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Conditions of Uncertainty the Social and Political Dimensions of Risk Management in the Transition to the Biomedical Era of HIV Prevention

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Conditions of Uncertainty the Social and Political Dimensions of Risk Management in the Transition to the Biomedical Era of HIV Prevention Conditions of Uncertainty The Social and Political Dimensions of Risk Management in the Transition to the Biomedical Era of HIV Prevention Mark Gaspar A Thesis In the Department Of Humanities Centre for Interdisciplinary Studies in Society and Culture Presented in Partial Fulfilment of the Requirements For the Degree of Doctor of Philosophy (Interdisciplinary Studies in Society and Culture) at Concordia University Montréal, Québec, Canada March 2017 © Mark Gaspar, 2017 CONCORDIA UNIVERSITY SCHOOL OF GRADUATE STUDIES This is to certify that the thesis prepared By: Mark Gaspar Entitled: Conditions of Uncertainty: The Social and Political Dimensions of Risk Management in the Transition to the Biomedical Era of HIV Prevention and submitted in partial fulfillment of the requirements for the degree of PhD in Humanities, Centre for Interdisciplinary Studies in Society and Culture complies with the regulations of the University and meets the accepted standards with respect to originality and quality. Signed by the final examining committee: Dr. Philippe Caignon, Etude Françaises Chair Dr. Martin Holt, Centre for Social Research in Health, External Examiner UNSW, Sydney, Australia Dr. Martin French, Sociology and Anthropology External to Program Dr. Valérie de Courville-Nicol, Sociology & Anthropology Examiner Dr. Marc Lafrance, Sociology & Anthropology Examiner Dr. Viviane Namaste, Simone de Beauvoir Supervisor Approved by Dr. Bina Freiwald Chair of Department or Graduate Program Director 2017 Dr. André Roy Dean of Faculty iii ABSTRACT Conditions of Uncertainty: The Social and Political Dimensions of Risk Management in the Transition to the Biomedical Era of HIV Prevention Mark Gaspar, Ph.D. Concordia University, 2017 The HIV prevention field in Canada has failed to achieve a stabilising point, a lack of consensus on the effectiveness of risk management strategies, in its third decade, the transition to the biomedical era of HIV prevention. Under these conditions of uncertainty we have witnessed epistemic and social and political uncertainties proliferate. Experts debate long-standing and emerging prevention strategies. Newly produced knowledge complicates our understanding of gay male HIV prevention but often lacks appropriate validity and generalizability. Governing practices are implemented to respond to this knowledge, but in conflicting ways. For everyday social actors, these uncertainties morph into complicated forms of experiential uncertainty. I first present this dissertation as a work of critical social science on HIV. Drawing from critical studies on risk and uncertainty I then produce an original analytic framework termed the uncertainty triad. I then examine biomedical and public health research and critical perspectives on gay male HIV prevention, arguing that the field cultivates uncertainty to “beat-up” the epidemic. I then present data from 33 in-depth interviews conducted with young HIV-negative gay men to discuss their everyday confrontations with serostatus uncertainty (an inability to confirm one’s HIV-negativity). This is a move away from analysing motivations for condomless anal sex and focusing exclusively on “high risk men.” To avoid exclusively tapping into the HIV epistemic community, the interviewees hadn’t previously participated in a research interview about HIV and had no regular involvement with an AIDS service organisation. I then present an original theory on risk disposition, which investigates a social actor’s processes of risk reflexivity and his tolerance to serostatus uncertainty. Social conditions affecting the experiences of health maintenance, institutional navigation and sexual practice can iv shape tolerance to serostatus uncertainty by minimising or fostering anxiety. Drawing on the notion of sexual practice over sexual behaviour, I then examine HIV-negative gay men’s confrontations with HIV-related ethico-political challenges such as HIV stigma, serosorting and the criminalisation of HIV non-disclosure. I argue that biomedical optimism does not necessarily lead to the abandonment of condoms among HIV-negative gay men and that many remain sceptical of the prevention benefits of HIV treatments. v This dissertation is dedicated to my parents. Also in loving memory of Avo Zenadia DaSilva and Tiu Manuel Gaspar vi Acknowledgements This dissertation would not have been possible without the help of many people. First and foremost, there is Viviane Namaste, my primary academic advisor. From the very beginning of this journey Viviane has been a marvellous mentor, offering an unparalleled degree of commitment and energy