What Are People Learning About HIV/AIDS In The PrEP Era? What Are Serosorting, 'Inevitable’ Transmission, and U=U?
Out of sight, out of mind. HIV/AIDS is not in the news, it is not mentioned as much as it used to be, and is considered a non-issue for many. So why do we care? Why are we not caring as much anymore? It seems the closest discussions our community has around HIV/AIDS is the debate about PrEP, But is PrEP more about not halting the spread of HIV, but so people can believe they don't have to wear condoms? Are we fogetting why we are wearing condoms in the first place? PrEP = no condoms, oh yeah, and that things about AIDS.
Do we need a shot in the arm to remember that HIV/AIDS is out there? I recall the one time a former partner told me he was HIV positive. While waiting for my test results, I had some of the longest hot showers ever, just standing there, thinking, wondering, worrying.
Most of us don't stop and think about 'IT' as much as we used to. But some of us are still fighting the fight personally, while others are fighting the fight so others do not have to think about it as much as before. Gareth Johnson, from MainlyMale.com, caught up with Chase Ledin to talk about his research into HIV and AIDS.
What drew you to the study of HIV in the UK and US?
I come in contact with HIV every day — when I log onto Grindr, when I talk queer theory with my colleagues, and when I explain the historical trends of sexual health, wellness, and queer culture to my students. Though I am seronegative, I’m asked to negotiate behaviours within the realm of serosorting.
I came out in a time period distinctly after the first-wave HIV epidemic. This period has saturated most spheres of my life with the message that HIV is treatable. This narrative is part of my shared-community history of queer kinship — it’s uniquely removed from the devastation of the ‘lost’ generation.
My inquiries started with undergraduate studies exploring queer literary history, especially invested in MSM socioeconomic histories, their queer community histories, and their sexual encounters before and during the first-wave epidemic. I was drawn into HIV studies when exposed to the works of Sarah Schulman, Tim Dean, Samuel R. Delany, Christopher Castiglia, and Christopher Reed. These scholars expressed concern about an ideological shift of social contact and the subsequent ‘gentrification’ — alteration, forgetting, erasure, departure — of queer history.
Introducing deeply unnerving case studies about perceptions of the HIV epidemic, many of these authors responded to public discourses constructing the AIDS epidemic as an ‘isolating event’ that estranged social practices and altered localities within queer history — such as bathhouses, sex clubs, bars, literary salons, and queer camping. I found myself attracted to the arguments because they pointed at a social juncture and existential dread that many gay men experience even today — the legacy of HIV and its perpetual complication of queer life.
I probed the archive for specific examples of ‘departure’ in queer history during my master’s coursework. I was drawn to the work of Andrew Sullivan — especially his 1996 article in The New York Times, When Plagues End. Sullivan spoke of a rupture within the primary AIDS narrative. He most likely sought to construct a departure of medical categories — HIV/AIDS — providing unique foresight to the ‘end of AIDS’ as a widespread and deadly disease which could be replaced by the chronic wonders of anti-retroviral therapies. Instead, his article was received as a premature and swift departure from the memorialisation that hung over US and UK communities. Sullivan’s proclamation permeated cultural discourses about HIV. His work colluded with larger structural changes, such as international efforts to provide HIV medicine to countries in Africa, and allowed for a larger dismantling of the AIDS=Death narrative.
My professional and doctoral work looks closely at the changes in queer health and period immediately following the epidemic — 1996–2012. Part of contemporary thinking about the epidemic and continued transmission relates to a narrative that says young queers ‘lack’ empathy. Whether or not this is true, this mode of thinking says that the HIV epidemic at large derives its power from insufficient standardised settings — such as education systems, and accessible and appropriate forms of queer consumerism.
The ‘lack’ of queer-initiated and sub-cultural norms — as LGBT folk are mainstreamed — is the absence of queer-specific tactics for managing sexual, emotional, and mental health, instead directing individuals to private, corporate, or national entities that manage queer care ‘outside’ of the queer sphere. An important other narrative within this mode of thinking suggests that the ‘lack’ within the ‘post-AIDS period — after 1996 — is an inability to speak candidly about the devastation and the unwillingness to signify sexual practices largely at play during the epidemic period. As this public narrative suggests, HIV and STIs can be managed and suppressed by highly-effective contemporary medicine — the urgency to tackle issues of gonorrhoea, syphilis, and chronic HIV is reserved for specialists, and community members are free to focus on social issues and developing a new status quo.
The ‘lack’ or ‘gap’ in historical empathy is sometimes mistakenly written in popular media as a wilful rejection of queer history and the differentiation of queer generations. The ‘gap’ in empathy for queers who do not have direct access to mentors who maintain oral histories before, during, and after the epidemic is not a fault of their own but a larger systemic ‘lack’ that can’t be solved by establishing a narrative of generational difference. In order to understand how we can resolve the ‘epidemic pain’ endemic to generational difference, and how we can provide a foundation of care within digitally-facilitated sexual interactions, we need to uncover how the epidemic has positively impacted queer contact in the twenty-first century and how queer markets can expand to better educate queer demographics.
