Speculative pragmatism and intimate arrangements: online hook-up devices in gay life.

This paper considers how certain functions of online hook-up devices are participating in the emergence of new forms of sexual relation, new distributions of intimacy and new sexual arrangements. Though not without precedent, it argues that online hook-up devices generally act in gay culture as 'framing devices', framing sex as a 'no-strings' encounter via their default application. These frames are variously rejected, reconfigured, re-embedded or confounded by participants; they become subject to various forms of overflowing. Understanding this dynamic, its typical forms of connection and estrangement, is pivotal for grasping the emergence of new forms of sexual community and new sexual publics among gay men--and/or 'un-community', as some have put it. My analysis prompts a series of methodological reflections wrought from the encounter it stages between queer theory and Science and Technology Studies. At a time when marriage and monogamy are increasingly monopolising the public discourse of gay life, digital devices are affording novel ways of arranging sex, intimacy and sexual community, with their own qualities and limitations.

Controlling for pleasure and risk: The experiences of sexuality and gender diverse people who use GHB.

BACKGROUND: GHB is used among some sexuality and gender diverse populations at elevated rates, however little qualitative research has explored GHB use among these populations with regards to diverse contexts, settings, practices, and experiences of use. Internationally, harms relating to GHB overdose appear to be increasing. Research outlining consumers' experiences of GHB-related pleasures and their strategies to reduce harms may inform GHB education and intervention responses. METHODS: N = 31 participants reporting three or more occasions of GHB use within the previous 12 months were recruited via digital advertising and snowball methods. Semi-structured interviews were conducted, data were transcribed and analysed in NVivo using a thematic framework analysis. Emergent themes were charted, and divergences and convergences were considered with regards to the sexuality and gender identities of participants. RESULTS: Pleasures associated with GHB were described in relation to the sensation of the GHB high and experiences of intimacy, and connection. GHB was used to enhance socialising and sex in domestic, private, and commercial venues. Participants prioritised terminology of 'control' when describing their practices associated with GHB dosing, measuring, timing and peer moderation. Most participants reported personal experience of GHB overdose with loss of consciousness. CONCLUSION: Participants' near-ubiquitous experience of GHB overdose highlights ongoing education needs around overdose prevention. Efforts must target people new to GHB use who appeared particularly susceptible to overdose. Inconsistencies in understandings around GHB overdose, the perceived severity of overdose and the differences between GHB and its precursors GBL and 1,4-BD, highlight potential focus areas of future education responses. Further research is required to better understand consumers' experiences of sexual violence in the context of GHB use.

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.

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.

HIV Education: Reflections on the Past, Priorities for the Future.

From early in the epidemic, education has been central to HIV prevention, treatment, and care. This paper reflects on lessons learned over the last 30 years. It signals the limits of high level international commitments to education and HIV and the strategies of information-giving and life skills development adopted in their wake. It argues for the adoption of a more genuinely educational approach to HIV, sex, and sexuality education in which difficult questions are raised, diversity is recognized, and options are provided for a differentiated yet effective response. The lead currently offered by community organizations and the social media should be built upon in developing forms of HIV education that are more honest and contextually relevant than previously.

Thinking with pleasure: Experimenting with drugs and drug research.

Within the field of drug and alcohol studies, researchers think about pleasure or against it; we analyse, consider, investigate, invoke or ignore it. The philosophically inclined may think of pleasure or write on it, but in each of these scenarios pleasure is kept at an arm's length while the researcher appears to remain unmoved - detached observers, objective scientists, conceptual experts, program directors, sharp critics, policy advocates - sober judges whose sovereignty is secured by the formal conventions of positivist research, established theory, institutional authority and/or disciplinary knowledge. This paper asks what happens when pleasure is allowed to emerge as a constitutive element in the relations of drug and alcohol research. What happens when we conceive our work as thinking with pleasure, rather than simply researching pleasure or thinking about it? I return to the later work of Foucault, reading it alongside conceptions of the experiment drawn from Science and Technology Studies, arguing that both the pleasures of drug consumption and drug research might be conceived more generatively as mutually implicated in events.

