Competing realities, uncertain diagnoses of infectious disease: Mass self-testing for COVID-19 and liminal bio-citizenship.

Diagnoses of infectious diseases are being transformed as mass self-testing using rapid antigen tests (RATs) is increasingly integrated into public health. Widely used during the COVID-19 pandemic, RATs are claimed to have many advantages over 'gold-standard' polymerase chain reaction tests, especially their ease of use and production of quick results. Yet, while laboratory studies indicate the value of RATs in detecting the SARS-CoV-2 virus antigen, uncertainty surrounds their deployment and ultimate effectiveness in stemming infections. This article applies the analytic lens of biological citizenship (or bio-citizenship) to explore Australia's experience of implementing a RAT-based mass self-testing strategy to manage COVID-19. Drawing on Annemarie Mol's (1999, The Sociological Review, 47(1), 74-89) concept of ontological politics and analysing government statements, scientific articles and news media reporting published during a critical juncture of the strategy's implementation, we explore the kind of bio-citizenship implied by this strategy. Our analysis suggests the emergence of what we call liminal bio-citizenship, whereby citizens are made responsible for self-managing infection risk without the diagnostic certitude this demands. We discuss how the different realities of mass self-testing interact to reinforce this liminal citizenship and consider the implications for the sociology of diagnosis.

Searching for diagnostic certainty, governing risk: Patients' ambivalent experiences of medical testing.

Diagnosis is pivotal to medicine's epistemic system: it serves to explain individual symptoms, classify them into recognizable conditions and determine their prognosis and treatment. Medical tests, or investigative procedures for detecting and monitoring disease, play a central role in diagnosis. While testing promises diagnostic certainty or a definitive risk assessment, it often produces uncertainties and new questions which call for yet further tests. In short, testing, regardless of its specific application, is imbued with meaning and emotionally fraught. In this article, we explore individuals' ambivalent experiences of testing as they search for diagnostic certainty, and the anxieties and frustrations of those for whom it remains elusive. Combining insights from sociological work on ambivalence and the biopolitics of health, and drawing on qualitative interviews with Australian healthcare recipients who have undergone testing in the context of clinical practice, we argue that these experiences are explicable in light of the contradictory impulses and tensions associated with what we term 'bio-subjectification'. We consider the implications of our analysis in light of the development of new tests that produce ever finer delineations between healthy and diseased populations, concluding that their use will likely multiply uncertainties and heighten rather than lessen anxieties.

The "Be All and End All"? Young People, Online Sexual Health Information, Science and Skepticism.

In this article, we investigate young people's trust in online sexual health resources. Analyzing interviews with 37 young people in Australia using Irwin and Michael's account of science-society relations and Warner's conceptualization of "publics," we explore the processes by which they assess the credibility of online sexual health information. We suggest that when seeking medical information, young people opt for traditionally authoritative online sources that purport to offer "facts." By contrast, when seeking information about relationships or sexual practices, participants indicated a preference for websites presenting "experiences" rather than or as well as "facts." Regardless of content, however, our participants approached online sexual health information skeptically and used various techniques to appraise its quality and trustworthiness. We argue that these young people are productively understood as a skeptical public of sexual health. We conclude by exploring the implications of our analysis for the provision of online sexual health information.

COVID-19 and the biopolitics of stigma in public housing: dividing practices and community boundaries in pandemic times.

The COVID-19 'hard lockdowns' in Melbourne, Australia in 2020 targeted public housing estates thus trading on perceptions of risk associated with public housing as some of the most stigmatised sites in post-industrial cities. This article draws on interviews with Melbourne public housing tenants on their experience of COVID-19 lockdowns to analyse the place of stigma in residents' accounts. Pairing Wacquant et al's (2014) concept of 'territorial stigma' with sociological work on the biopolitics of stigma we consider the dynamics of stigma, tracing how it functions to delimit community boundaries and justify pandemic containment measures. Residents navigate multiple layers of stigma, including stereotypes of public housing, normative judgements of neighbouring residents, and a broader public housing system riven with structural issues. Members of these communities are both the targets of stigma and seek to distance themselves from those seen as vectors of stigma. Our participants report mobilising social distancing strategies couched in normative assessments of perceived risk based on physical appearance, presumed drug use and past conduct. We explore the implications of these enactments of territorial stigma and trace the logics of abjection that construct public housing as deprived urban zones, home to abject 'Others' perceived as threatening the health of the community.

