‘HIV Both Starts and Stops with Me’: Configuring the Neoliberal Sexual Actor in HIV Prevention

Abstract

This article argues that newer HIV prevention campaigns and health promotions that focus on reaching the public with information on how to prevent HIV infections or treat them once a person becomes HIV positive are mainly built upon the rationale of what has been called ‘a neoliberal sexual actor’. The sexual actor being represented is predicated upon the tenets of a neoliberal subject wherein market choice, rational risk analysis, personal responsibility, and personal entrepreneurship are in focus. Whereas many of the newer health promotions are built upon the tenets of neoliberalism, these health promotions while being both inclusive in terms of sexualities and racialized identities nevertheless play on neoliberal ideals that may or may not be available for the people who are most vulnerable in terms of HIV risk. The article ends up by arguing that while many of these health promotions are both ‘sex-positive’ and avoid the specter of ‘risk’ and ‘infection’ and rather play on neoliberal concepts, they nevertheless also leave behind those that for whatever reasons cannot comply with or access these tenets. In an era when the HIV effort strongly plays on a rhetoric of ‘leaving no one behind’ such an overt focus on the neoliberal concepts of free choice, market freedom, personal responsibility, and ‘rational’ risk calculation, might end up leaving behind the most vulnerable people within the HIV epidemic.

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Notes

  1. 1.

    For the full biography of the HIV Stops with Me campaign, see http://hivstopswithme.org/about/.

  2. 2.

    See New York City Department of Health and Mental Hygiene website, https://www.health.ny.gov/diseases/aids/ending_the_epidemic/.

  3. 3.

    See the NYC Health website for the ‘Play Sure’ promotion, https://www1.nyc.gov/site/doh/health/health-topics/hiv-besure-playsure-staysure.page.

  4. 4.

    See YouTube for examples of videos with the search criteria’s of ‘Play Sure’ and ‘HIV’, https://www.youtube.com/results?search_query=play+sure+HIV.

  5. 5.

    See the Play Sure website, https://www1.nyc.gov/site/doh/health/health-topics/hiv-besure-playsure-staysure.page.

  6. 6.

    See the Play Sure website, https://www1.nyc.gov/site/doh/health/health-topics/hiv-besure-playsure-staysure.page.

  7. 7.

    See the Play Sure website, https://www1.nyc.gov/site/doh/health/health-topics/hiv-besure-playsure-staysure.page.

  8. 8.

    See the Play Sure website, https://www1.nyc.gov/site/doh/health/health-topics/hiv-besure-playsure-staysure.page.

  9. 9.

    See the Play Sure website, https://www1.nyc.gov/site/doh/health/health-topics/hiv-besure-playsure-staysure.page.

  10. 10.

    See the Play Sure website, https://www1.nyc.gov/site/doh/health/health-topics/hiv-besure-playsure-staysure.page.

  11. 11.

    See the Play Sure’s website for information on the kit itself, https://www1.nyc.gov/nyc-resources/service/5500/play-sure-kit.

  12. 12.

    See the YouTube video in its entirety here, https://www.youtube.com/watch?v=W3ErsNQiZUA.

  13. 13.

    See the video at https://www.youtube.com/watch?v=RjfMj3FQULk.

  14. 14.

    See http://www.thebody.com/content/75525/new-york-citys-new-hiv-awareness-campaign-shows-in.html for full image.

  15. 15.

    See the promotional agency’s own webpage for the entire imagery, https://desireekennedyproductions.wordpress.com/2015/12/15/i-bet-by-now-you-have-seen-the-nyc-plays-sure-campaign-on-the-subway/.

  16. 16.

    http://hivstopswithme.org/about/.

  17. 17.

    http://hivstopswithme.org/treatment-info/.

  18. 18.

    http://hivstopswithme.org/treatment-info/.

  19. 19.

    http://hivstopswithme.org/treatment-info/.

  20. 20.

    http://hivstopswithme.org/treatment-info/.

References

  1. Adam, B. D. (2005). Constructing the neoliberal sexual actor: Responsibility and care of the self in the discourse of barebackers. Culture, Health and Sexuality, 7(4), 333–346.

    Article  Google Scholar 

  2. Adam, B. D. (2006). Infectious behaviour: Imputing subjectivity to HIV transmission. Social Theory and Health, 4(2), 168–179.

