PrEP at the After/Party (2019)


Weil, B., & Ledin, C. (2019). PrEP at the After/Party: The “Post-AIDS” Politics of Frank Ocean’s “PrEP+”. Somatosphere. 4 Nov. [Online].

The medical anthropology journal Somatosphere has published a co-authored article about Frank Ocean’s recent “PrEP+ Party”. In this essay, Ben Weil and I examine Ocean’s attempt to revivify the HIV prevention-access circuit party using HIV prevention history. This piece considers how the biomedical technology HIV pre-exposure prophylaxis (PrEP) is employed, first, to recall dance cultures from the 1980s and, second, to construct an “inclusive” social space through the prism of HIV/AIDS history. We suggest that the co-optation of PrEP to create a version of the prevention-access circuit party in the late 2010s evokes a particular image culture that is “not-about-AIDS”.

In an effort to signify cultural inclusivity, Ocean’s circuit party over-simplifies the medicalised histories of the circuit party and thus re-constructs technological determinism through anachronism. Different than creating positive (+) social networks for people living with HIV, and those communities deeply impacted by HIV transmission, Ocean’s circuit party reifies and absolves the “post-AIDS” pharmaceutical and medical realities that continue to bar access to HIV prevention both locally and globally. Thus, we draw attention to the ways in which PrEP shapes or ought to shape life beyond the clinical experience. We counter Ocean’s mis/context by turning to video artist Leo Herrera’s (2018) “post-AIDS” project, which constructs a differently politicised queer-led healthcare reform using the prevention-access circuit party. We argue that Herrera’s project provides a more compelling revisioning of the prevention-access party and employs a critically-applied approach which scholars might use to better understand sociocultural context/s in medical anthropology. In our view, the contexts of PrEP far exceed the walls and gaze of the clinic, where PrEP is often framed as residing, and must be understood to include (queer) social, sexual and cultural spaces, like the circuit party, which are implicated in and can help to shape the politics of PrEP and prevention access.

Urgency as Incentive: The Future & PrEP


The UK-based movement in favour of pre-exposure prophylaxis (PrEP) has come face to face with an unreasonable hurdle.

That is to say, activists must now approach selective regulatory policy that rises to meet their feet just as change can occur. England’s National Health Service (NHS) has poured concrete around the base and built the hurdle higher, making it impossible to jump over bureaucratic stop-gaps and once again reinforcing the government’s inflexibility. Dare we recall thirty years of slow improvements to HIV medicine, the NHS’s announcement reminds us that health is afforded, first, to those who ‘need it most’.

The most are more often a few, as the privatised American health system exemplifies. Who are the most in relation to HIV in England? What is the government’s capacity to ensure the health and well-being of its citizens, especially as new statistics reveal a tremendous increase in mental health distress, indebted, in part, to working conditions and social stressors that tamper with one’s access to health itself?

For England, the most are those already HIV positive. The NHS can undertake effective treatment once the virus has been transmitted. Before that, you better use a condom.

Established safer-sex initiatives are crucial for deterring the transmission of HIV, but nothing is more crucial than to add new tools to the toolbox. Tools approved by a swath of esteemed medical clinicians and supported by MPs across the nation should not be ignored. We must speak out against the injustice of unhealthy regulation.

The law comes up to meet our feet as we stride toward greener pastures. Our greener pastures are a future where HIV transmissions have shrunk to an infinitesimal statistic. The focus on finding a cure, post-exposure prophylaxis, and HIV-positive regulatory medicine(s) is fine and well, but these measures are not enough. The present is not a viable future. Only if we add to regulatory reasoning effective prevention can we then uncover a future that, now, seems lost in the mire of soaring transmissions.

PrEP does not yet symbolise our overdue (and forthcoming) reactionary tactics. At the moment, the little blue pill represents everything bound up in the tenants of HIV’s history. The pill is a reflection of people living with AIDS and HIV (PLWA, PLWH). The pill gestures at the lives we can save in the wake of those who are lost. The pill is a simple tactic; it is the fundamental freedom of a free society, imparted by a government that can and should care passionately about the health of its citizens. The pill represents anger (our anger), because those at risk are not afforded the same preemptive measures otherwise given to patients of cancer and leukemia and irritable bowel syndrome.

PrEP is a blue pill turned red in anguish. Our future, according to the press release, is limited to the efficacy of funding a preventative medicine that could potentially displace ‘other “candidate” treatments and interventions’, as if equal share, over urgency, were the most provocative justification for dropping PrEP from funding on a national scale.

In other words: Where is the urgency? We must ask this of ourselves and resignify PrEP as a reactionary measure against bureaucracy.

This is the process of community building, which activists like Greg Owen and David Stuart continue to engender and employ. As Simon Watney once wrote, we must be cautious to conflate the differences within our queer communities as the wholeness that binds us. Which is to say, perhaps we have no essential ‘sexual’ community or biological binds to connect us, but we have validity in the anger that brings our bodies together. Today, the anger that binds us is the urgency of transmission. That urgency is:

  1. Five men testing positive each day in London.
  2. HIV organisations taking significant blows to their funding, laying off critical educational and administrative staff, and closing spaces in key ‘risk areas’ of the city.
  3. Living with constant anxiety because condoms are difficult, uncomfortable, or forgotten in practice.
  4. Being unable to visit a sexual health clinic because the wait is too long.
  5. Not knowing your status.