The timing of local SARS-Cov-2 outbreaks and vaccination coverage during the Delta wave in Melbourne.

OBJECTIVE: This article presents a longitudinal analysis of COVID-19 infection and vaccination coverage in Melbourne metropolitan local government areas (LGAs) during the 2021 Delta wave. METHODS: COVID-19 vaccination and infection data from 12 July to 27 November 2021 were sourced from government websites. Summary statistics and associated 95% confidence intervals (95% CI) were compared by LGA ranked according to socioeconomic status: total "burden" (total infections per thousand), "peak" (highest weekly infection rate), "lag" (interval between peak and 70% double vaccination). RESULTS: LGAs in the bottom five deciles for social advantage experienced higher infection rates (39.0 per thousand [95% CI: 38.5, 39.5] vs. 14.8 [14.7, 14.9]), and had lower two-dose vaccination coverage (23.8% [23.6, 23.9] vs. 32.7% [32.6, 32.7]) compared with LGAs in the top five deciles. LGAs that achieved 70% coverage two weeks or more after the infection peak experienced nearly twice the total infection burden (27.7 per 1000 [27.3, 28.0] compared with 14.9 [14.7, 15.0]) than LGAs with a shorter lag. CONCLUSIONS: Exposure and transmission risk factors cluster within disadvantaged LGAs. The potential for large local outbreaks is heightened if vaccination uptake trails in these communities. IMPLICATIONS FOR PUBLIC HEALTH: In a pandemic, decision-makers must prioritise disease control and harm reduction interventions for at-risk LGAs.

The dynamics of more-than-human care in depot buprenorphine treatment: A new materialist analysis of Australian patients' experiences.

BACKGROUND: Long-acting injectable depot buprenorphine has become an important treatment option for the management of opioid dependence. However, little is known about patients' experiences of depot buprenorphine and its embodied effects. This qualitative study aims to explore patients' experiences of depot buprenorphine treatment, including how it feels within the body, experiences of dosing cycles across time, and how this form of treatment relies on wider ecologies of care beyond the clinical encounter. METHODS: Participants were recruited from sites in Sydney, regional New South Wales, and Melbourne, Victoria, Australia. Thirty participants (16 men, 14 women) participated in semi-structured interviews. Participants had histories of both heroin and prescription opioid consumption, and opioid agonist therapy including daily dosing of buprenorphine and methadone. RESULTS: Our analysis illuminates: (1) how patients' expectations and concerns about treatment are linked to past embodied experiences of withdrawal and uncertainty about the effectiveness of depot buprenorphine; (2) the diverse meanings patients attribute to the depot buprenorphine substrate 'under the skin'; and, (3) how depot buprenorphine is embedded within wider ecologies of care, such as counselling and social supports. CONCLUSION: Our analysis destabilises commonplace assumptions about a linear, causal relationship between the pharmacological action of depot buprenorphine and experiences of treatment. Instead, it highlights patients' variable experiences of depot buprenorphine, tracing the everyday practices, embodied feelings, expectations and wider networks of care that shape patient experiences. We conclude with some reflections on the implications of our analysis for alcohol and other drug treatment, specifically how they might inform the design of client education materials and care.

Improving understandings of trauma and alcohol and other drug-related problems: A social research agenda.

Trauma is increasingly understood to shape a range of alcohol and other drug (AOD)-related problems, including addiction, relapse, mental illness and overdose. However, the merits of understanding AOD-related problems as the effect of trauma are uncertain with the nature and implications of such linkages requiring closer scrutiny. Where trauma is linked to AOD-related problems, this relationship is typically treated as self-evident, obscuring the uncertainties in knowledge surrounding the notion of trauma itself. Informed by insights from critical drugs and trauma scholarship that challenge deterministic notions of AOD 'problems' and trauma, this essay identifies key issues for social research in this area that warrant further consideration. We argue that there is a pressing need to acknowledge variation and diversity in the relationship between trauma and AOD-related problems, and the gendered and sexual dynamics shaping the expansion of the trauma paradigm. We then outline how critical Indigenist interdisciplinary work can inform culturally specific knowledge on trauma and AOD-related problems, and also suggest targeted research on the delivery and experience of trauma-informed approaches in the AOD context. To this end, we present several recommendations for a social research agenda underpinned by critical, qualitative research into how people experience and manage trauma and AOD-related problems in their everyday lives.

