PrEP and TasP – Beware of History Repeating Itself

I’ve just come back from the 2nd International Conference of the Association for Social Science and Humanities in HIV (ASSH). It was a terrific event.

I have to admit that I was slightly anxious about attending – and about the politics of a conference that spoke of – and to – this virus from a non-biomedical model. Can researchers working outside of the ‘hard sciences’ be doing anything that can make a difference to the HIV/AIDS epidemic? And I thought this even though I myself have been engaged in work that focuses on gay men’s sexual health promotion work for several years.

Thankfully, my anxieties were put to rest very early on in the conference. Research into the social and cultural dimensions of HIV/AIDS, prevention work and treatment regimes is needed – now more than ever – to temper and to critique and, yes, to displace and complicate the primacy of the biomedical response to the epidemic. I do not have the space to engage in a lengthy overview of the conference (it was an intense conference – I am very tired) but I’ve included a link above to the conference website and, hopefully, presentations will be appearing there soon.

But what I did want to spend a little bit of time reflecting upon is the rhetoric of PrEP and TasP that dominated many of the conversations at the conference. Its prominent feature at the conference is hardly surprising given the fact that both treatments are being heavily ‘marketed’ (in every sense of the word) as the next big step in HIV prevention work. I think it was Gary Dowsett, in one of the first panels of the conference, who asked the question ‘how do new technologies such as PrEP, TasP, home-testing etc get incorporated into new behaviours, and new cultures and new sexual practices?’

This, I thought was a very pertinent question, and it resonated with me throughout the conference, not least because I think this question is one that I’ve been trying to answer (from a different perspective, and in a different context) for several years now. Instead of PrEP, for instance, I (and others) have inadvertently been asking ‘how did condoms get incorporated into new behaviours and new cultures and new sexual practices’ for some time.

Indeed, this was one of the themes of my own paper at ASSHH this week. I was presenting some of the findings from last year’s Porn Laid Bare project and underpinning these findings is the belief that we need to understand the culture of barebacking, and the popularity of bareback pornography, as an incorporating practice of the kind that Dowsett is enquiring after.

Did the condom code create barebacking? No.

Did the promotion of condoms as the primary method of HIV prevention cause barebacking to appear in porn? No.

The pictureis far more complex (and includes HAART, AZT, time, history and politics as well as health promotion)

However, we *can*, I think, argue that, as a technology, condoms became incorporated into gay male sexual practice and sexual cultures in a variety of ways, and that such integration is not static. We need only look at the history of gay porn since the late 1970s for evidence of this. During the 70s and early 80s, gay porn did not feature condoms – but that was because this technology had not been ‘introduced’ into gay male subcultures. At the height of the AIDS epidemic in the USA, we saw condoms becoming a standardised part of the gay porn industry. Today, condoms continue to be integral to gay porn today even when they are not present. Bareback pornography is not a return to the hedonistic days of the 1970s. Bareback porn represents just as much a cultural integration of the condom as porn of the late 80s was. That integration might not take the form of condoms being used in bareback porn – of course it doesn’t. But nevertheless, the production of bareback porn, the distribution of bareback porn and – perhaps most importantly – the consumption of bareback porn, is framed by the technology of the prophylactic.

Why am I talking about bareback porn in a post about PrEP and TasP? Well because I think we need to look to the (recent) past in order to answer – but perhaps also extend – Dowsett’s question. We need only look at bareback porn to see how technologies of HIV prevention can be incorporated into gay men’s sexual cultures in ways that run counter to the intents and purposes of that technology.

I do not want to speculate (but I will) as to the ways in which PrEP and TasP might also be integrated into sexual cultures in ways that counter their original purposes, but given the hyperbolic talk of bug-chasing, pozzing up and gift-giving that pervade particular  Internet forums, I would imagine that the fantasy of playing around with PrEP (if not the reality) will feature at some point in the not too distant future.

Perhaps it’ll be in a forum post that flirts with coming off PrEP for ‘one night only’; or ¬†perhaps not using PrEP will become (yet another) way of inscribing a hypermasculinity on your personal profile within a particular sub-cultural online space(‘Real men don’t do PrEP’ – I can hear it now). These might seem fantastical, but then again, didn’t barebacking also seem that way ten years ago?

What can we learn from the history of biomedical technologies and HIV prevention? Well that things don’t always work out the way we expect, that treatment and prevention technologies can be appropriated in diverse ways – some of which run counter to their intent – and that we need to be prepared to consider how PrEP and TasP might actually have their limitations and lifespan culturally, if not medically.