Here's to illuminating strategies to protect ourselves and the ones we love and lust for...
“segregate and stigmatize.”
[Mark Hubbard, aka middle - pictured below right - is a community organizer, educator, and activist in Nashville, Tennessee. He gleefully reports that he met his husband 18 months ago on a popular
hook-up website]
In the weeks leading up to the recent U.S. National HIV Prevention Conference, I listened in on a sort of “think tank” call held by a favorite advocacy group. The focus was analysis of sexual networks to help identify new types of HIV prevention structural interventions.
I’m onboard with the idea that such research could lead to a new category of intervention. My experience resonates with the description of certain MSM sexual networks that mix “low risk” individuals and “high risk” individuals.
But when I flipped to a slide indicating one idea was to “develop interventions to reduce disassortive mixing,” my activist mind went on red alert. When it was stated that a guiding principle of a network intervention could be “pulling apart” "high-risk" and "low-risk" individuals, I got riled.
When “pulling apart” is said in the context of male-male sex, what I hear is “segregate and stigmatize.” My mind reels with the image of Jerry Falwell aiming a garden hose at two men caught in the act. The phrase brings to mind religious fundamentalists, moralizing politicians, homophobes, promoters of stigma, and other sex-negative pundits. You know – all those who make it their business to “pull us apart.”
I know I was not in the presence of the enemy. I assume that the people involved have excellent credentials, are are very intelligient, dedicated to the cause, and honestly want to help. In their defense, human rights and maintaining freedom of choice were also listed as guiding principles.
Yet as an experienced, long time poz treatment activist, I believe this group of motivated and caring people needs a reality check. Language matters, sensitivity matters, and I think others will react similarly.
Beyond the language issue, I’m dubious about practical applications. Of the three examples presented to illustrate the concept, two were utterly unconvincing.
The first was the existence of two bathhouses in a city where only one (supposedly) enforces a ‘no unprotected sex’ policy. Another caller asked how such a policy is enforced - but forget that. The assertion that “high risk” gay men will be drawn to a “high risk” bathhouse and vice versa demonstrates a serious lack of understanding about how the culture works.
The second example was a similar comparison of a bareback and safe sex focused websites. Naive. As someone who’s spent serious time on such sites, I’d love to say I’ve found a reasonably populated safe sex website. Newsflash: one doesn’t exist.
Finally, the focus fell on a very popular hook-up site where users can indicate aversions to specific kinds of risk and clearly identify what they believe is their HIV status.
Terrific. I support that. It’s an opportunity for truth. It’s a stab at inoculating against denial. But it’s not “pulling apart.” It’s not even “reducing disassortive mixing.” It does relate to another stated guiding principle - “help individuals make more informed choices.”
Right on. Let’s call it “illuminating.”
If we want to intervene in a network that has high and low risk members, let’s shed light on the reality of the network without shaming anyone involved, support open discussion about the real ways we meet and interact, and do what we can to focus on wellness in the context of choices made.
So, here’s to 2008.
Here’s to taking care with language.
Here’s to participatory research.
And here’s to illuminating.
/v. ɪˈluməˌneɪt; [v. i-loo-muh-neyt] –verb (used with object) | 1. | to supply or brighten with light; light up. |
| 2. | to make lucid or clear; throw light on (a subject). |
| 3. | to decorate with lights, as in celebration. |
| 4. | to enlighten, as with knowledge. |
Humm - I read "Finally, the focus fell on a very popular hook-up site where users can indicate aversions to specific kinds of risk and clearly identify what they believe is their HIV status.
ReplyDeleteTerrific. I support that. It’s an opportunity for truth."
Is it really an opportunity for the truth or is it more of an opportunity to give more creditability to a self defined status of negative when it is nothing more than a personal assumption?
