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.