues or concerns does PREP raise for you?

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