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.

PrEP: controversy, agency and ownership.

Pre-exposure prophylaxis (PrEP) has been and continues to be an intervention that causes controversy and debate between stakeholders involved in providing or advocating for it, and within communities in need of it. These controversies extend beyond the intrinsically complex issues of making it available. In this commentary, some of the possible roots of the air of dissent and drama that accompanies PrEP are explored. The similarities between the controversies that dogged the earliest human trials of PrEP and the ones we see today in the era of licensing and implementation are explored. We outline five mediating principles or cultural norms that may influence arguments about PrEP differently. Three areas of specific concern are identified: medical risk versus benefit, distrust and fear of healthcare interventions, and fears for individual responsibility and community cohesion. The fear that PrEP may somehow represent a loss of control over one or more of these domains is suggested as an underlying factor. The development of countervailing measures, to institute greater community "ownership" of PrEP, and concomitant improvements in the sense of individual agency over sexual risk are outlined and recommended.

Sustaining safe practice: twenty years on.

This paper examines the ways in which populations at risk of HIV in the developed world have enculturated the knowledges and technologies of both the medical and the social sciences. By revisiting a number of review papers and by reviewing findings from a range of studies, we argue that gay men have appropriated information that has enabled them to sustain safe practices while they have eschewed information that has made maintenance difficult. The paper describes a range of risk reduction strategies and compares the responses of populations at risk of HIV in the years before the advent of highly active antiviral therapy (HAART) with their responses after the introduction of HAART in 1996. We concentrate our argument on the changing responses to HIV risk of gay men, although occasionally illustrate our argument with reference to the responses of injecting drug users. The responses of gay men to risk post-HAART--particularly those who reside in Australia--speak to the adoption of a range of considered strategies, not altogether safe, to reduce harm. We argue that such strategies need to be understood and addressed within a 'new' social public health, that is, a public health that takes what social analysis has to say seriously. The paper examines the differences between the traditional, the 'modern' epidemiological/clinical and the 'new' social or socio-cultural public healths and describes the tensions between the medical and the social science disciplines in their efforts to inform public health. Key concepts provided by social science such as agency (including individual and collective agency), alongside its methodological reflexivity are key to effective public health. The risk avoidance strategies adopted by gay men suggest a way forward by turning our attention to the ways in which medicine is taken in(to) their practice.

Revaluation of risk among gay men.

This article reviews recent studies investigating sexual practice among gay and homosexually active men in Australia. The concept of ethics, understood as practical techniques adopted for the achievement of certain implicit and explicit goals, provides a framework for understanding the relation between gay men's engagement with medicine and their sexual practice over time. I argue that rather than producing straightforward complacency, the introduction of highly active antiretroviral therapy provided the conditions of emergence of a partial revaluation of risk among many gay men. "Negotiated safety" and "barebacking" might be understood as historically situated prevention ethics, scientifically plausible in some circumstances. Though emerging prevention ethics pose challenges for education, the strategy of enabling gay men, in conversation with health authorities, to be responsible for evaluating risk, has been remarkably effective. Enhancing the viability of prevention ethics begs attention to the quality and availability of public contexts within which embodied and lived experience can be brought into articulation with medical knowledge, raising the value of what is here described as "counterpublic health."

The difference practice makes: Evidence, articulation, and affect in HIV prevention.