    Article  Google Scholar 

  3. Adam, B. D. (2016). Neoliberalism, masculinity, and HIV risk. Sexuality Research and Social Policy, 13(4), 321–329.

    Article  Google Scholar 

  4. Adam, B. D., Hart, T. A., Mohr, J., Coleman, T., & Vernon, J. (2017). HIV-related syndemic pathways and risk subjectivities among gay and bisexual men: a qualitative investigation. Culture, Health and Sexuality, 19(11), 1254–1267.

    Article  Google Scholar 

  5. Adam, B. D., Husbands, W., Murray, J., & Maxwell, J. (2005). AIDS optimism, condom fatigue, or self-esteem? Explaining unsafe sex among gay and bisexual men. Journal of Sex Research, 42(3), 238–248.

    Article  Google Scholar 

  6. Auerbach, J. D., Kinsky, S., Brown, G., & Charles, V. (2015). Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care and STDs, 29(2), 102–110.

    Article  Google Scholar 

  7. Belluz, J. (2014). The Truvada wars. BMJ, 348, g3811.

    Article  Google Scholar 

  8. Boltanski, L., & Chiapello, E. (2005). The new spirit of capitalism. International Journal of Politics, Culture, and Society, 18(3–4), 161–188.

    Article  Google Scholar 

  9. Brown, W. (2009). Edgework: Critical essays on knowledge and politics. Princeton: Princeton University Press.

    Google Scholar 

  10. Bruce, D., & Harper, G. W. (2011). Operating without a safety net: Gay male adolescents and emerging adults’ experiences of marginalization and migration, and implications for theory of syndemic production of health disparities. Health Education and Behavior, 38(4), 367–378.

    Article  Google Scholar 

  11. Calabrese, S. K., & Underhill, K. (2015). How stigma surrounding the use of HIV pre-exposure prophylaxis undermines prevention and pleasure: A call to destigmatize “Truvada whores”. American Journal of Public Health, 105(10), 1960–1964.

    Article  Google Scholar 

  12. Chakrapani, V., Newman, P. A., Shunmugam, M., Logie, C. H., & Samuel, M. (2017). Syndemics of depression, alcohol use, and victimization, and their association with HIV-related sexual risk among men who have sex with men and transgender women in India. Global Public Health, 12(2), 250–265.

    Article  Google Scholar 

  13. Cohen, M. S. (2010). HIV treatment as prevention: To be or not to be? Journal of Acquired Immune Deficiency Syndromes. https://doi.org/10.1097/qai.0b013e3181f0cbf3.

    Google Scholar 

  14. Cohen, M. S., McCauley, M., & Gamble, T. R. (2012). HIV treatment as prevention and HPTN 052. Current Opinion in HIV and AIDS, 7(2), 99.

    Article  Google Scholar 

  15. Collier, K. L., Colarossi, L. G., & Sanders, K. (2017). Raising awareness of pre-exposure prophylaxis (PrEP) among women in New York City: Community and provider perspectives. Journal of Health Communication, 22(3), 183–189.

    Article  Google Scholar 

  16. Cristian Rangel, J., & Adam, B. D. (2014). Everyday moral reasoning in the governmentality of HIV risk. Sociology of Health and Illness, 36(1), 60–74.

    Article  Google Scholar 

  17. Desai, M., Field, N., Grant, R., & McCormack, S. (2017). State of the art review: Recent advances in PrEP for HIV. BMJ (Clinical Research Edition), 359, j5011.

    Article  Google Scholar 

  18. Diprose, R. (2008). Biopolitical technologies of prevention. Health Sociology Review, 17(2), 141–150.

    Article  Google Scholar 

  19. Dworkin, S. L., & Ehrhardt, A. A. (2007). Going beyond “ABC” to include “GEM”: Critical reflections on progress in the HIV/AIDS epidemic. American Journal of Public Health, 97(1), 13–18.

    Article  Google Scholar 

  20. Dyer, T. P., Shoptaw, S., Guadamuz, T. E., Plankey, M., Kao, U., Ostrow, D., et al. (2012). Application of syndemic theory to black men who have sex with men in the Multicenter AIDS Cohort Study. Journal of Urban Health, 89(4), 697–708.

    Article  Google Scholar 

  21. Flew, T. (2012). Michel Foucault’s The Birth of Biopolitics and contemporary neo-liberalism debates. Thesis Eleven, 108(1), 44–65.