Acknowledgement of our urgencies is already undertaken in the medical and charity core. Ian Green, Matthew Hodson, Mags Portman, Michael Brady, Deborah Gold — the voices of reason, the experts — reiterate statistics and demand medical freedom(s) based on dizzying increases in HIV transmission. Their work compels war cries for PrEP. But how can we face an impossible hurdle if even the voice(s) of reason fail to establish the ‘necessary’ level of urgency?

PrEP is not a panacea, but it is an effective solution in the grab bag of measures. We need to turn to PrEP, because it is a ‘future-logic’: that is, a medical technology that signifies the future of health, the future of community, and the future (as Nikolas Rose might say) of life itself. What other purpose does cutting-edge medicine contain if not to allow society to burgeon in such an aggressive way that we can now live twenty to forty years beyond the life expectancy of the nineteenth century?

We can incentivize our urgency as a means to employ PrEP as a preventative measure and re-establish the future. In other words, we must compound our urgency to remain HIV negative, to cut down transmission rates, and to demand greater access to sensible, sensitive, and proven medicines, situating these demands as a promissory note that says the future resumes here.

It is the urgency of transmission that is our incentive. More than the urgency charities and medical practitioners place on statistics and numbers (though those are at the core of our anger), what I want to impress, even briefly, is that our urgency needs to derive from the knowledge that our future stops here when we fail to fight for our health and the health of others. Our future evaporates the moment we feign interest in community health. Believing our own safer-sex practices and drug use exist outside of communities at risk is dangerous at best and intentionally malicious at worst.

Only through our urgency for better health, for community, and for a future beyond HIV, does PrEP become more than simply an expense. Through multiple urgencies, through the enactment of a liveable future beyond HIV, PrEP embodies the core value of human lives — HIV-positive and HIV-negative lives in tandem — all working together for greater health, and less bureaucracy.

When Generations Hurt


It’s Thursday afternoon. Activists are shifting stance outside the Department of Health in Whitehall. A friend and I approach the small gathering, unsure about who is here to speak and who is here to listen. We look around anxiously. A woman hands me a United4PrEP sign. When she nods approval, I thank her. I know one of the organisers and think to flag him down. But he looks busy. A bit flushed and scurrying from a news representative to a fellow organiser. He looks already out of touch. Instead, I watch a man fumble with the sound system, and wonder whether we are here to listen to tirelessly methodical prose about the government’s ineptitude, or if the organisers have something more creative up their sleeves. The department’s tall windows are damasked with impenetrable beige curtains. Can the health officials see us from beyond those unwelcoming windows?

A representative from ACT UP London, in an ‘I Want PrEP Now’ t-shirt, steps up with a microphone. After a moment of introduction, he starts chanting: ‘Seventeen a Day Won’t Go Away’. The growing crowd follows with a slow and effervescent response. My attention is caught between the presence of media personnel and protestors lining up with signs. Around me, bystanders mingle with the more formal presence of ACT UP London, Gay Africans for PrEP, the National AIDS Trust and the United4PrEP coalition. I nudge shoulders with a man from Gay Africans. He smiles and asks why I’m there. I tell him, and he responds before I can finish. Do people your age, you know, your friends, normally turn up to these? I notice almost immediately that I’m distinctly young by comparison, perhaps by ten years or more. I look around. The age gap in the crowd is far greater than I anticipated.

The organisers ask those in attendance to bunch up behind a row of protestors. The protestors hold signs that read: ‘I am number 1 of 17 diagnosed with HIV today because…’ Many of the protestors are not seropositive. Still, many hold the signs in dissent, because they know this is the right cause. Behind them, we hold signs representing our various organisations. Picturesque, you may think, as we come together for a perfect view of the vacated pavement and the place where officials might listen. The officials fail to show; we acknowledge their failure to listen.

When our chanting subsides, a chasm of silence falls on our shoulders. I look around with a feeling of discomfort. This sudden, if ephemeral, lapse in energy chases the urgency in our voices as we re-arrange in a semi-circle. The lukewarm anger, the anger lodged deeper in my stomach, bounces through my bounces, even though it doesn’t show. A woman dumps a handful of chalk into my hands and pushes me toward the protest line. When we throw blue chalk on the ground before the doors—some hitting the brick; we’re told to avoid the windows—our bodies follow. We are implicated with the residue of an action that is met with indifference. Then, we walk away with bright-blue palms. We speak out against the government’s indifference to our health; the residue of death lingers on our hands.

That evening, I meet an American friend at a café on Berwick Street. Thom is perched at the window, his ass on the edge of the stool. It’s the same striking position in which I found him when we first met in a small bakery in Columbus, Ohio. Hardly one to dither, we get on about our love lives (or lack thereof). He asks, with sudden interest, about the rally.

