Opening up the debate about #PrEP

This year for World AIDS Day, the Wheeler Centre has kindly published a longform article I wrote about PrEP titled ‘The other blue pill’.

I wanted to resist taking a side in the debate ‘Is PrEP good or bad’ or ‘Should we fund PrEP’.  These are phoney debates: we toss around arguments for/against, even though PrEP is going to happen. 

What we’re really fighting over is different ways of framing the problem that lead in different program and policy directions.

As a piece of social science writing, I wanted to leave readers with a couple of different ways of thinking about how those debates are framed. Framing PrEP in terms of ‘who should pay’ and ‘who deserves access’ leads naturally to discussions about limiting access.

We know where that leads.  Victoria has a post-exposure prophylaxis (‘PEP’) program that was funded via block grants to hospitals rather than the PBS.  Funding hasn’t kept up with demand and the use of newer, more expensive drugs.

As a result, we have de facto rationing.  There is no incentive to promote PEP widely in the gay community, and awareness of PEP has remained stubbornly around 65% on the gay periodic surveys.  ‘Repeat presenters’ — people at high risk of HIV infection who we most want to target — report encountering ‘moral friction’ from hospital providers, with remarks like ‘It’s not the morning-after pill, you know!’  The Alfred Hospital has resumed its policy of refusing international students access to PEP — even though PEP isn’t funded by Medicare.

So my goal in the Note is to challenge the implicit logic that makes ‘But should we pay for that?’ a rhetorical question, answerable only in the negative.  I’m walking in the foot-steps of Gregory Tomso’s analysis of public health responses to barebacking:

In his essay “Violence and Metaphysics,” Jacques Derrida … writes of philosophy’s “unbreachable responsibility” to poses questions in such a way that “the hypocrisy of an answer” is not yet “fraudulently articulated within the very syntax of the question.” (p91)

Framing therefore involves symbolic violence: it poses the question in a way that closes off certain answers.  As Tomso notes, “there is also the violence that belongs to wanting to know something about another, the Other, who is not the self” (ibid).

So I didn’t want to argue my case via universalising discourses like human rights, the responsible subject, or ‘we all want the same things really’.

The article describes cultures of sexual adventurism among gay men as one of those laboratories for learning about challenges that face the broader community — such as the sustainability of monogamous relationships and the ethical negotiation of casual sex.

But it also flips the script a bit: instead of pathologising sexual adventurism, it uses major representative studies (HILDA and ASHR) to de-naturalise  heterosexual practices of monogamy and highlight the need for the ideas and practices queer culture is experimenting with.

And it points out the injustice of relying on social innovators experimenting on their own bodies and relationships without providing them with the basic resources needed to do this safely.

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how social change happens

In case the idea of ‘cultural laboratories’ sounds a bit weird, it reflects some thinking I’ve been doing on the side of (recently-concluded) project work with the ‘What Works and Why’ study led by Dr Graham Brown at the Australian Research Centre in Sex, Health and Society.

This thinking considers how social change happens if we understand society as a complex adaptive system: a ‘complex macroscopic collection’ of relatively ‘similar and partially connected micro-structures’ formed in order to adapt to the changing environment, and increase its chances of survival (Wikipedia).

In a 1999 paper, the European social theorist Klaus Eder set out to explain why ‘society learns, and yet the world is hard to change’.  If we can get a bunch of AFL footballers in the room and convince them that homophobia is bad (social learning), why is it so much harder to discourage homophobia as part of the culture of Aussie rules in society (social change)?

Eder suggests that we learn how to overcome social problems in small networks — but that only leads to social change when our discoveries get captured, remixed and amplified through higher-level processes, such media narratives, popular culture, government policy, etc.

In my example, this might occur via the AFL changing the rules to heavily penalise homophobic behaviour.  No doubt this would cause a fair amount of backlash, but that’s part of the amplification process.  The change might occur through public debate triggering similar learning processes and the dissemination of findings across a much wider range of ‘cells’ in the honeycomb fabric of society (clubs, schools, families, etc).

In an earlier post I argued that news coverage alone is pretty unlikely to achieve this, but feature journalism probably does, because it provides enough space to offer an alternative framework for understanding the issue, and it allows the mixture of research, argument and personal narratives.  We’ve become literate in science writing but the genre of social science writing can barely be said to exist, beyond the Gladwells and the Freakonomics of this world.

But even when social learning produces innovative strategies, the achievement of widespread social change is by no means guaranteed.  Different ways of having the debate, as I argue above, can stifle the change process.

