1 This is the second of our seminar series (repeated in different locations across the UK).
These seminars are a novel way for us at Sigma to share some of the overlapping findings from recent studies we have done as part of our work for CHAPS. We want these seminars to help you to consider how to carry forward the findings that arise from that research, in your own work affecting homosexually active men.
Responsibility is quite a nebulous or abstract term. It‟s one we use all the time – and as Catherine will come on to talk about – it permeates a great deal of our society. But we don‟t often reflect on what responsibility means, how it intersects with our work, and how it is considered by the homosexually active men that we aim to influence.
By facilitating the afternoon, we want you to feel you have the space to consider how your own approaches to responsibility, and how homosexually active men‟s approaches to responsibility – influence the effectiveness of HIV prevention interventions. The ultimate aim of the afternoon isn‟t to have designed an intervention aimed at gay men about responsibility, but more to have a broad discussion about the role responsibility as a concept plays in the work that we all do - whether that‟s in direct contact work, therapeutic interventions, media design, policy development or commissioning or any other area of work that influences homosexually active men. 2 So what we‟re going to do today is spend the first 30 or 40 minutes giving you a chance to talk with one another and with the whole group – guided by some questions that we provide.
Then the two of us will lead a presentation that shows the different ways that men participating in some of our recent research reflect on responsibility, and how they operate in sexual settings in order to maintain their regard for themselves as responsible sexual beings.
We‟ll have a chance for a tea and coffee break, after which, Alan will join us for a few minutes to give us his/her response to some of the things we have said, with a particular reflection on local work in London and the work of THT.
After this, Catherine will dazzle us with some exciting illustrations which we hope draw together and summarise a lot of what we will have said, and then we want you to have an opportunity to engage with the three of us in a broad discussion to elaborate any aspects of these research findings we are presenting, ask us any questions about it, as well as raising issues and ideas we haven‟t already touched on.
The last main session of the afternoon will involve working in smaller groups to consider in detail how responsibility may influence our HIV prevention goals. Adam and I will work with each group to elicit examples of the way in which responsibility can operate to facilitate and also to hamper those goals in different contexts. This has direct implications for the way we plan HIV interventions, making this a key focus of the final session. 3 5 mins to introduce task [Distribute scenario cards – 4 different scenarios – one for each pair of participants]
Scenario 1 You are at a party, and the conversation turns to your line of work. A friend asks: “So, where would you say the responsibility lies for the state of the HIV epidemic in the UK today?” What is your response? Scenario 2 You are at a local community event, and the conversation turns to your line of work. A local faith leader asks: “So, where would you say the responsibility lies for the state of the HIV epidemic in the UK today?” What is your response? Scenario 3 You have been asked to speak to a journalist from the gay press about your work. Their opening question is: “So, where would you say the responsibility lies for the state of the HIV epidemic in the UK today?” What is your response? Scenario 4 You have been asked to speak to a journalist from the Daily Mail about your work. Their opening question is: “So, where would you say the responsibility lies for the state of the HIV epidemic in the UK today?” What is your response?
4 Before heading straight into the research findings, I wanted to take a few moments to consider responsibility as a concept. Responsibility is about being accountable. There are all kinds of ways in which accountability can work, but in the main, it is the constant undercurrent in most people‟s lives that propels them toward „doing the right thing‟, and that is precisely what most of us want to be able to do, most of the time. Responsibility is commonly regarded as the capacity to forsee a range of potential consequences and choosing the one that will lead to least harm, and the most good, not just for me, but for everyone else as well.
*CLICK - And it is in this way that we see that responsibility is closely tied to morality. Having a moral order, means deciding where I fit into that with my own views of rights and wrongs. How I define what is best for me, and best for the others that my actions might influence is informed by my moral centre. My choice to act on that, or not act on that might be regarded as my responsibility. (for example, think about...)
*CLICK - At the same time, we might consider examples where responsibility is what is raised after decisions are taken, and their effects are felt, and „those held responsible‟ are sought out after the fact (most commonly this is when things go wrong instead of when they go right). So here, responsibility becomes bound up with blame. And as we have discussed at some length already, because of the social meanings tied up with HIV transmission, blame has historically been the keynote of HIV response. You might want to consider how many features of the community HIV prevention response, are formulated alongside, in anticipation of, and seeking to insulate against blame. (for example...think about...)
5 *CLICK - The idea of responsibility as the basis of a social contract has been explicitly taken up within the world of politics. It was a central theme in the growth of New Labour, and more recently we hear it as a central plank of David Cameron‟s election campaign. Those who influence and make social policy decisions emphasise idea that citizenship and responsibility are closely bound up with one another. They often argue that those who expect to be bestowed with rights should also recognise their duties as responsible citizens. This story now runs as a thread through most media treatment of social issues, particularly in discussions of those who are socially marginalised. And what it allows policy makers to do is to focus all of the discussion about responsibility on individuals: whether they are the hoodies getting ASBOS, or muslims who should root out extremism in their ranks, or parents who are accused of doing a rubbish job of raising their children because they put junk food in their lunch boxes. Most new domestic policy announcements relate in some way to ensuring that individuals lead more responsible lives. We live in a culture that is completely drenched in discussion about responsibility.