I saw you were in Whitehall today. I meant to stop over. Is everything okay?

I clarified why I was there. He looked at me calmly.

You know, you could have stayed in America if you wanted PrEP. But I guess it’s great that you’re doing this; you’re really putting yourself out there. Not a lot of guys your age, I mean young guys like you, feel the need to go out there and have a say. What’s there to say, right? I mean, maybe it’s a different case in America, but it seems to me that guys here, you know, the young guys, really don’t care about this stuff.

I ask him what he means.

I know you’re not like this, you don’t believe this. But it really does seem like PrEP is not an issue… not a capital-I issue for men your age. I know I’m generalising. I’m generalising, you know, because someone else is fighting for the cure. The twink around the corner. He’s in his late twenties, he’s fighting for a chance to have sex because… well they think he’s fighting because he has too much sex. Or the daddy that approaches you when you first enter the pub. He’s fighting for PrEP because he wants to have sex with you but he’s positive. Does that make sense? I mean, I haven’t met a young guy who’s said, I don’t want to fight for this; I just want to have sex and be left alone. Okay, some guys want that. But I get the sense that young guys don’t want to talk about this. They just want to have sex and not talk about the virus. They don’t want to talk to the daddy at the bar or the twink on Grindr, because it’s scary, you know? To think about the virus.

When Thom gets up to use the toilet, I take a deep breath. I feel distressed, wondering why Thom would assume that I might not be part of this younger class of gay men. Why would my scholarly interests impart a sense of ‘care’ about the issues? I am still part and partial to the community of young gay men. I ask him why he thinks of me in this way.

Because I like you. I love what you’re creating. But really, because there are only a few young men I’ve met who have been intentional, I hesitate to say genuine, about engaging me. Not that I see myself as particularly old, but I don’t see myself as young-in-body as I used to be. And that’s really present when I interact with young men like you. Men who look me up and down, they probably think: look at his shiny head; I bet he had a great cock once. Which is funny, considering I still get compliments about my cock. But there’s this assumption… this assumption that something is different about us, not even specifically about looks or how big your cock is. I had coffee with my friend Andrew the other day. He was having some anxiety about a guy he met at a bar. The guy was in his late thirties. Andrew’s concern was that the guy was being shifty, he wouldn’t tell him his status. I’d be naturally hesitant, too. But then Andrew says, I can’t see this guy if he has AIDS. What will I do if I get AIDS?

Thom stops.

And I guess I gave an audible, really boisterous, HUH! Because he grabbed my leg and said: You get it. I knew you would understand.

Thom grabs my shoulder, to keep himself from sighing.

I knew I had to leave. I paid for the coffees, said our swift goodbyes. I biked home and pulled the curtains shut and stewed on the couch. How could he say that? What will I do if I get AIDS? I mean, was that a genuine question? Was he concerned about AIDS, or is he concerned about the fact that the guy has gorgeous dark eyes and is afraid to say he’s positive? Or what if the guy isn’t positive, or the guy hasn’t been tested in ages. God knows Andrew hasn’t had a test in years. Is this about being infected? I had an experience like this right before I took off. This college student in a booth, red jersey, tight white pants, is looking me up and down. His friend keeps teasing him to move his ass; I can hear them talking between the lapses in music. So I go over to him, and realise he’s smirking and not really watching me as I walk up to him. And before I get a word in, he asks: Are you desperate? He doesn’t skip a beat. I hear you’re positive. So, of course, I back away. But the guy keeps looking at me. He sticks his tongue out. And that’s probably the first time I felt genuinely alone in a bar. All those beautiful men, all those faces that usually say—hey, come kiss me. They turned into this black-blob mess. Mostly young guys, too. Just staring me down as I paid for my drink and left.

This year marks 37 years of viral crisis. In 1981, the virus was understood as a ‘rare, homosexual cancer’, soon to be revised to the acronym GRID (gay-related immunodeficiency disorder) and, later, to the more-complex HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome). With the advent of the viral load test in 1996 and effective combination antiretroviral therapies (cART) in the late-1990s, the virus came to be understood as a ‘liveable’ condition, if only because one surpassed death by the successful suppression of the virus. The understanding of the virus as a ‘liveable’ or ‘manageable’ condition implicated in the ability to outlast immunodeficiency has overcome previous apocalyptic interpretations of the virus. Now, it would seem that, far from the devastating history of the epidemic (seen within the timeframe of 1981-1995), the virus has taken to a cold-bath within society—gay communities or otherwise—reducing but sloshing around while we wait for a cure.

As the recent PARTNER study has revealed, with effective treatment, modern medicine can effectively stop the transmission of HIV. The virus that once swept through the sexual communities and took the lives of hundreds of thousands of queer folk, no longer imparts its ‘death threat’ upon said communities. Because of this change in health—the ability to live with the virus and not die—the virus has been renegotiated as something here, something there, something here but not there, significantly within in the growing (mis)understanding that AIDS has come and gone, and, in its place, a ‘manageable’ HIV remains. It’s easy to point out instances where AIDS (in the Western world) has become a disease of the past. It’s easy to see why one generation might think that, indeed, because a person is seropositive, one need not concede one’s claim on life.

