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Gay Men's Hiv Risk Reduction Practices: the Influence Of AIDS Education and Prevention, 26(3), 214–223, 2014 © 2014 The Guilford Press GAY MEN’S HIV RISK REDUCTION HOLT GAY MEN’S HIV RISK REDUCTION PRACTICES: THE INFLUENCE OF EPISTEMIC COMMUNITIES IN HIV SOCIAL AND BEHAVIORAL RESEARCH Martin Holt Since the mid-1980s, Australian social researchers have investigated the sexual practices of gay men, describing those that protect men from HIV or put them at risk of infection. Ground-breaking (and controversial) publica- tions have highlighted a variety of ways in which gay men protect them- selves and their partners, including condom use and non-condom-based risk reduction strategies. HIV social research in Australia has been heavily influenced by a distinctive network of experts or epistemic community with shared principles and beliefs and a commitment to influencing policy and practice. This epistemic community has articulated a ‘social public health’ view of HIV that emphasises partnership, agency, understanding practices and reflexivity. This approach has clashed with those of other epistemic communities, notably around ideas of relapse and unsafe sex. This article uses the examples of negotiated safety and serosorting to illustrate this Australian epistemic community’s approach to HIV risk reduction among gay men. INTRODUCTION Know your epidemic, know your response, is the strategy advocated by United Na- tions Program on HIV/AIDS (UNAIDS), to plan a national HIV response: garner research evidence to identify which groups are most at risk of HIV and why, de- velop targeted programs and interventions in collaboration with affected communi- ties, and monitor impact and effectiveness. However, even Michel Sidibé, UNAIDS Executive Director, acknowledges that generating knowledge of an HIV epidemic is insufficient for building an effective response; one also needs to understand the conditions under which research evidence affects policy and practice (Buse, Dickin- son, & Sidibé, 2008). Why do some ideas come to prominence while others remain ignored? Buse and his colleagues remind us that policy emerges from interactions between institutions that shape how decisions are made, the framing of problems Martin Holt is with the Centre for Social Research in Health, University of New South Wales, Australia. The author thanks Peter Aggleton, Susan Kippax, and two anonymous reviewers for their constructive comments on earlier versions of this article. The Centre for Social Research in Health is supported by the Australian Government Department of Health and Ageing. Address correspondence to Martin Holt, Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia. E-mail: [email protected] 214 GAY MEN’S HIV RISK REDUCTION 215 and potential solutions and the interests of individuals and groups who are affected by change. HIV responses, including research, are highly dependent on national po- litical conditions and international dynamics. If you look at any field of expertise, it is important to remember that it could have been otherwise; if different people had been involved, with different interests, values and training, the knowledge produced and the pre-eminence of particular ideas would almost certainly have been different (Latour, 2005). In this article, I contrast the types of knowledge generated by Australian re- searchers about gay men’s HIV risk reduction practices with international research on similar topics. In doing so, I suggest that the partnership model prominent in Australian social and behavioral research constitutes an epistemic community with shared values and beliefs (Haas, 1992). Through the promotion of certain types of collaborative research, the epistemic community that I describe has sought to foster a particular type of HIV response in Australia. It has also intervened in international debates about how to think about and conduct HIV prevention. When I began writing this article I wanted to provide an overview of the distinc- tive contribution made by Australian researchers to understanding risk reduction practices; the practices that gay men engage in to reduce the risk of HIV transmis- sion, particularly during unprotected sex (Mao et al., 2011). Out of necessity, I have restricted my focus to the examples of negotiated safety and serosorting. My hope is that in analyzing these topics, readers will get a sense of how the Australian response to HIV has been shaped by a particular type of social research, and how the response could have been very different. EPISTEMIC COMMUNITIES The concept of epistemic communities is derived from political science (Haas, 1992). It is one way to account for the influence that networks of knowledge-based experts have in defining complex problems at a national or international level, framing de- bates and suggesting solutions. An epistemic community is defined by Haas (1992, p. 3) as “a network of professionals with recognized expertise and competence in a particular domain and an authoritative claim to policy-relevant knowledge within that domain.” An epistemic community consists of professionals from a variety of disciplines and backgrounds who share normative and principled beliefs, shared causal beliefs, shared notions of validity (criteria for evaluating knowledge), and a common policy enterprise to improve the problem or issue area with which they are engaged (Haas, 1992). I have chosen this concept because it is an existing framework with which to analyze the practice of knowledge generation and influence; it is not the only frame- work and it is not without its limitations. My point is that HIV research can and should be analyzed for its history, assumptions, and contingencies. An analysis of an epistemic community involves describing its membership and shared beliefs, tracing its actions, and evaluating its impact, including its success in resisting policy directions which contradict its principles (Haas, 1992). The analy- sis offered here is retrospective, focusing on publications and related commentary to illustrate the principles, beliefs, and common policy enterprize of an HIV social research epistemic community. The approach of this epistemic community is con- trasted with that of researchers in other countries, particularly those from the United States. 216 HOLT AUSTRALIAN HIV SOCIAL RESEARCH The first case of HIV in Australia was diagnosed in 1982 (Mindel & Kippax, 2013). That first case, and the majority that followed, were among gay men. The Aus- tralian research response to HIV followed community activism and the funding of community-based AIDS Councils in the mid-1980s (Kippax, Connell, Dowsett, & Crawford, 1993; Mindel & Kippax, 2013). These organizations have remained cen- tral to the Australian response (Altman, 1994). In 1985, the AIDS Council of New South Wales approached social psycholo- gists and sociologists at Macquarie University to acquire better information to guide HIV prevention activities for gay and bisexual men (Kippax, Connell et al., 1993). This request initiated the first large social science project on gay men and HIV in Australia: the Social Aspects of the Prevention of AIDS (SAPA) project. The project relied on collaboration between the researchers, community organization represen- tatives and the state government. Many of those involved were gay community activ- ists. The partnership developed in SAPA laid the foundations for the epistemic com- munity of Australian HIV social research. The project’s overarching finding was that the social and sexual involvement of gay and bisexual men with each other (what became known as gay community attachment) was associated with the adoption of safe sex practices. This finding, later duplicated in other countries, gave the nascent partnership confidence that HIV education and prevention needed to be community- based in order to be effective (Kippax, Connell et al., 1993). Partly because of SAPA’s success, when the federal government created three national HIV research centers in 1990, the Macquarie University group was invited to join the National Centre in HIV Social Research (Kippax, Connell et al., 1993; Mindel & Kippax, 2013). The creation of a HIV social science center was quite un- usual internationally, and institutionalized social research early in the epidemic. This commitment was underlined when the Australian Research Centre in Sex, Health and Society was established in Melbourne in 1993. Why did social science gain such a strong role in the Australian response? The federal health minister, Neal Blewett, was responsible for overseeing the develop- ment of Australia’s early national HIV strategy (Mindel & Kippax, 2013; Sendziuk, 2003). Blewett, a political scientist, relied heavily on his main advisor, Bill Bowtell, who argued against a medically-dominated model and supported a collaborative approach to HIV. Blewett’s 1984/85 visit to the U.S. also appears to have been in- structive. After the trip, Blewett favored the partnership approach he had seen in California. As well as medical and public health expertise, Blewett encouraged a leading role for affected communities in HIV education and prevention, supported by social science. If the health minister had been unsympathetic to social science, or had preferred the public health control model, then it is unlikely HIV social research would have been so prominent in Australia. So what are the normative and principled beliefs and common policy enterprise that characterize the epistemic community of Australian HIV social research (Haas, 1992)? The early
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