Pandemic policing and the construction of publics: an analysis of COVID-19 lockdowns in public housing.

COVID-19 responses have cast a spotlight on the uneven impacts of public health policy with particular populations or sites targeted for intervention. Perhaps the starkest example in Australia was the 'hard' lockdown of nine public housing complexes in inner-city Melbourne from 4 to 18 July 2020, where residents were fully confined to their homes. These complexes are home to diverse migrant communities and the lockdown drew public criticism for unfairly stigmatising ethnic minorities. This article draws on media articles published during the lockdown and the Victorian Ombudsman's subsequent investigation to explore the implications of broad, top-down public health measures for culturally and linguistically diverse (CALD) communities. Drawing on Lea's (2020) conceptualisation of policy ecology, we analyse the lockdown measures and community responses to explore the normative assumptions underpinning health policy mechanisms, constituting 'target populations' in narrow, exclusionary terms. We argue that the lockdown measures and use of police as compliance officers positioned tower residents as risky subjects in risky places. Tracing how such subject positions are produced, and resisted at the grassroots level, we highlight how policy instruments are not neutral interventions, but rather instantiate classed and racialised patterns of exclusion, reinforcing pervasive social inequalities in the name of public health.

Staying with the silence: Silence as affording care in online alcohol and other drug counselling.

As the name 'talk therapy' suggests, a key aim of alcohol and other drug counselling, psychotherapy and other talk therapies is to discuss issues, concerns and feelings with a health professional. Implicit here is the therapeutic value of talking through issues with a trained professional. But as with all interactions, therapeutic encounters involve silences and pauses as key aspects of the communicative process. Despite their ubiquity in the therapeutic encounter, research tends to either dismiss silences as inconsequential or as having undesirable effects, such as generating awkwardness or even disengagement from treatment. Drawing on Latour's (2002) concept of 'affordance' and a qualitative study of an Australian alcohol and other drug counselling service, we explore the varied functions of silences in online text-based counselling sessions. For clients, these include the role of silence in affording opportunities to engage in other everyday practices, such as socialising, caregiving or working - practices that can generate comfort and reduce distress, which in turn may support the therapeutic encounter. Similarly, for counsellors, temporal silences provide opportunities to confer with other counsellors and provide tailored care. However, protracted silences can raise concerns about the safety and wellbeing of clients who do not respond promptly or who exit encounters unexpectedly. Similarly, the sudden cessation of online care encounters (often associated with technical difficulties) can leave clients feeling frustrated and confused. In tracking these diverse affordances of silence, we draw attention to its generative potential in care encounters. We conclude by exploring the implications of our analysis for conceptions of care that underpin alcohol and other drug treatment.

Managing risks or generating uncertainties? Ambiguous ontologies of testing in Australian healthcare.

Medical testing promises to establish certainty by providing a definitive assessment of risk or diagnosis. But can those who rely on tests to offer advice or make clinical decisions be assured of this certainty? This article examines how Australian health professionals, namely clinicians, microbiologists, specialist physicians and health policymakers, delineate the boundary between certainty and uncertainty in their accounts of medical testing. Applying concepts from science and technology studies, and drawing on qualitative data from a sociological study of testing in Australian healthcare, we consider how professionals ascribe meaning to testing and test results. As we argue, for these health professionals, the 'evidence' that testing generates has ambiguous ontological significance: while it promises to provide diagnostic certainty and clear direction for advice or treatment, it also generates uncertainties that may lead to yet further tests. Our analysis leads us to question a key premise of testing, namely that it is possible to establish certainty in medical practice via the measurement of individual health risks and disease markers. Against this dominant view, the responses of the health professionals in our study suggest that uncertainty is intrinsic to testing due to the constantly changing, unstable character of 'evidence'. We conclude by considering the implications of our analysis in light of healthcare's increasing reliance on sophisticated technologies of 'personalised' testing using genetic information and data analytics.