That AIDS—especially the syndrome—no longer informs our present claim over gay life, however, is a popular myth substantiated by a lack of comprehensive education about the virus. That AIDS, in particular, is swept under the rug as something experienced in the past only relegates the virus to an assuming (and often lacking) pit where seropositive men are regarded as reckless and irresponsible for sexual behaviour associated with epidemic times. The boggling notion that recent generations (generations suddenly compelled to ‘be free’ with the legalisation of gay marriage, gay adoption, and generally more positive representations in the media) can—and must—build new communities without the grief of AIDS only reveals how quick we are to move past sore subjects and undermine the complex histories and people who make up our queer communities.

Upon leaving the PrEP rally, I reflected upon this distancing of AIDS-related histories from the gay community. I wondered why HIV and AIDS have perpetually come under fire in the social history of our community. Perhaps more urgently, as an activist and community builder, I thought: what will become of our community if we honestly believe that HIV, now a manageable condition, has nothing consequently to teach us about our rich and uneven queer history? Will AIDS remain a history that we feel sour about, a history we perpetually warp and denounce? Why do we slough ourselves of the viral past and let go of those men now pigeonholed as the ‘older generation’? What is so wrong with our past that we must ignore those who lived through the epidemic and continue to teach us profound lessons in life and death? Are we encouraging a generational divide simply because we refuse to acknowledge that their hurt is also our hurt? Are we dividing our gay communities on the (false) assumption that we can make something better of the future once we let go of the past?

A growing number of academic works have focused on how HIV and AIDS have impacted gay (and queer) communities. This body of work explores the complex ways in which communities, especially queer communities devastated by the virus, have changed emotionally. For instance, Walt Odets believed that the AIDS epidemic shattered the already-precarious psychological sphere of ‘gayness’. Gay men, and the ways in which they would come to interact—to make friends, lovers, and community—could never be the same in the wake of the epidemic. AIDS had changed the ‘negotiability’ of sexual encounter(s) and, more broadly, the ability to establish deep emotional connections with others.

In a similar sense, Christopher Castiglia and Christopher Reed believe that the epidemic obscured the ability to construct a clear time and place for queer ‘culture’ in the present. That ‘gayness’ became predicated upon the crux of a viral past—looking back at a time before the epidemic, unable to recuperate ‘the golden age of promiscuity’ and unable to finish mourning the hundreds of thousands lost to AIDS—opened up a chasm of emotional deprivation. That time for mourning, and the emotions that came from the epidemic’s toll, was quickly swept away by renewed fervour to progress and seize our gay rights (or, our place of acceptance within the mainstream). With the combination of increasingly gentrified queer spaces, the inability to effectively mourn the loss of an entire generation of gay men, and a precipitously conservative ‘gay agenda’, the time and place of HIV and AIDS, within gay communities especially, has been forcefully pushed out of the spotlight.

Threatened by a new generation that views AIDS not as a loss, but as history, community consciousness has split into us-versus-them ultimatum: one generation pitted against the other in a confusion of what progress entails. But ignoring the fact that progress cannot be immediately accomplished, we must question how this generational divide, indeed, the relationship between the generations, relates to our disinterest in talking about the social lives and histories of HIV. After all, this generational divide is all about one’s proximity to the epidemic. At the juncture of generations (that period in the mid-1990s when protease inhibitors and combination antiretrovirals were introduced), this tension about experiences—Did you have the same seroconversion illness(es) as I had?—reared its head. This juncture produced an anxiety about one’s relationship to the virus, distinguishing those who seroconverted during the early stages of the epidemic (1981-1994) from those who seroconverted in the epidemic’s later years (1994-1998) and beyond the time of the epidemic (1996-present).

It should come as no surprise that as we recede from the ‘time of AIDS’ (1981-1996), the greater the disparity, and the greater the feeling of abandon and hurt, between generations appears. As was the implicit feeling at the PrEP rally, when we talk about engaging our ‘gayness’ or ‘queerness’ in the present, we are necessarily implicated with hurt feelings. When Sarah Schulman says that the younger generation is unable to empathise or ‘imagine a more humane, truthful, and open way of life’, she means to say that a real emotional disparity exists and continues as a result of the epidemic. Forget about the place of our community within mainstream society: the progress of our feelings (our emotions, our community aura, if you will, shared amongst all who experience homosexual desire) are so disproportionate between generations, our ability to conceptualise and share similar emotions becomes a demanding, if seemingly impossible, task. The generational division that emerges from the epidemic has much to do with one’s proximity to epidemic times, but it also depends upon our willingness (both from the ‘younger’ and ‘older’ generation) to reconcile our emotions, even when they’re disparaging.