    Article  Google Scholar 

  22. Foucault, M. (2007). Security, territory, population: Lectures at the Collège de France, 1977–78. New York: Springer.

    Google Scholar 

  23. Foucault, M. (2008). The birth of biopolitics: Lectures at the Collège de France, 1978–1979. New York: Springer.

    Google Scholar 

  24. Giroux, H. A. (2008). Beyond the biopolitics of disposability: Rethinking neoliberalism in the new gilded age. Social Identities, 14(5), 587–620.

    Article  Google Scholar 

  25. González-Guarda, R. M., Florom-Smith, A. L., & Thomas, T. (2011). A syndemic model of substance abuse, intimate partner violence, HIV infection, and mental health among Hispanics. Public Health Nursing, 28(4), 366–378.

    Article  Google Scholar 

  26. Grant, R. M., Anderson, P. L., McMahan, V., Liu, A., Amico, K. R., Mehrotra, M., et al. (2014). Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. The Lancet Infectious Diseases, 14(9), 820–829.

    Article  Google Scholar 

  27. Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., et al. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363(27), 2587–2599. https://doi.org/10.1056/NEJMoa1011205.

    Article  Google Scholar 

  28. Hardt, M., & Negri, A. (2001). Empire. Cambridge: Harvard University Press.

    Google Scholar 

  29. Holt, M. (2015). Configuring the users of new HIV-prevention technologies: The case of HIV pre-exposure prophylaxis. Culture, Health and Sexuality, 17(4), 428–439. https://doi.org/10.1080/13691058.2014.960003.

    Article  Google Scholar 

  30. Karlsen, M. P., & Villadsen, K. (2016). Health promotion, governmentality and the challenges of theorizing pleasure and desire. Body and Society, 22(3), 3–30.

    Article  Google Scholar 

  31. Kenworthy, N., Thomann, M., & Parker, R. (2018a). Critical perspectives on the ‘end of AIDS’. Global Public Health, 13(8), 957–959.

    Article  Google Scholar 

  32. Kenworthy, N., Thomann, M., & Parker, R. (2018b). From a global crisis to the ‘end of AIDS’: New epidemics of signification. Global Public Health, 13(8), 960–971.

    Article  Google Scholar 

  33. Koren, D. E., Nichols, J. S., & Simoncini, G. M. (2018). HIV pre-exposure prophylaxis and women: Survey of the knowledge, attitudes, and beliefs in an urban obstetrics/gynecology clinic. AIDS Patient Care and STDs, 32(12), 490–494.

    Article  Google Scholar 

  34. Kurtz, S. P., Buttram, M. E., Surratt, H. L., & Stall, R. D. (2012). Resilience, syndemic factors, and serosorting behaviors among HIV-positive and HIV-negative substance-using MSM. AIDS Education and Prevention, 24(3), 193–205.

    Article  Google Scholar 

  35. Larsen, L. T., & Stone, D. (2015). Governing health care through free choice: Neoliberal reforms in Denmark and the United States. Journal of Health Politics, Policy and Law, 40(5), 941–970.

    Article  Google Scholar 

  36. McCormack, S., Dunn, D. T., Desai, M., Dolling, D. I., Gafos, M., Gilson, R., et al. (2016). Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomized trial. The Lancet, 387(10013), 53–60. https://doi.org/10.1016/s0140-6736(15)00056-2.

    Article  Google Scholar 

  37. McGrath, J. W., Winchester, M. S., Kaawa-Mafigiri, D., Walakira, E., Namutiibwa, F., Birungi, J., et al. (2014). Challenging the paradigm: Anthropological perspectives on HIV as a chronic disease. Medical Anthropology, 33(4), 303–317.

    Article  Google Scholar 

  38. McGuigan, J. (2014). The neoliberal self. Culture Unbound: Journal of Current Cultural Research, 6(1), 223–240.

    Article  Google Scholar 

  39. Mimiaga, M. J., Cleirigh, C., Biello, K. B., Robertson, A. M., Safren, S. A., Coates, T. J., et al. (2015). The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. Journal of Acquired Immune Deficiency Syndromes (1999), 68(3), 329.

    Article  Google Scholar 

  40. Mirowski, P., & Plehwe, D. (2015). The road from Mont Pèlerin: The making of the neoliberal thought collective, with a new preface. Cambridge: Harvard University Press.