Making publics in a pandemic: Posthuman relationalities, 'viral' intimacies and COVID-19.

The COVID-19 pandemic has placed sexual relationships into sharp focus as strict containment measures, including physical distancing and 'stay at home' restrictions, were initiated to control the spread of the virus. Governments in some jurisdictions prevented contact between non-cohabiting sexual partners (except for couples in pre-existing relationships), while community organisations recommended people avoid casual sexual encounters. This article analyses Australian media articles, commentary and public health messages published during March to October 2020 to explore the normative assumptions underpinning these measures. Applying posthumanist perspectives and Warner's (2002) conceptualisation of 'publics', we consider how COVID-19 public health advice enacts the (human) subject of public health as monogamous, coupled, and living with their partner or nuclear family. Those in non-normative relationships and households are not only excluded from this narrow enactment of the 'ideal' public health subject, but are rendered potentially risky disease vectors by virtue of their alternative kinship arrangements. We explore the implications of these findings for the more-than-human relationalities that shape health inequalities and processes of marginalisation during public health crises, and we offer suggestions for public health measures that address the needs of diverse 'publics'.

Basic care as exceptional care: addiction stigma and consumer accounts of quality healthcare in Australia.

The discrimination faced by people understood to have alcohol or other drug addictions has been the subject of extensive research, with many studies documenting experiences of stigma within healthcare services. Building on this literature, we examine the role of stigma in shaping the healthcare expectations of people seen as affected by alcohol and other drug addictions. Our analysis draws on recent theorisations of stigma as a process of social production to analyse in-depth, qualitative interviews with 20 people who had recently attended an inpatient withdrawal management service. Participants describe as exceptional forms of care that are often taken for granted by other members of the community. We argue that routinised experiences of discrimination work to constitute basic care as exceptional. This finding is significant for two reasons: (1) people who consume alcohol and other drugs often have complex healthcare needs and already encounter obstacles to accessing the care they need, and (2) by positioning people who consume drugs outside the purview of healthcare, this dynamic obstructs their fundamental right to care. We conclude by reflecting on the implications of these findings for those who are often positioned as not entitled to high quality healthcare.

Enacting 'more-than-human' care: Clients' and counsellors' views on the multiple affordances of chatbots in alcohol and other drug counselling.

Forms of artificial intelligence (AI), such as chatbots that provide automated online counselling, promise to revolutionise alcohol and other drug treatment. Although the replacement of human counsellors remains a speculative prospect, chatbots for 'narrow AI' tasks (e.g., assessment and referral) are increasingly being used to augment clinical practice. Little research has addressed the possibilities for care that chatbots may generate in the future, particularly in the context of alcohol and other drug counselling. To explore these issues, we draw on the concept of technological 'affordances' and identify the range of possibilities for care that emerging chatbot interventions may afford and foreclose depending on the contexts in which they are implemented. Our analysis is based on qualitative data from interviews with clients (n=20) and focus group discussions with counsellors (n=8) conducted as part of a larger study of an Australian online alcohol and other drug counselling service. Both clients and counsellors expressed a concern that chatbot interventions lacked a 'human' element, which they valued in empathic care encounters. Most clients reported that they would share less information with a chatbot than a human counsellor, and they viewed this as constraining care. However, clients and counsellors suggested that the use of narrow AI might afford possibilities for performing discrete tasks, such as screening, triage or referral. In the context of what we refer to as 'more-than-human' care, our findings reveal complex views about the types of affordances that chatbots may produce and foreclose in online care encounters. We conclude by discussing implications for the potential 'addiction futures' and care trajectories that AI technologies offer, focussing on how they might inform alcohol and other drug policy, and the design of digital healthcare.

Data-driven intimacy: emerging technologies in the (re)making of sexual subjects and 'healthy' sexuality.