At base, the inability to effectively reconcile our emotions arises from the fact that the virus refuses to sit still: it mutates, it infects some and not others, it spreads across ‘at risk’ populations and ‘the public’ alike, and it fails to discriminate. The problem is that the virus is a distinctly ‘new’ virus: in a sense, a virus informed by thirty-five years of medical progress and a virus that is experienced by the younger generation as a ‘manageable condition’. This is in stark opposition to the hopeless time of inevitable death that characterized the age of epidemic. Much of the anger that fills the divide between generations is not only about the inability to reconcile emotions but even more about the very potential (in terms of health, lifestyle, and longevity) that this new viral state enables.

‘In the event of a cure,’ Odets once wrote, ‘the enemy [AIDS] will no longer seem indomitable, but petty and unworthy of those it took from us’. While we haven’t come up with a vaccine, we have come into a time of a ‘false cure’: which is to say, the new, liveable virus has drawn from the well of this anxiety, that all those lost to AIDS no longer need to be exemplified or remembered. The virus appears, in retrospect, questionable and outmoded, and those who fought so hard against a virus they knew so little about will come to be seen as nostalgic, melancholic, and, themselves, lost in history, simply because they feel the need to remember that loss, to remember what came before. The managed virus (‘the [false] cure’) has no history and has no need to remember bad feelings or conditions before it. The new virus has swept in to eradicate death—death, which proliferated a life of honest and respectful feelings, which required so much community involvement and care—and will sweep AIDS out from our shared history.

With that in mind, the stress placed upon generational differences is understandable (if understated). The growing gap of empathy is not of our own choosing, but of an inevitable and historical context. The generations cannot be blamed, per se, for their hurt or experiential differences. We can only be questioned based on our inability to come together and recognise the ways in which the virus has changed us: as individuals, as a community, as members of a shared history that hasn’t stopped and must not be eradicated. That we regularly slough the value of the virus’s history is the crisis that destroys our ability to be a cohesive (virally-impacted) community. We have turned from the fear of viral apartheid to the negation of community, under the assumption that because our health is manageable, we no longer need to learn from the virus in its past forms. Because of this, we have failed to mobilize our cross-generational differences. We have failed to synthesize our experiences based on the old and new forms of virality. Our disinterest in connecting the severity of AIDS in 1980s New York with the manageable HIV in 2010s London stands in the face of what community can enact today. It substantiates the divide that threatens to keep us apart.

There is no one solution to reconcile the differences in emotion and hurt currently dividing our community and destroying our shared history. There is no one utopian time and place where our differences can come together in perfect harmony. As many activists have argued, fervent engagement with the powers that be (though important) is no longer the gel that brings us together as a community committed to change. We have changed a lot, and for the better. And we need to accept that we must build strong emotional communities based on what tools we now have. As much as this ambiguity feeds into the bad feelings that thread our disinterest in talking about the virus (in letting it back into our history so that we can make some meaning of how it will continue to inform our present and future), recuperating these emotions and reconciling the difference will re-new the well of hope that seems to be slowly (but surely) filling as we distance ourselves from the epidemic.

We must endeavour to make of history what it makes of us. We must engage our viral history. We must take it upon ourselves—as seropositive men, as seronegative women, as sero-unsure queers—to learn our history, which is not material laid to rest in textbooks and necessarily forgotten. The virus lives with us. We can make something of its queer (and viral) potential to imagine and build wildly different cultures based on our ability to be here and our ability to functionalise history, and ultimately our ability to propose and rearrange our communities based on the fact that we live, we live virally, we are all, in a sense, connected.

Community is built on the realization of our connectedness, a connectedness that is larger than anonymous encounters (though those are important, too); a connectedness that renews the pressure of human contact, through sex, through oral history, and making history by self-documenting the lives of all queers, of all ages. Undertaking this task, we will strengthen the sense of urgency that our lives—far from merely mediated, managed, and maintained by effective biomedical advancements—are part of a vast and intelligible network of queer bodies and pleasures and statuses. Our lives can be our own intelligible and communal histories when we see that the virus does not simply evaporate when a false ‘cure’ seeks to separate us. The virus is a part of us.

In short, I ask myself: Is the virus a means by which we can better understand our community connections? Or is the virus, in itself, a grave?

When Negative Means More Than Abstaining


HIV makes sex messy. Confusion about who does what, who wants to do what, who can do what, can quickly slip into mystifying jargon. Since HIV makes us talk about the ‘tough topics’ we weren’t taught to appreciate in secondary school, sometimes we’d prefer not to talk at all. But perhaps the mess has less to do with HIV. As numerous activists and organisations have pointed out recently, something is bubbling in our actions and mentalities, something that can’t initially be denied by saying: stop. There is something more in our statuses.

We have activists, like Greg Owen, Dan Glass, David Stuart, and others, who are talking about their statuses, who are encouraging us to talk about their statuses–who are more or less putting the rhetorical junctures of ‘status’ and ‘status-making’ on the map. Those people are at the fore of the movement to tackle, unpack, negate, and educate stigmatisation of HIV serostatus. They perpetually ask us to look inward. They say: there’s something we need to acknowledge in ourselves. We have a problem about the way in which HIV is talked about in the media, how gay men (in particular) volley the term like an epithet, and how the government looks idylly toward a cure and consistently fails those most at risk and already living with HIV.