    Book  Google Scholar 

  41. Mitchell, W. T. (2013). Iconology: Image, text, ideology. Chicago: University of Chicago Press.

    Google Scholar 

  42. Molina, J.-M., Capitant, C., Spire, B., Pialoux, G., Cotte, L., Charreau, I., et al. (2015). On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. New England Journal of Medicine, 373(23), 2237–2246. https://doi.org/10.1056/NEJMoa1506273.

    Article  Google Scholar 

  43. Murphy, E. M., Greene, M. E., Mihailovic, A., & Olupot-Olupot, P. (2006). Was the “ABC” approach (abstinence, being faithful, using condoms) responsible for Uganda’s decline in HIV? PLoS Medicine, 3(9), e379.

    Article  Google Scholar 

  44. Nealon, J. (2007). Foucault beyond Foucault: Power and its intensifications since 1984. Palo Alto: Stanford University Press.

    Google Scholar 

  45. Rowniak, S. (2009). Safe sex fatigue, treatment optimism, and serosorting: New challenges to HIV prevention among men who have sex with men. Journal of the Association of Nurses in AIDS Care, 20(1), 31–38.

    Article  Google Scholar 

  46. Sastry, S., & Dutta, M. J. (2012). Public health, global surveillance, and the “emerging disease” worldview: A postcolonial appraisal of PEPFAR. Health Communication, 27(6), 519–532.

    Article  Google Scholar 

  47. Shefer, T., Strebel, A., & Jacobs, J. (2012). AIDS fatigue and university students’ talk about HIV risk. African Journal of AIDS Research, 11(2), 113–121.

    Article  Google Scholar 

  48. Singer, M., Bulled, N., Ostrach, B., & Mendenhall, E. (2017). Syndemics and the biosocial conception of health. The Lancet, 389(10072), 941–950.

    Article  Google Scholar 

  49. Smart, B. (2003). Economy, culture, and society: A sociological critique of neo-liberalism. Buckingham: Open University Press.

    Google Scholar 

  50. Spieldenner, A. (2016). PrEP whores and HIV prevention: the queer communication of HIV pre-exposure prophylaxis (PrEP). Journal of Homosexuality, 63(12), 1685–1697.

    Article  Google Scholar 

  51. Stockman, J. K., Schwarcz, S. K., Butler, L. M., de Jong, B., Chen, S. Y., Delgado, V., et al. (2004). HIV prevention fatigue among high-risk populations in San Francisco. JAIDS Journal of Acquired Immune Deficiency Syndromes, 35(4), 432–434.

    Article  Google Scholar 

  52. Thomann, M. (2018). ‘On December 1, 2015, sex changes. Forever’: Pre-exposure prophylaxis and the pharmaceuticalisation of the neoliberal sexual subject. Global Public Health, 13(8), 997–1006.

    Article  Google Scholar 

  53. UNAIDS. (2018). Miles to go—Closing gaps, breaking barriers, righting injustices, 268.

  54. Venugopal, R. (2015). Neoliberalism as concept. Economy and Society, 44(2), 165–187.

    Article  Google Scholar 

  55. Volk, J. E., Marcus, J. L., Phengrasamy, T., Blechinger, D., Nguyen, D. P., Follansbee, S., et al. (2015). No new HIV infections with increasing use of HIV pre-exposure prophylaxis in a clinical practice setting. Clinical Infectious Diseases, 61(10), 1601–1603.

    Article  Google Scholar 

  56. Weber, H. (2017). Politics of ‘leaving no one behind’: Contesting the 2030 sustainable development goals agenda. Globalizations, 14(3), 399–414.

    Article  Google Scholar 

  57. WHO. (2016). Action plan for sexual and reproductive health. Towards achieving the 2030 agenda for sustainable development in Europe—Leaving no one behind.

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Acknowledgements

I would like to thank the journal editor as well as the anonymous reviewer who gave invaluable advice and whose comments really lifted the article as a whole.

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This study was done in connection to post-doctoral research work at the place of employment of the author, but no specific funding grant was funding this study.

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Correspondence to Tony Sandset.

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Sandset, T. ‘HIV Both Starts and Stops with Me’: Configuring the Neoliberal Sexual Actor in HIV Prevention. Sexuality & Culture 23, 657–673 (2019). https://doi.org/10.1007/s12119-018-09584-1

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Keywords

  • HIV/AIDS
  • Neoliberalism
  • PrEP
  • Prevention
  • Health promotions