Discussion: Knowing the sexual-health subject differently
During the course of a New York based pilot study (2016-2017), we drew
from multiple sources of data to investigate gay and queer identifying
men’s social-sexual health practices at the nexus of virtual worlds and
technologised HIV prevention strategies (particularly, Pre-Exposure
Prophylaxis).The different data entry points included digital
ethnography on cruising/dating apps, reading through participants’
biweekly social-sexual health diaries, follow-up interviews, and the
experimental visual based methodology we named Embodied
Mapping13. In the process of the pilot, it became
evident that methodological choices were productive of different
discursive-materializations of participants’ self-understandings,
embodied sexual-health practices, socio-spatial-sexual histories and
entanglements with public health discourses and biomedical and
communication/mediatic technologies. In other words, each research
engagement brought researcher and participant into different
epistemological and material relationships with phenomena central to our
research study - HIV risk, risk management, and their entanglements with
virtual-real-time social-sexual intimacies.
A Case illustration: Ian’s embodied sexual-health experiences
read through the different methodologies of our pilot serves as
illustration. Ian is a mid 20’s black, gay identifying man. An
epidemiological approach would categorise Ian as belonging to a
population group at high risk for HIV infection. As of 2017, the Center
for Disease Control reported that black/African American identifying gay
and bisexual men ”accounted for 26% of new HIV
diagnoses”30. Key social determinants of health
contribute to these elevated risks: the legacies of racist violences
against black/African American communities, lower levels of HIV literacy
in comparison to the general population, and due to socio-economic or
migratory status, black queer/gay and bisexual men are more likely to be
under or uninsured, making access to prevention and care difficult.
Certainly, a SDH approach is a helpful entry point for understanding
Ian’s vulnerabilities and responses to HIV risk. This form of
epidemiologically driven knowledge, affirmed through conventional
approaches to cultural humility allows the researcher/practitioner to
tease out the tensions between Ian’s social-identity markers, his lived
racialized experiences and privileges as a USA born gay-citizen. As we
learned from his interviews and diary writing, Ian’s social identities
and sexual health histories criss-cross epidemological facts. He has
secondary education, no employer paid access to health coverage, and
rudimentary levels of knowledge about current HIV prevention
technologies and public health. In the interviews, we learnt that Ian
made claims to being a responsibilized sexual citizen; By his own
admission, he always ”plays safe” - a vernacular expression originating
in public health discourse to signal a belief in using condoms and/or
other negotiated sexual practices to prevent HIV transmission. From the
sexual diaries, we also learnt that Ian was embedded in digital and
real-time sexual-social networks nurtured, to an extent, by a public
health call for PrEP uptake as an HIV prevention technology. In Ian’s
narratives, gay pornographic web-mediated imaginaries were
simultaneously present with his experiences of sexual rejections and
attractions based on his racial presentation. A reflexive stand that
considers the broader socio-cultural determinants of health is attuned
to analysing the cascading effects of power on Ian’s life and on his HIV
prevention strategies. However, we were left wondering whether there
were other meanings and bodily affects that troubled his felt sense of
”being safe” in excess of what this framing could highlight, or whether
the phenomena of safety and risk that we were trying to grasp wasn’t
singular but multiple and differently configured depending on what
elements were being brought into play.
Embodied Mapping’s diffractive approach (see Figure 1) opened up new
possibilities for recording these ”heterogeneous histories” that were
becoming evident in our pilot study29. Thinking
diffractively allowed new analytical sight-lines for seeing risk and
virtual intimacies as emergent, multiple, and contingent
discursive-material phenomena. It attuned us to power differently, not
as predetermined conditioning forces, but as relational time-space
occurrences13.Through Ian’s mapping of intimacies and
risks, we learned that lack of biomedical information is not
foundational to his rejection of Pre-exposure Prophylaxis (PreP).
Rather, it was the specificities of Ian’s relational ‘real-time’/
virtual entanglements that are constitutive of his health
decision-making. In the map-making process, Ian identifies that while
serving in the military he became seriously ill, which he attributes to
the military’s purposeful and deceitful exposure of his body (and
others) to the anthrax virus. The maps highlight the highly contextual
matrix of elements constitutive of this felt bodily risk: the military’s
betrayal of its promise to materialise basic citizenship rights,
including access to healthcare; violent discursive/material biopolitical
histories involving the routinized scientific exploitation of
marginalised subjects for drug experimentation, vaccine trials and
disease prevention; and his experiences of being racially profiled and
exoticised in the virtually intimate worlds of hook-up apps. As a
diffractive approach, Embodied mapping was able to trace the ways in
which the entanglement of militarised histories, biomedical
experimentations, and his situated experiences of imbricated
masculinities across geopolitical landscapes and the social-sexual
worlds of hook-up app technologies were productive of PrEP, in Ian’s
words, as a “creeper” materiality that compromised his capacity to
play safe.
At one level of analysis, Ian’s rejection of PrEP is certainly a product
of the traumatic effects of power and is outside of the reach of current
HIV prevention logics. But to name this rejection as rooted solely in
Ian’s own cognitive-bias or his racialised victimhood - a certainty that
could be ascertained through a reflexive, social-determinants of health
framing - misses the multiple and entangled processes that comprise
Ian’s world making in digital hook-up culture and real-time exchanges. A
diffractive, culturally humble approach, instead, records the ways in
which the discursive-materialities and histories of bio-power become
entangled in his psychical and bodily sense of well-being. In turn,
thinking diffractively would allow for the researcher/practitioner to be
attuned to how these materialisations of power are constantly emerging
and in flux through his hook-up app use. In other words, our proposed
methodology highlights Ian’s here and now movements across different
geo-political, familial and technologised sexual-social spaces (and we
must add, movements within the clinical exchange, or during the process
of research) as they are cut through with these space-time
configurations of state facilitated violences and their resistances.
Approaching the work of cultural humility differently enables
understanding Ian’s possibilities of risk and safety not as mere
artifacts of the mind or education, but rather as negotiated relations
sedimented with the histories and effects of biopolitical economies and
secured by digitalised communications flows.