In a recent article in FS Magazine, Matthew Hodson, chief executive of GMFA, enumerated the importance of critically attuned communication about HIV-positive men who have sex with men (MSM). Hodson laid out eight tactics for speaking sensitively, thoughtfully, and ‘appropriately’, some of which I excerpt here:

(1) Don’t ask them how they contracted the virus.
(3) Don’t assume they’re a power-bottom.
(5) Don’t assume he will/does feel inferior due to his status.
(6) Don’t assume he wants to talk about it.

Hodson is clear: assumptions dictate our initial reactions. We read bodies the moment we perceive them, and we create additional gradations when language enters our intimacy. But what’s plain about Hodson’s voice is his position. Hodson speaks on behalf of the HIV-positive activist. He tells us what works, what doesn’t, because the HIV-positive person is, in many ways, the most authentic and accurate voice speaking to the effects, stigmatisations, and emotional trauma of living with a life-long illness.

Surely those experiencing and living with HIV are, first and foremost, subjects of this specific virus. But what peaks my intrigue is the attentiveness to which people living with HIV give their positions on sex, love, and desire. They are, for lack of better words, the ‘go-to’ experts on troubled desire in a prolonged era of HIV and AIDS. And it is through their accounts that we start to see the relative silence on the part of HIV-negative persons.

Is it that HIV-negative men simply don’t care? Is it that HIV-negative MSM are necessarily ill-equipped to speak about HIV, to talk about the men they want (and convince themselves they cannot have) all thanks to a virus, which is now a condition of life? Is it for fear that mixed-status desires border on recognition of our historically racist behaviours? Or is it that we do not challenge or think critically about our negative statuses? Is there a possibility that negativity is, in fact, the lack, the newfangled deviant, and that which much be approached with great expediency?

In a Cap City Kink article for World AIDS Day 2015, Christopher Hetzer expounded upon his experience(s) contracting and ‘dealing’ with HIV positivity. Hetzer provides a telling list of active dating tips for the HIV-positive man. His suggestions range from the mental and emotional effects of dealing with HIV to finding the courage to step back into the dating/sexual ring. He lays bare a clear list of what HIV-positive people can do to keep their mixed-status relationship(s) ‘healthy’:

(1) Take your antiretroviral therapy consistently and correctly.
(3) Be HONEST and RESPECTFUL with all partners.
(4) Continue to talk about HIV, STIs and sex.
(5) Have some CONDOM SENSE!
(6) Be safe when exploring each other’s sexual fantasies.

Hetzer points out a few simple suggestions for HIV-positive partners in mixed-status relationships so that they can make the most of their sexual- and self-knowledge. In this way, Hetzer positions the HIV-positive partner as an active agent in the relationship, cognizant of their status whilst necessarily provoking intimate, and necessary, dialogues about medicine; honesty, respect, and boundaries; condoms; and sexual fantasies. Even emphasis placed on ‘honest’, ‘respect’, and the humourous ‘condom sense’, suggests the frank (and playful) tools one can (and must) bring to a loving mixed-status relationship. Yet there’s a deep implication that the HIV partner takes up the responsibility for talking about and politicising sexual statuses simply because they have the ‘HIV experience’. This may not be true of all mixed-status relationships (dialogue is key), but the initial agentic and explanatory HIV-positive subject is imbued with assumptions that they must speak.

What I want to suggest is that we must politicise the negative accounts of status. HIV-positive narratives are only one way to think about HIV; there are more we can include. HIV/AIDS statuses are not the only form of sexually-transmitted disease that asks us to think deeply about our desires and sexual actions. But it is through the perpetual, and now increasingly devastating, HIV/AIDS epidemic that the age-old binary again comes to light: the normal and the deviant; the ‘clean’ and the ‘dirty’; the sexually promiscuous and the (‘non-adulterous’) committed; and the knowing and the unknown.

The assumptions indebted to such binary thinking are now available to the public thanks to decades worth of critical queer theory concerning racism, identity politics, gender, and sexuality. To extend such research into the public sphere, I believe it is important now to think about HIV in terms of negativity. HIV and AIDS are charged with positive (and dialectical) implications that have pervaded media and medical speak since the rise of the epidemic in the 1980s. Each day since we have had to negotiate our actions based on status. Status is a subject marker we all have, we all access and negotiate, and which changes over time. That is, status follows us through all stages of life.

It is through status that we often negotiate and talk about our sexual actions. For that very reason, it is necessary for MSM not to rely only on HIV-positive men to control the movement and dissemination of desire marked by positive statuses. In fact, in doing so, we engender an ideological system of racism: a hierarchy of desires predicated upon status, desire, and comfortability — which is to say, we claim not only that the HIV-positive subject is in some way different than the HIV-negative subject, but also that the HIV-positive subject must inform us of their difference.