We know that major social change tends to happen when learning bubbles up from a particularly innovative network during a ‘window of alignment’ among much larger social processes — such as a media crusade and a tidal swell of popular opinion and a change of government: moments that Kingdon called ‘policy windows’.  That’s why timing is such a crucial part of effectiveness in policy advocacy.

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trying to make social change happen

Having an account of ‘how social change happens’ is not the same as knowing ‘how to make social change happen’.  To be clear upfront, I don’t think there is a recipe you can follow that’s guaranteed to make social change happen.  But there are preconditions we can achieve to make it more likely.

One is to keep the innovation bubbling away in those smaller networks — they are the cultural laboratories of change. If they dry out, you can’t just restart them at will when you need some good ideas in a hurry.

I saw this in action at the first national conference for the Australian Forum on Sexuality, Education and Health, with a panel featuring young queer educators talking about trigger warnings, activities for teaching affirmative consent, etc.  Some of the strategies sounded impractical to me, but practicality is not the point: experimental intensity is the point.

Second, we need a middle tier of project workers, researchers and policy advocates, who are paying attention above and below, identifying and validating good strategies from the laboratories and thinking about how to package them up, so there are policy options ready to go when those windows of opportunity appear.

Both of these suggestions depend on our health and welfare systems and the human services sector having enough resources flowing within them to support redundancy, which is essential for diversity.  Without that, you don’t get the multiple competing ideas that are essential for innovation.

Stigma is about social exclusion

In the conversations we have about HIV at national and global conferences, the word ‘stigma’ is all too often used to mean ‘HIV-positive people having negative experiences’.  When I first began working on stigma as an issue, back in 2008, my goal was to expand our sense of what stigma means.  I wanted the sector to adopt a language for talking about stigma that acknowledges that it has different components and works on multiple levels.

In particular, I wanted the sector to focus on how stigma is implicated in social exclusion — people not being welcome in particular social networks or settings — and social participation — people not being able to play a meaningful role within communities, workplaces, sexual cultures, social movements, arts and culture, policy-making, governance and democracy.

Along the way I’ve noticed parallels between the work I was doing around HIV stigma and anti-racist social movements.  For instance, stigma can be a productive framework for understanding sexual racism as a stereotype driven process for excluding non-white men as potential sexual partners.*

I am absolutely blown away by this article by Hanif Abdurraqib in Pitchfork magazine, looking at the failure to think about racism, and the way violence may be differently experienced by black people, as drivers of his experience of exclusion and alienation from the Midwest punk community.

Not least because the writing is so damn powerful:

I don’t remember the first time I noticed the small group in the back corner of a punk show at the Newport (one of the many venues that I fell in and out of love with in my hometown of Columbus, Ohio), all of them, in some way, pushed out of the frenzied circle of bodies below, and the alleged loving violence that comes with it. I do remember the first time I became one of the members of that group in the back corner of shows. At 18, I hung in the back corner of the Newport and watched NOFX with the rest of the kids who didn’t quite fit, or at least became tired of attempting to fit. I looked around and saw every version of other, as I knew it. The black kids, the girls my age and younger, the kids most fighting with the complexities of identity. We sat back and watched while NOFX tore through an exceptionally loud version of “Don’t Call Me White”, and watched below, as a monochromatic sea crashed against itself.

In a piece evocatively titled ‘The Rice Steamer’, Australian researcher Gilbert Caluya has described something similar on the gay scene:

During one of my trips to a particular club I must have looked confused or perhaps just out of place because a white man came up to me to offer some help. ‘If you’re looking for where the Asians are you can find them over there’, he said pointing to a group of Asian men. Over the course of the fieldwork it became evident that this nightclub seemed to ‘reserve’ this particular space for Asian men and rice queens who huddled around the bottom of the stairs next the stage.

Caluya uses the concept of ‘striated space’ from Deleuze and Guattari (1988) to analyse how gay community venues are partitioned into zones where people of non-white race can experience more or less microaggressive friction — such as the ‘helpful’ direction he recounts in the quote above.

These two quotes can help us think about how stigma is involved in experiences of social exclusion that accumulate and calcify into social structures that are, in turn, implicated in the inequitable distribution of access to life chances — such as opportunities for love, sex, and social connection; and more concretely, health services like counselling and technologies for health like PrEP and HIV testing and treatment.


* I wouldn’t go as far as Link, Phelan and Dovidio (2008) in speculating on stigma and racial prejudice being the same things.

Writing after trauma

Trigger warnings for family violence and sexual assault.


Fig. 296 ‘How to repair a hammock or a fish net’

My new year’s resolution, declared on twitter, was to write properly about trauma. Here we are, a couple of weeks later and it’s August.

