Symposium: Still warm, still moist and still intensely human: social aspects of a changing response to HIV

Date: Thursday, 31 March 2016
Time: 1.45 pm – 3.00 pm
Location: Seminar Room 2
Chair: Daniel Madeddu, Director, Population Health Programs, Centre for Population Health, NSW Ministry of Health
Speaker(s): Martin Holt, Asha Persson, Kane Race, Darryl O’Donnell

Associate Professor Martin Holt, Centre for Social Research in Health, UNSW
m.holt@unsw.edu.au

Dr Asha Persson, Senior Research Fellow, Centre for Social Research in Health, UNSW
a.persson@unsw.edu.au

Associate Professor Kane Race, Department of Gender and Cultural Studies, University of Sydney
kane.race@sydney.edu.au

Mr Darryl O’Donnell, ACON
dodonnell@acon.org.au

In 1993, the Victorian AIDS Council/Gay Men’s Health Centre published ‘Because it’s warm, it’s moist and it’s intensely human’, a report by Bruce Parnell on why gay men were “still practicing unsafe sex”. Its title was a cheeky riposte to the endless studies of the time that sought to identify personality or contextual variables associated with unprotected sex. Soon, the phrase negotiated safety would be coined, and later, we would speak of gay men’s adaptations to HIV. In 2016, we are experiencing a period of transformative change in the possibilities of HIV prevention and in the responses of communities. New prevention and testing technologies, and new understandings of HIV treatment, bring with them the opportunity to end HIV transmission. HIV treatment as prevention and pre-exposure prophylaxis have the potential to re-shape social relations between those living with and without HIV, and gay men are talking about their sexuality and fears of HIV in new ways. But these possibilities rest upon human adaptations and HIV remains, in the words of Susan Kippax and Martin Holt, a profoundly social disease. What have 30 years of HIV social research taught us that can assist us to understand the current moment? What questions arise from these new possibilities and new adaptations? What do we need to know in order to fully realise the potential that new understandings, technologies and responses present?

Mr Daniel Madeddu: Chair’s welcome (5 mins)

The Chair will welcome the audience, outline the symposium objectives and format, and introduce speakers.

Associate Professor Martin Holt: The more things change, the more they stay the same? Reflecting on 25 years of HIV social research with gay and bisexual men (12 mins)

The social research response to HIV in Australia has followed the practices of gay and bisexual men for over 25 years. This research suggests that for every innovation in testing, treatment or prevention technology, gay men have responded with vernacular strategies, beliefs and practices, often at odds with the intended uses of the technology. For every helpful or protective innovation in practice we can see the parallel emergence and continuation of practices that appear to offset preventive benefits e.g. seroguessing, optimism about oneself or one’s partners, and various forms of stigma. Why would we expect it to be different in the current moment? And are we doing enough to assess the impact of biomedical prevention on shifting norms and practices?

Dr Asha Persson: Biomedical prevention and serodiscordant sexuality: Researching intersections and upshots (12 mins)

Serodiscordant couples are considered key candidates for the biomedical prevention technologies of TasP and PrEP. This presentation highlights how qualitative research can reveal diverse and sometimes unanticipated responses to prevention interventions. Drawing on in-depth interviews with serodiscordant gay couples, I use "pharmaceutical citizenship" as a conceptual tool to examine how TasP and PrEP were mobilised, embraced and resisted by the couples in different ways and with multiple effects. Broadly, TasP enabled a powerful sense of social and sexual eligibility that exceeded mere disease control. But this pharmaceutical citizenship was not uniform or uncomplicated; it was also challenged by negative partners' disinterest in PrEP, by questions around trust and the distribution of responsibility in couples, and by censorship and criticism in online and offline social environments, marking out old and new positions in the contemporary biomedical prevention age. As these findings show, biomedicine and lives intersect in ways both desired and unforeseen by the HIV sector, highlighting the importance of understanding these through socially situated research.

Associate Professor Kane Race: Biomedical Prevention and Counterpublic Health (12 mins)

Biomedical prevention is proposing radical new redefinitions of sexual safety as well as new imperatives for community education and service provision. But some of these redefinitions interfere with habits that have historically configured the good gay citizen (condoms, marriage). The desire for equality spawns homonormative desires to dissociate homosexuality from culturally undesirable practices such as promiscuity, drug use, sex work and HIV/AIDS. But this leads to further stigmatization of those most at risk of HIV infection and contributes to avoidance of care on the part of these subpopulations. I argue that new modes of research and criticism are necessary to realise the aims of biomedical prevention.

Mr Darryl O’Donnell: Because it’s thick and sticky: Why we need social research to End HIV (12 mins)

Community advocacy for better HIV public policy has seen Australian governments progressively reshape our domestic HIV policy settings since 2012. Demands for better testing options and technologies, PrEP, and easier, cheaper access to treatment, has seen renewed focus on supply-side problems in HIV. Our governments' responses deserve credit. What, however, of our communities? How are we to understand this advocacy and these demands? If thirty years of HIV social research has taught us anything, surely it is this: communities lead and we recognise, learn from and act upon their adaptations in retrospect. This is the story of negotiated safety, of post-AIDS, of revaluations of risk and it will be the story of Ending HIV. In each of these moments, social research has helped us to understand and intervene in communities' responses to HIV. Governments and research institutes face an immediate task of further engaging scholars from under-represented disciplines and encouraging the use of novel methodologies so that we can understand the large-scale community adaptations to HIV currently occurring. In this presentation I offer a community perspective on the pressing need for a critical and diverse and deeply social social research program and propose the beginnings of an agenda for research that can assist our communities in Ending HIV.

Mr Daniel Madeddu: Moderated audience discussion

The Chair will facilitate an extended discussion arising from the brief presentations.