Perhaps there is no difference. Or, perhaps HIV-negative MSM are the difference. Perhaps those who are without HIV stigma are the gap that substantiates the divide between positive and negative desires. Just as we cannot control who we long for, who we lust after, and/or who we love, we rarely can determine the impulse of status. Status, I contend, is everything: everything to the modern sexual body, which is now overwhelmed with the potential to desire. Status is indebted to desire.

It is by putting pressure on the divide between HIV-positive and HIV-negative agency that we can sift through the negative representations we inadvertently (and sometimes inevitably) place upon people living with HIV/AIDS, and bring about more positive behaviours and desires. In doing so, we begin to see who is tasked with talking about HIV/AIDS and who can simply abstain from agency. No one should be exempt from agency. Desire is an act of agency. It is a force. If it is true that most people desire, we cannot demand that HIV-positive persons teach us about their desires. We desire, too. We cannot remain quiet once we have learned, and we cannot ruminate about experiences which aren’t ours or which we can’t necessarily change.

HIV-negative MSM have desires, and they can (and should) be positive. Positive desires proliferate at the moment when we learn so much about others that we find ourselves in the cracks they open in themselves.

Positive desires are informed. That is, the desires we find in self-revelations are often the most intimate, the most complex, and (I would argue) the most fulfilling. Focusing on the status of HIV-negative persons is one lens through which we build fulfilling definitions of status, desire, and intimacy. It’s also a crucial educational tool that we can do at the individual level. Holding to account our HIV-negative positions ensures that everyone has access to desire. We can further come to terms and act upon ourselves, in a sense, by politicising and appreciating our desires for what they are: not as opposition to HIV-positive statuses, but as statuses that are self-contained and multiple.

The task of rethinking status is as simple as turning positive-dependent agency on its head and asking HIV-negative MSM to stand out in support of sex regardless of status. At the same time, we must acknowledge that status is everything. Status doesn’t disappear because we say we are blind to status. Language erases, in a sense, but erasure doesn’t mandate self-realisation. So it is here, at this paradoxical occupation, that we can confidently ask HIV-negative MSM to reflect how their status effects, reflects, and adds to HIV-positive desires. Those who are negative can support positive lives by legitimating HIV-positive desires, by fighting for sex-positive medicines (including PEP and PrEP), and making a concerted effort to learn about, engage, and disseminate information about positive sex.

By way of positive sex, we learn more about what it means to have desire at all. Desire makes most of us whole, in a sense, only if we are informed and curious about our bodies (inside and outside), and what these preventative medical measures can do to enhance our chances to live happily and healthily. Prescribing a one-sided politics — that is, by focusing solely on HIV positivity as the authoritative voice on desire in the age of epidemic — allows HIV-negative men to abstain from thinking about positive desire. We must attempt to close this particular sexual division in our queer communities.

On PrEP & the Problem of Access


Just this week, San Francisco startup, Nurx, launched a new service to provide prescriptions for pre-exposure prophylaxis (PrEP) via smartphone. In what seems an almost-expected next step for providing access to PrEP, co-founder Hans Gangeskar said the company is providing this service because ‘[PrEP is] not as widely available as [it] should be for the populations who need [it].’ Effectively, Nurx will streamline the process from health survey and blood sampling to prescription and delivery, by making all materials accessible through a simple mobile application. A new technology for an needing market. Check.

This new technology makes abundantly clear how the market is responding to our needs. And not only that, such technology almost buzzes in response to resolute anger concerning accessible medicine (both for sexual health and more generally) here in the UK. Just as well, this new access appears increasingly open; it purports to provide exponential networks of connection for many of the people in the ‘high-risk group’ regularly tied to PrEP. But let’s not chew our tongues with glee just yet.

The problems circumscribed in PrEP, not especially the moralistic onanisms, but rather issues of accessible economics, appear obfuscated within public discourse. A public discourse, that is, founded upon hundreds of hours of film, travelling photo exhibits, sex education workshops; protests, sit-ins, and marches; Twitter campaigns, rambling Facebook posts, and the occasional personal blog entry. In all this, I hear my fellow activists scream: The epidemic isn’t over. Indeed, the epidemic isn’t over, but who would know unless provoked to ask?

This is first to say, PrEP is tied up in a battle to understand whether or not we occupy a state of emergency.

I write, now, partly in anger that the NHS decided earlier this month that it will not commission PrEP for HIV prevention, contrary to an eighteen-month period of preparatory consultations with key clinicians, counsellors, and community advocates (see Mags Portman’s recent blog post). But even more than that, I shudder each time an article appears where access goes uncomplicated. In other words, UC San Fransisco Professor Robert Grant’s statement in the Nurx announcement went without mentioning the pitfalls in its potential accessible network.