Why the delay? It was not reluctance to start but facing down the central problem of writing after trauma: finding where to begin and how to end. Trauma, by definition, resists those acts of location.

Continue reading

Naming, shaming and blaming on social media

lord-of-the-flies-originalI’ve been interested in shame and stigma for a long time, so I was looking forward to last night’s Midwinta discussion panel on ‘Naming, Shaming and Blaming on Social Media’ at Hares and Hyenas.  The convener was Lana Woolf and the panelists included commentator Clementine Ford, performer and thought-provoker Lauren Stardust, and my colleague and friend, Natalie Hendry, whose PhD research looks at how young people with mental health conditions use social media spaces.

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Language and the blame game in global HIV policy

I am loving this post by Alice Welbourn on the 50.50 blog at openDemocracy.

Some UN documents, such as the 2013 WHO HIV treatment Guidelines, seek for us to “achieve viral suppression” and if we don’t, health staff –  even some male activists with HIV – brand us as “defaulters”, “failures” “wasting resources” and worse, with their targets and goals unmet. Susan Sontag wrote of this “blame the victim” mode long ago and nothing has changed. Even the phrase “lost to follow up” and “treatment-naïve patients” also make us sound somehow – well – naïve, careless and thoughtless, as if there might not be key intentional reasons for our “failure” to return to a clinic. In a recent trial in South Africa, where it was discovered that young women participants had not in fact made use of a tablet and gel that were being trialed when they said they had, they were deemed by the researchers to have ruined the trial by “lying”.  As Professor Ida Susser explains: “when a study fails, we must be careful not to imply that the subjects are at fault. My analysis of the study suggests, rather, that research design was to blame.”

Read the full article here.

Why I’m not ‘non-racist’

lilting 1


I have a piece titled ‘Love and the Other’ in the new edition (#26) of The Lifted Brow, reviewing the film Lilting and the questions it raises around the ethics of being the White partner in a gay relationship with an Asian man. From the piece:

The film opens in the aftermath of Kai’s death. As it plays out, we see that scene three times, differently inflected each time. We meet Kai in Richard’s memory as well, and it becomes apparent these are not simple flashbacks: there is imagination and longing in the mix.

Knowing that Junn speaks no English and learning she has a suitor, Richard organises to visit with an interpreter, “To help them understand each other.” In so doing, he reveals himself to Junn’s questions – why are you here? – and must decide how much to tell her about his relationship with her only son.

In the piece I review my own history of relationships with Asian men, and why I identify as a racist person with anti-racist political commitments:

Thinking back to the poor little arsehole that was my late teen self, I had bought into the Hollywood notion that a non-white partner could help me ‘get in touch’ with all the things white people believe they have lost since the Industrial Revolution, including: sex, embodiment, eating and cooking food, rhythm, dancing, style, spirituality, emotionality, family, community, and connection with the land.

It would be a lie to say I learned over time how to be non-racist; it would be more accurate to say that, as I learned over the years how to better manage my ego and emotions, my espoused anti-racism became less bullshit.

The Brow has only been out a few days and I’ve already been asked about the point I’m making here.

I’ve had various barnies on twitter with people who asserted non-racist identity while at the same time espousing either racist views or support for policies that assert and reproduce value hierarchies based on race.

Reflecting on my absolute confidence as a young gay man that I was ‘one of the good ones’, I have come to acknowledge that I was brought up racist, I was educated racist, I live in a racist society, I am a white person from a colonial heritage (Dutch) and, with all that in mind, it would be ridiculous to claim that I am not racist.

I see that acknowledgment as consistent with my anti-racist politics: it’s a necessary first step towards identifying the unconscious attitudes and thoughtless practices that, via my own behaviour, reproduce racism.

And I’ve seen anti-racist organisations where all their non-white staff are casuals, where non-white staff are discouraged from applying for management roles because ‘your English isn’t good enough’, where white staff with anti-racist politics spoke louder and more slowly to non-white staff who spoke English as a first language.

If we weren’t so desperate to other racists as bad, ignorant people, we’d be in a better place to reflect on our own contribution to racist structures in our personal relationships and workplace life.  Without this, our efforts to change the behaviour of those other people are inherently unconvincing.


  1. If you do happen to get a copy of the Brow #26 — it’s a lovely edition! — you may find my contribution reads a bit disjointedly.  There were originally rows of asterisks indicating the section breaks, but they have disappeared.  Feel free to imagine them wherever it would help my writing to make sense.  Or you could be like my flatmate, recalling Vonnegut in Slaughterhouse Five, and imagine them as rows of little arseholes.  This would be thematically consistent.
  2. My thinking around this issue owes a debt to Australian and New Zealand writers and thinkers on Indigenous health and cultural safety, particularly Prof Linda Tuhiwai Smith, A/Prof Dennis McDermott, Siv Parker, Luke Pearson, and Peter Waples-Crowe, as well as non-Indigenous teachers like Dave Sjoberg.