to my career and well-being. She has consistently challenged me to strengthen my ideas, while also encouraging me to have fun along the way. Most importantly, Viviane has managed to advise me while allowing me to find my own intellectual voice. I remain deeply humbled by her staggering achievements as an academic and activist and will be forever grateful for all that she has done as a mentor. I have also been extremely fortunate to have a scholastically well-rounded, encouraging academic committee. Valérie de Courville Nicol and Marc Lafrance, my remaining academic advisors, have offered invaluable scholarly insights to this project along the way and have always been very generous with their time. Their commitment has been essential to my success. They have provided supportive yet rigorous reflections on my work from its initial conceptualisations to the final iteration readers have before them. Their dedication, professionalism and passion for quality scholarship are an inspiration. A big thank you is in order to the Humanities Department and the Centre for Interdisciplinary Studies in Society and Culture, including Bina Freiwald, Marcie Frank and Erin Manning. A very special thank you is in order for Sharon Fitch for always responding to my (many) inquiries ever so promptly and always being willing to listen to the trials and tribulations of graduate student life. I would also like to thank the Sociology and Anthropology department and the Simone de Beauvoir Institute at Concordia University, two departments that I was regularly involved with during my tenure as a graduate student. A general thank you goes out to the Humanities PhD student community. It has been an honour to work and learn beside such wonderful and widely eccentric characters. I have made some terrific colleagues and genuine friendships along this journey. There are way too many people to list here, but a special thank you goes out to Ardath Whynacht, Margaret Westby, Florencia Marchetti and Phil Lynes, who are brilliant scholars and wonderful human beings. A big round of hugs goes out to the “family”—an absolutely incomparable support system that extends far beyond academics. Natalie Duchesne and I have been something of a team from the very beginning and I can’t speak more highly of her as a researcher and intellectual, and perhaps more importantly, as a friend. Liam Michaud, Alexander McClelland and Nora Butler Burke are the support network every graduate student wishes for and the type of friends everyone needs. All of these individuals have pushed me intellectually and politically in ways that have dramatically improved the thinking presented in the following pages. Outside of Concordia many academics, researchers, community leaders and friends played a role in my success. These include Eric Mykhalovskiy (who is responsible for connecting me to Viviane and whose encouraging words about my work I will never forget), vii Marc Stein, Francisco Ibanez-Carrasco, Catherine Worthington, Jonathan Postnikoff, Daniel Grace, Mark Gilbert, Barry Adam, Colin Hastings, James Wilton, Len Tooley, Ed Jackson, Michael Kwag, Nicole Greenspan, Nathan Lachowsky, Sarah Chown, Daniel Pugh and the Social and Political Thought Community at York University. A special thank you to the Social Research Centre on HIV for promoting my research and helping with the transcriptions. I have dedicated this dissertation to Frank and Maria Gaspar. Hands down, I couldn’t ask for better, more supportive parents. I would also like to acknowledge the emotional support I received from my sister Jennifer and her family, Robert, Izabella and Grace Tusa. A shout-out goes to the Gaspar family more generally and a specific mention to Lucie, Carmen, Matthew and Alana Giambattista for helping me through some stormy times; and also a very important mention to my avo Rosaria Gaspar, for her inspiring reliance. I love you all. When it comes to friendships, I remain incredibly fortunate. Some very important people in my life include Kai Yapp (who helped me move back to Toronto and has always been my biggest cheerleader), Golshan Abdmoulaie (whose strength of character has always inspired me), Dolores Sanguedolce and Michael Ferrari (who always make me laugh the hardest and make me feel like I’m home), Heather Sebastian, Juan Gonzalez-Calcaneo, Ross McMartin, Michael Denino, Linda Grande, Gregory Tranah, Akshara Kothari Chandhok, Johannes Messmen, Jacob Pollice, Karl Schober, Sirat Aman, Tim Smith, Evangelos Tziallas, Kelly Phipps, Craig MacKie, Dan Petrescu, Vivien Lee and Michael Conners Jackman. A very special thanks goes out to Philip Fortin for seeing me through some of the more challenging times, for being ever so patient with me, and for helping me out with the recruitment. Love you Philip. Obviously, a huge thank you is in order to all of the guys who made this project possible by offering interviews or helping out with the recruitment process. It
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