“I like that Nurx makes PrEP available to people who may be afraid of doctors or may be afraid of the judgment that they’ve experienced from doctors. We need to work to make medical services as friendly as possible and try to eliminate the shaming that comes with going to the doctor.” -Robert Grant, University of California San Fransisco

Grant makes a key, and correct, claim: preventative medicine and privatised medicine in the United States need to address the psychological stress of visiting the clinic. Not only is it clear that clinicians aren’t always prepared to talk about the socio-economics of sex and its acts, the system, on the whole, is relatively unprepared to talk about ‘sex as a healthy act’ outside of monogamy. Hence, access to information is encrypted, sensitised, blocked, or opaque in the medical system. The shame to which Grant refers is none other than those repressive threads fed from our (hyper)unsexual medicalisation of the body.

Of course, medical care in the U.S. differs from the U.K. in that Americans subscribe to a highly privatised system based on emergency response. The issue is that a large number of needing people, with or without Obamacare, only receive satisfactory or suitable coverage for their needs. That there continue to be people in the U.S. without emergency coverage, let alone cyclical and meticulous coverage, reminds us of the messy state of the medical industry. That a medical mogul can steamroll Americans in favour of a 5,000% price increase says something about the relationship between Americans and the medical industry. And this is to say: The medical industry, not far from medical practice, dictates practice. Practice becomes catered to what sells; people become bound to profit. What happens when profit compounds profit, but those positioned low on the socio-economic ladder are unable to deal with escalating (mind-numbing) compounding profit? They lose.

In the U.S., and even greater in the U.K., the honest problem with PrEP is access. But there’s another form of access I want to address, and that’s access to societal change. PrEP is making waves. Indeed, PrEP will go so far as to revolutionise sexual potential in our era. PrEP will breathe relief into men most ‘at risk’ for contracting (or already having contracted) HIV. PrEP will mean gay men, in particular, can fear a little less a virus that has caused massive devastation in our time. PrEP will engender a new sexual future, one that is not a utopia but is full of desire and potential. PrEP, by all means, will enact societal change.

Regardless of the bubble of lives PrEP will inevitably save, however, our inability to use this medical technology to turn our attention to societal levels outside the middle-to-upper class means that we will continue to replicate medical oppressions of those who need PrEP most. PrEP will be lost to a class who, still much deserving, fails to recognise coalition, solidarity, and change across economic strata. Organisations like ACT UP London, PrEPster, and Positive East; grassroots efforts; and even Twitter campaigns do speak out against economic crisis that never left our community (in fact, through the devastation of the first epidemic, the distance between the queer impoverished and the rich could swallow the whole of England), but they are few in number. Too few of us outside these organisations, within extended and overlapping and social queer communities, who will end up on PrEP the moment it is institutionalised, will give a second thought about how PrEP can change a life.

Whose life could PrEP change for the better? PrEP could oversee the impending decriminalisation of sex work. A nationalised PrEP campaign (already sparsely undertaken by PrEPster) could explode the fight for re-funding massive cuts to HIV/AIDS services, particularly through the NHS. And, perhaps most importantly, PrEP, when incorporated into sex education workshops, could spell a movement towards a sex-positive future. Who knows? PrEP could be the impetus to push for change to sex ed in classrooms across the UK.

None of this matters if PrEP isn’t a mean as well as an end. PrEP can spell anger inasmuch as it can spell passion and pleasure. But we have to learn to care — if not again, so much more than our critics claim we do. We must care in two directons. If we can, we must dismantle our disposition against the political sphere in order to even start a cycle of growth. We must tell our lovers, amidst our acts of fiery love, that our love is still political, for loving means caring for others around us. Loving is a network of communication. Loving is endemic to queerness. We are bound to this claim.

If this is not an urge, it is in the least a plea to recognise which directions PrEP is pointing. In which ways will you access PrEP? In which ways can’t you? How can you help others access PrEP who might need it more than you? When and where can you talk about PrEP? How often do you talk about PrEP with gay men who don’t know what PrEP is or people who would otherwise not know about PrEP? How can you learn to care in the eternity that is this epidemic?

I want to end with a few truisms, which we all must reiterate, unpack, and expound upon in order to move toward a ‘sex-positive future’. Only by recognising what PrEP says can we begin to open up the implications for social change. Let’s begin:

[1] Until education practices concerning safe sex, condoms, and abstinence are revised, altered, or abandoned, PrEP will remain surrounded by myths, stereotypes, and stigma.

[2] Until it reaches the underrepresented populations that are most ‘at-risk’, especially those populations that cannot afford or are in no social situation to accept it, PrEP will remain a bourgeoise preventative medicine.

[3] PrEP is a bourgeoise preventative medicine until it caters to a full spectrum that purports to ‘access life’ in addition to ‘access pleasure’.

[4] To ‘access life’ entails reiterating that HIV ≠ death. Instead, HIV must equal life; but in doing so, HIV becomes a livable procurement of the medical system.

[5] Finally, we are all indebted to the medical system to some degree. To repay our debt, we can only: Act Up, Fight Back, Fight HIV and AIDS.

In order to fight, we must acknowledge there is a fight to be won. The epidemic is not over. The epidemic never was over. We live in an era of epidemic. Live now. And live with us.