Sit back and listen

Reflections from tonight’s VAC forum on Navigating Sexuality, Gender, Culture and Religion, moderated by Maria Pallotta-Chiarolli (Deakin University) with speakers Gilbert Caluya, Monique Hameed, Lia Incognita, Raina Peterson, Nur Wasame and Shinen Wong.

As I walked in the door, convenor Budi Sudarto sighed theatrically, ‘it’s the same old suspects’. Way to make a guy feel welcome! But in fact it wasn’t: pretty soon the room was packed, with an audience of mostly ‘community people’ — not the usual crowd of academics and project workers. Also, the panel included queer speakers from African and Muslim perspectives and counting the moderator it was more than half women. Monique Hameed noted her experience in ‘coming out’ was marked by a lack of ‘brown and gay’ role models. This panel was significantly more inclusive than similar events I helped organise about five years ago, and Monique’s remarks underscore the importance of that — so full credit to the organisers and the panellists for that.

These are just some fragmentary reflections from moments that resonated with me personally — any errors are on me (please feel free to point them out or add your thoughts in the comments).

  • Maria asked if queer is a Western concept.
  • Shinen traced the imaginary geography of Australia’s cultural identification — calling ourselves ‘Western’ traces a lineage back to Europe.
  • Raina described looking to the historical record of Indian culture for affirmation in images and texts about same gender desire.
  • Gilbert pointed out how if we see queer as a moment of breaking away from Gay liberation, we can forget how much the earlier homophile movements looked for validation in anthropological records of same gender desire in other cultures.
  • Lia noted the risk of erasure when we look back and claim historical people and practices as queer.
  • Shinen contrasted the Western secular atheist notion of history as progressive with the cyclical conceptions of time prevalent in Buddhist thinking, and noted how the conditions we establish today in the name of justice will be future conditions of repression
  • Maria asked the panel about the politics of coming out and what it feels like.
  • Monique noted that ‘mainstream services targeting LGBTIQ people often focus on coming out as a defining moment after which you get to experience being truly gay and true to yourself.’ (quotes to indicate close to verbatim quotation)
  • Nur noted that ‘coming out’ is very, very serious in his community: ‘it’s your life on the line’.  But he sees it as important for the young people — not just young gay Muslims but to reach non-gay Muslims as well.
  • Lia described her concern with overly literal responses to the problem of invisibility — simply getting seen more is not an answer to invisibility of particular intersections of identity, such as femme lesbians or black women in fashion photography; it just leads to a proliferation of the same visual stereotypes encoded in problematic ways.
  • For Lia greater visibility was not an answer to the question of how to find and how to recognise each other.
  • Gilbert noted one of the most challenging things for his partner, a white man, was having to think about race when he’d never had to before being partnered for ten years with another white man.
  • Maria asked the panel whether privileged people have a responsibility to help — but also how they can do that without taking over or appropriating.
  • Raina differentiated anti-racist discourse, with its focus on structural racism, and the Australian multicultural identity of ‘we all have differences’.  She noted how ethnic communities adopt a low profile as they settle, trying to avoid attracting abuse.  She suggested, and this is my takehome for the night, maybe white people can do that, for a change: ‘try to be a bit quiet’.  She said she was tired of being a focus group participant for white people making their career in multicultural policy.
  • Lia recounted how she’s done a few of these forums lately and often there’s a question from the audience, ‘what can white people do?’  She suggested, you know, put a bit of effort into it and find the answer for yourself, but also noted that under oppressive structural conditions there’s no ‘better’ course of action: all the available paths are marked by those unequal power relations.
  • Monique described majority-white mainstream organisations wanting access to her project’s participants; funding arrangements that anticipate partnerships that are enacted in inequitable ways; and trying to engage with staff who have no lived experience of what’s at stake for ethnic queer people: you know, ‘maybe it means you’re not the right person for the role.’
  • An audience question made a really great point, that ‘diversity isn’t a substitute for justice’.

There was the usual smattering of audience questions, including some from people who missed Raina’s takehome point, and the event closed.  If you want to be kept informed of upcoming events, like the Australian GLBTIQ Multicultural Council on Facebook!

Feel free to comment but remember, if you find this stuff ‘really interesting‘, it probably means you’re not a member of the group who have the most at stake with this issue, so please frame your response to show respect for that.