This paper considers the difference that a conception of sex as social practice has made to the relations articulated in HIV social research in Australia. In defining sexual practice as "fluid, embedded in specific social formations, and involving the negotiation of meaning" (Kippax & Stephenson, 2005), social researchers put their own research categories and questions at risk by constructing situations in which the objects of research were given occasions to counter researchers' presumptions through the use of their own categories. Taking this risk produced sharp insights about the evolving dynamics of gay sexuality in this context and produced distinctive, interesting findings. It enabled the articulation of the practice of negotiated safety and later strategies of HIV risk reduction emerging from gay men's practice, for example. I draw on Latour's (2004) concept of articulation to make sense of these innovations and cut through some of the key distinctions that organize HIV research: qualitative/quantitative; social/biomedical; subject/ object; human/nonhuman; interpretations/evidence. Rather than rest on the organizing power of these distinctions, keeping HIV prevention effective, engaging and interesting will require specific attention to the embodied articulation of HIV relations in the present.

Framing responsibility: HIV, biomedical prevention, and the performativity of the law.

How can we register the participation of a range of elements, extending beyond the human subject, in the production of HIV events? In the context of proposals around biomedical prevention, there is a growing awareness of the need to find ways of responding to complexity, as everywhere new combinations of treatment, behavior, drugs, norms, meanings and devices are coming into encounter with one another, or are set to come into encounter with one another, with a range of unpredictable effects. In this paper I consider the operation of various framing devices that attribute responsibility and causation with regard to HIV events. I propose that we need to sharpen our analytic focus on what these devices do, their performativity-that is, their full range of worldly implications and effects. My primary examples are the criminal law and the randomized control trial. I argue that these institutions operate as framing devices: They attribute responsibility for HIV events and externalize other elements and effects in the process. Drawing on recent work in science and technology studies as well as queer theory, I set out an analytic frame that marks out a new role for HIV social research. Attentiveness to the performative effects of these devices is crucial, I suggest, if we want better to address the global HIV epidemic.

Gay men's perceptions of sexually transmissible infections and their experiences of diagnosis: 'part of the way of life' to feeling 'dirty and ashamed'.

BACKGROUND: Gay men are considerably more likely than their heterosexual peers to be diagnosed with a sexually transmissible infection (STI), yet relatively little has been published on gay men's perceptions of STIs other than HIV. METHODS: Drawing on interviews conducted with Sydney gay men, we analysed perceptions of STIs, and men's experiences of testing and diagnosis. RESULTS: Over half the men in the study had ever been diagnosed with an STI. STIs were generally regarded as inconvenient consequences of sexual activity. Viral, recurring STIs were viewed as being more serious than curable, bacterial STIs. However, all STIs were considered as considerably less important than HIV. Condom use and regular STI testing were the most commonly used strategies to manage the risk of STIs. Despite the relative lack of concern attributed to STIs, being diagnosed with an STI could generate feelings of shame, embarrassment and annoyance. For some men, education campaigns appeared to have helped destigmatise STIs and encourage regular testing. CONCLUSIONS: We believe that to maintain high rates of STI testing among gay men, community education efforts should continue to reduce the stigma associated with STIs and greater support should be offered to gay men when they receive an STI diagnosis.

The use of pleasure in harm reduction: perspectives from the history of sexuality.

The absence of pleasure in harm reduction discourse is more and more frequently noted, but few have considered what, exactly, more attention to pleasure might do. What is the value of pleasure for harm reduction praxis? Central to such an inquiry is the question of how pleasure is grasped, conceptually and methodologically. In this paper I use Foucault's History of Sexuality to elaborate a perspective on the use of pleasure within harm reduction. I argue that Foucault's work suggests a distinction between therapeutic and social-pragmatic approaches to pleasure, and that such a distinction is important for harm reduction--to the extent that it seeks to maintain a critical awareness of the relation between stigma and care--in that the latter model raises the possibility of maintaining de-pathologizing modes of care. An appreciation of pleasure in terms of its social pragmatics helps to recognize practices of safety, care and risk that might otherwise go unregistered in the current punitive political environment. It provides a basis for conceiving practical measures that are in touch with given concerns and bodily practices, and thus have more chance of being taken up. It also enables a more dynamic and responsive approach to the practice of bodies and pleasures.