Wireless sex toys are new technologies that enable sexual partners to connect remotely across long distances. Promoted as enhancing intimacy and pleasure as part of a healthy sex life, these devices buttress a 'sex for health' discourse which relies on the collection of intimate data purportedly used to improve current and subsequent teledildonics models. This article draws on two case studies of sex toys developed by leading sex-tech/teledildonic companies Lovense® and Kiiroo® to examine how the relationship between data and sexual subjectivity is being transformed through these emerging technologies. Applying concepts from new materialism, and extending the work of Faustino [(2018). Rebooting an old script by new means: Teledildonics-the technological return to the 'coital imperative'. Sexuality & Culture, 22, 243-257]', we explore how sexual practices, intimacy and pleasure become 'datafied' through these sensory technologies. Inspired by the concept of the 'sexuality-assemblage', we pose teledildonic-enhanced sex as a 'sexuotechnical-assemblage', a term that highlights the uniquely technological dimensions of sex in the age of teledildonics. Approaching these devices as sexuotechnical-assemblages highlights the generative role of data as lubricants of long-distance intimacy, and central actors in the (re)making of sexual subjects, and by extension, 'healthy' sexuality.

Drugs as technologies of the self: Enhancement and transformation in LGBTQ cultures.

The consumption of drugs has long been a mainstay of urban queer cultures and it is well-recognised that complex connections exist between sexual minoritisation and desires to chemically alter bodily experience. Yet despite evidence that rates of consumption are higher among LGBTQ populations, research exploring the gendered and sexual dynamics of these forms of consumption is limited and tends to frame such consumption as a response to stigma, marginalisation and discrimination. Against this dominant explanatory frame, this article explores the diverse experiences of LGBTQ consumers, and in so doing highlights both the pleasures and benefits of consumption, as well as potential risks and harms. Contributing to the growing body of ontopolitically oriented research that treats the materiality of drugs as emergent and contingent, we trace the ontologies of drugs, sexuality and gender that LGBTQ subjects generate through specific practices of consumption. Our analysis draws on qualitative interviews with 42 self-identified LGBTQ people from an Australian study designed to explore how sexual and gender-diverse minorities pursue particular drug effects to enhance or transform their experience of gender and/or sexuality. Our participants' accounts illuminate how drug consumption materialises in relation to sex, desire and play where it enhances pleasure, facilitates transgression and increases endurance. In the context of gender variance, our findings suggest that drug use can transform gendered experience and enable the expression of non-normative gender identities, in the process challenging gender binarism. By considering the productive role of drugs in enacting queer identities, this article treats drugs as 'technologies of the self' (Foucault 1988) and explores how drug consumption, sex and gender shape each other across a range of settings. We conclude by reflecting on the implications of our findings for research and service provision, and suggest ways of engaging LGBTQ consumers in terms that address their diverse priorities and experiences.

Matters of fact and politics: Generating expectations of cancer screening.

Many countries, including Australia, the United Kingdom and the United States have established national screening programs in the effort to advance the early diagnosis of cancers. Australia has population screening programs for breast, bowel and cervical cancers, and this article focuses on breast and cervical cancer screening as the two longest running programs in Australia. While these screening programs are well-established and report relatively high participation rates, the effectiveness of population screening is a contested issue, subject to significant, ongoing debate about its purported benefits (Armstrong, 2019). In this article, we draw on ideas from sociology of science on the construction of scientific facts to analyse how evidentiary claims are presented in policy documents for Australia's breast and cervical cancer screening programs, and the implications for those who are the targets of screening. We explore how screening-related information assumes the status of scientific 'facts', and argue that presenting information as neutral and objective obscures the political choices involved in its generation. Importantly, some of the claims presented in the policy documents have a tendency to emphasise the benefits, and minimise the risks and harms of population-based screening. In doing so, we suggest that the current national policies may be contributing to sustaining expectations of screening that are higher than warranted. Higher expectations may bring with them unintended societal and economic costs to the public. We conclude by noting how deeply ingrained socio-cultural meanings of cancer shape public expectations of the protective value of screening, which allows current screening approaches to become further entrenched and resistant to challenge.

Problematising LGBTIQ drug use, governing sexuality and gender: A critical analysis of LGBTIQ health policy in Australia.