I don't know that the choices would be as simple as positive, negative, don't know, and blank on Manhunt had I the choice to add this option today. The fields were included at the request of the health community four or so years ago. Knowing what I know now HIV status in profiles would look much different. The question would certainly exist but in the context of a conversation rather than a blanket yes, no, maybe and, nothing.
In adding the HIV Status fields I wanted to achieve two goals:
1. Help members make more informed (and therefore safer) choices around their play.
2. Create a permanent but subtitle way to introduce the conversation around HIV status into the community.
Looking at profiles I believe that the second goal has been achieved, but I am not certain that goal one has worked to its fullest potential.
Profiles are marketing tools and marketing works but some of the best and most effective marketing in the world is not based in the truth.
My question is this: Does the inclusion of HIV status lend more creditability to a potential unknown? If a member says they are negative in their profile does reading it as a statement of fact give it more creditability than it deserves?
The conversation about a individual's HIV status is not a "yes" or "no" question, it is just that - a conversation. Whether a person is HIV-positive or negative HIV status is a very personal conversation and part of all of our stories.
I don't work in HIV prevention, so I got a bit confused by the terminology. What are "low-risk individuals" versus "high-risk individuals"? Does this refer to those who engage in safer-sex practices versus those who don't?
ReplyDeleteShawn,
ReplyDeleteThis is a great question. In the context of this call, which was HIV prevention, risk refers to activity which has risk for HIV transmission, i.e. unprotected sex or sharing of needles.
The terms "high risk individuals" or "low risk individuals" in the context of a sexual network analysis would be defined within a given analysis. As an arbitrary example, you could classify persons who've had more than 6 instances of unprotected anal intercourse or 3 instances of sharing needles in the last 90 days as "high risk individuals" and the remaining persons as "low risk individuals."
Incidentally, I intentionally put the terms in quotes. Although the language is probably standard within the public health profession, I'd prefer to see "higher risk individuals" and "lower risk individuals" because I think it would convey better understanding (and because I don't like binary language or thought.)
I should be clear and say that I'm a community activist and not a professional in public health.
- Mark Hubbard
As a HIV+ (long time) man, I applaud the philosophical reflections by the author. I admit ambivalence on serosorting (HIV+ seeking only HIV+; HIV- seeking only HIV-). My choice is that I am only interested in fellow HIV+ individuals; I respect others may make other choices, "safer" sex or no. I see many self-described HIV- seeking other HIV- partners. How naive; how dangerously naive. People lie "to get some;" people think they are HIV- without realizing that they only tested negative last time, which may have been before converting, which is unrelated to if they have had sex since, and bandy about their negative status as a "lure." Each person would be best off if each person took personable responsibility, knowing full well some lie, some don't know the actual status. I know of all too many "good" persons who thought they were in a monagamous relationship only to find out too late that their trust had been misplaced. Each negative person would do well to better understand stigma. It is real; it is profound. The "culture" seems to encourage HIV+ people to lie--a gossipping partner can adversely affect family relationships, friendships, employment, career. All to often discloseing in confidence is too much to bear for the confident, and word spreads "in confidence." Depending on one's mindset (some stigma is self imposed), stigma varies over a wide range of intensity depending on one's social group, geographical area/location, and employment--in the best of situations, it's not an issue, in others in the same locale one may be labeled a "leper" and fired. What REALLY riles me is that tendency of men who have sex with mens tendency to label and shun. How about self labeling as "clean?" What does that make us "others"? How is that helpful? Why not be more humane and recognize sexual activity and/or intimacy can be motivated as much or more by emotions or lust than mindful thought? Where's the humility of the negatives who are sexually active that, so far, they've lucked out? Where is there the understanding that people may become positive for a host of reasons, from not being self-responsible, to trusting a (former?) partner/lover/trick had known but didn't tell? I see too many postings on Craigslist, for instance, labelling HIV+ persons as whores, sluts, etc. And this comes from people looking to hook up! Where's the humanity? HIV+ means a person has a virus; HIV does not mean a person is immoral, amoral.
ReplyDelete