My research analyses how this epidemic event, and its subsequent waves in the US and UK, continues to serve as an underlying informant that threads every booming neo-liberal sexual market. Every market item, including PEP, PrEP, and advanced sexual devices, is informed by the ‘epidemic pain’ turned into possibility for an easier sexual, social, romantic, and cultural life for queers. Sexual markets are saturated by viral discourses. Forgetting the pain of the epidemic period is not erasing the agentic and forward-thinking tactics of those brave ACT UP and Queer Nation activists, and does not remove the virus from our queer realities. Instead, these markets integrate the ‘pain’ from lessons learned and enable the proliferation of systemic change, even when such change cannot be reflected in each queer individual.
Is it important that young gay guys, who are beginning to learn about sex in the era of PrEP, have an understanding of what the medical and social history of HIV has been?
Young queers have an obligation to learn about viral history because it pertains to their sexual well-being, and because queer history provides extensive examples and opportunities for developing empathy and experiencing psychological ‘likeness.’ Both sexual well-being and empathy help to build a healthy queer individual.
Learning about the extent of the devastation is not necessary inasmuch as understanding the social and cultural tactics for confronting a ‘plague’ that was denigrated to gay men. When we learn from positive reactions to negative situations — such as ACT UP’s activism against the CDC ignoring requests for rapid anti-retroviral approval — we inculcate tactics to develop queer community.
Perhaps the number-one reason why generational tensions emerge is failure to engage with others’ life experiences. When handed an opportunity to reflect upon the past, especially a sexual past arguably all queers share, young queers should, in the least, cultivate a critical awareness of physical, psychological, and ideological barriers rampant during the 1980s and 1990s that, perhaps more covertly, continue to thrive today.
In the least, young queers must learn that HIV doesn’t discriminate based on sexual orientation. Young queers should integrate sexual history into their daily lives especially because serosorting and HIV stigma are common practices within the queer community. Stigma is derived from lack of social and medical contexts in addition to cultural and historical contexts. One systemic solution to HIV stigma emerges from the standardisation of queer life in educational settings, providing plain-fact science in addition to multiple cultural contexts for queer life across human existence. Even if young queers are to integrate this information from outside of institutions, they must, in the least, learn communication methods for introducing, analysing, and ‘unpacking’ these big ideas with their friends and partners.
I was quite moved by Matthew Hodson’s recent article, which reminded me that the ‘lack’ of our post-AIDS period is defined by a lack opportunities for practising cultural acculturation. Young queers hardly ever have opportunities to critically respond to queer messaging, especially since they’re not taught anything significant about queer life in standardised educational settings — and especially because queer adult life rarely mandates the exchange of ideas between experienced and inexperienced queers.
The myth of the ‘gay disease,’ for example, is substantiated by skewed numbers — queers who align with such a theory must continue to explore the vast archive of HIV and queer history to understand that queer life is not defined by a ‘gay’ disease. Importantly, by accessing these resources, young queers can build safe and respectful communities having learned from those who have come before them.
Is there a unified and consistent queer narrative regarding the experience of gay men with HIV and AIDS, or are there competing narratives?
There are competing narratives and will always be competing narratives regarding HIV. Today’s increasingly popular narrative is U=U, or undetectable equals untransmittable, which emerged in recent years. We also continue to have narratives that find their roots in the first-wave epidemic, such as serosorting. Serosorting is a common practice for many queer men. Many use serosorting to reject seropositive partners as a prevention tactic. Naturally, the problem created by this social narrative of exclusion, in order to prevent, ignores science and begs an updated understanding of HIV transmission and safer-sex tactics.
Another widely held narrative is the belief in ‘inevitable’ transmission, which, though less common than the former two, also derives its significance from the first-wave epidemic. This narrative suggests that, whether or not HIV is treatable, a large portion of gay male populations partaking in ‘risky’ sex are liable to acquire HIV, so it’s better to receive the virus as quickly as possible in order to start anti-retrovirals and continue with sexual practices. These three are not an exhaustive list but certainly some of the most prevalent in contemporary public discourse.
What are some of the current areas of focus for your study?
My current focus is on chronic medicine and how anti-retroviral technologies — before PrEP — changed queer life. For instance, I’m exploring perceptions of ARV adherence during the treatment era, and narratives that explore the boundaries of life ‘after’ HIV. There are a number of authors who continue to toe the line between ‘chronic’ narratives and ‘life without HIV’ speculation, which introduces a new element of ‘anticipation’ or ‘future’ unlike in AIDS discourse defined by terminal illness. My research focuses on the historical development of HIV in the UK, but is by no means isolated from the global expansion of HIV treatment and technologies.
I’m also working on a monograph about the representation and disclosure of HIV through body modifications and tattoos.
Originally from Australia, Gareth now lives in London. A non-smoker who loves to laugh, Gareth writes about all aspects of the LGBTQ experiences, with a particular passion for travel, sport, and films.