It is well-established that a high prevalence of substance use is found in lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) populations; a finding that researchers attribute to the stigmatised status of non-normative sexual and gender expression, and the role of illicit drug use in the collective production of socio-sexual pleasures, expressivity and disclosure in LGBTIQ communities. Despite the connections between sexual experimentation and substance use, LGBTIQ consumption practices have rarely received the attention they deserve within the alcohol and other drug (AOD) field. In this paper, we draw on concepts from post-structuralist policy analysis to analyse how AOD consumption among sexual and gender minorities is constituted in the policies of three Australian LGBTIQ health organisations. Following Carol Bacchi's (2009, p. xi) observation that we are "governed through problematisations rather than policies", we consider how substance use in LGBTIQ populations has been formulated as a policy problem requiring intervention. Doing so allows us to identify the normative assumptions about minority sexual and gender identities that underpin dominant problematisations of LGBTIQ substance use. These include: a) high rates of AOD use in LGBTIQ populations constitute problems in and of themselves, regardless of individual patterns of use; b) LGBTIQ people are a vulnerable population with specialised needs; and c) sexualised drug use is associated with "disinhibition" and a range of risks (including HIV transmission, drug dependence and mental health issues). Addressing the implications of these assumptions for how LGBTIQ communities are governed, we suggest that problematisation is an embodied, situated process, and that there is much to be gained by reframing dominant problematisations of AOD consumption so that this process is better informed by the inventive practices of LGBTIQ consumers themselves.

Rethinking the Poverty-disease Nexus: the Case of HIV/AIDS in South Africa.

While it is well-established that poverty and disease are intimately connected, the nature of this connection and the role of poverty in disease causation remains contested in scientific and social studies of disease. Using the case of HIV/AIDS in South Africa and drawing on a theoretically grounded analysis, this paper reconceptualises disease and poverty as ontologically entangled. In the context of the South African HIV epidemic, this rethinking of the poverty-disease dynamic enables an account of how social forces such as poverty become embodied in the very substance of disease to produce ontologies of HIV/AIDS unique to South Africa.

Telling different stories, making new realities: The ontological politics of 'addiction' biographies.

Personal narratives of alcohol and other drug addiction circulate widely in popular culture and they also have currency in professional therapeutic settings. Despite this, relatively little research has explored the conventions operating in these narratives and how they shape people's experiences and identities. While research in this area often proceeds on the premise that addiction biographies are straightforwardly 'true' accounts, in this paper we draw on the insights of critical alcohol and other drug scholarship, and the concept of 'ontological politics' to argue that biographies produce normative ideas about addiction and those said to be experiencing it. Our analysis compares traditional addiction narratives with the biographies we reconstructed from qualitative interviews with 60 people in Australia who describe themselves as having an 'addiction', 'dependence' or drug 'habit'. We track how addiction is variously enacted in these accounts and comment on the effects of particular enactments. By attending to the ways in which people cope, even thrive, with the kind of consumption that would attract a diagnosis of addiction or dependence, the biographies we produced disrupt the classic narrative of increasing drug use, decline and eventual collapse. Doing so allows for consideration of the benefits of consumption, as well as the ways that people carefully regulate it to minimise harms. It also constitutes individuals as active in managing consumption-an important move that challenges dominant understandings of addiction as a disorder of compulsivity. We conclude by considering the implications of our attempt to provide an alternative range of narratives, which resonate with people's diverse experiences.

The future of drugs: recreational drug use and sexual health among gay and other men who have sex with men.

There are complex historical connections between sexual minoritisation and desires to chemically alter bodily experience. For gay men, drug and alcohol use can be a creative or experimental response to social marginalisation - and not necessarily a problematic one in every instance. Numerous studies have found that infection with HIV and other sexually transmissible infections (STIs) is more likely among gay and men who have sex with men (MSM) who use recreational drugs than those who do not, but the causal nature of these relations is uncertain. Sexualised drug use is associated with a range of other problems, including dependence, mental health issues, accident and overdose. A growing body of work in the Alcohol and Other Drugs (AOD) field demonstrates the action of drugs and their purported effects to be a product of their relations with various other actors, contexts and practices. Given these contingencies, it is impossible to predict the future of drugs or their effect on the sexual health of gay and MSM with any degree of certainty. This article outlines some of the conditions most likely to mediate such futures in the medium term. Public funding for lesbian, gay, bisexual, transgender and queer drug issues should not remain restricted to questions of HIV prevention and sexual health. It should be expanded to equip sexual health and AOD service providers with the cultural and sexual literacy to mitigate stigma and allow them to respond constructively to drug problems among sexual and gender minorities as a matter of priority.