*CLICK – And yet it is that connection between responsibility and morality that can make it difficult for us, who work in HIV prevention, to talk about the topic directly. The gay rights movement has historically challenged traditional moral authority (*elaborate). So we may find it difficult, working within an HIV prevention sector embedded in the gay community to articulate a model of responsibility that fits our aims. There is little question that the work of HIV prevention is deeply infused with responsibility as our research will make clear, but how good are we at talking about it?
6 In your earlier discussions, some of you mentioned how the way we pitch responsibility can change, depending on the circumstance or context we find ourselves in. It can be a somewhat rocky road, and different peoples‟ take on responsibility can certainly mean it can require a fairly cautious footwork. You might think this doesn‟t have a whole lot to do with the work we aim to achieve on the ground, helping men avoid passing on and picking up HIV from one another. But what Adam and I want to turn to now is a discussion of our research findings that offer insight into just how much men‟s own thoughts about responsibility connect with their HIV prevention needs.
The last few reports we‟ve published especially have seen a great deal of overlap in terms of their themes, and we wanted a chance to draw together all these different bits of research. These studies were Relative Safety II (a study of UAI among men with diagnosed HIV), Wasted Opportunities (a investigation of problematic alcohol and drug use among gay and bisexual men), and Sexually Charged (a study that explored men‟s understandings and perceptions relating to the criminalisation of HIV transmission). In the last seminar on stigma, we mainly focussed on the first two projects. Today‟s presentation on responsibility will focus on the first and last of these studies.
7 Our plan is not to give you a typical research presentation that talks about all of the diverse issues that came up in a particular research project. Adam and I have plunged into this work and pulled out what we think are the salient insights that the findings tell us about men‟s views on responsibility. We tell you in only the briefest terms what the projects were and how we did them, so that we are then able to cut straight to the chase, however, for those of you who are bursting to know more about the projects in full, the reports are here for you to take away with you.
So I will start off by talking a bit about Sexually Charged. This was a report based on analysis of some very detailed information what we collected from men filling in the online version of the Gay Men‟s Sex Survey in 2006.
8 As some of you will know, the Gay Men’s Sex Survey is a periodic survey of homosexually active men living in the UK that Sigma undertakes for CHAPS with the support of over 100 voluntary and statutory sector agencies. In the 2006 online version, men completing the survey were asked: Do you think it is a good idea to imprison people who know they have HIV if they pass it to sexual partners who do not know they have it? There were three answers to choose from: YES, NO, NOT SURE
9 And then, it got interesting, because the second part of this question invited open ended responses by asking men to give the reason for their views. I will talk today only about our analysis of how responsibility arises in these responses, and some of the potential implications of this. The report itself talks about the full array of themes that came up among all those who answered these questions.
It‟s worth pointing out that the way the question is asked means it doesn‟t lead the respondent to necessarily reflect on himself. It is a question about „people‟ so lots took that to mean „other people‟.
But even with that in mind, we need to carefully consider what such a sizeable proportion of gay and bisexual men think of others‟ responsibilities for HIV transmission
10 So, putting this into context a bit, more than 8000 men answered the first (close ended) part of this question about whether they did or did not agree with prosecutions. [n=8252] This chart gives you an idea of the breakdown of the answers given. As you can see, most men supported prosecutions.
Four fifths of the men who answered the first part of the question offered a useable response to the second (open ended) part of the question. [n=6718] We managed to identify a core set of themes that arose in all of the responses to the second part of this question, regardless of men‟s agreement or disagreement with prosecutions.
Responsibility was the one theme that cropped up consistently when men explained why they agreed with, disagreed with, or weren‟t sure about criminal prosecutions.
11 Among the people in the BLUE section here a sizeable proportion (37%) used responsibility to explain why it was that they agreed with prosecutions. It was the second most popular theme that came up among these respondents. Among the respondents in the GREEN section, responsibility was the most common theme used to explain why they did not think prosecutions were a good idea (42%). In this lovely BEIGE section, representing those who were not sure about prosecutions, here we had a pretty mixed bag of responses when we asked people why they were not sure, yet even here, about 1/5th talked about responsibility in their answer (17%).
Responsibility is interesting in this data, because no other theme was as consistently raised by all the different men who described their different positions on criminal prosecutions.
Among the men we aim to influence, ideas about responsibility interact in a significant way with men‟s ideas about HIV transmission. Understanding that is an essential element to recognising how we should be planning interventions. Today‟s seminar is most certainly not about criminal prosecutions – however, focussing in on this question about criminal prosecutions allows us to open a window into men‟s thoughts about responsibility. And it is an interesting window indeed.
12 Among the survey respondents who agreed with prosecutions, comments about responsibility almost always focussed on what they regarded as diagnosed men‟s exclusive or at least primary responsibility to ensure their partners did not become infected. *QUOTE In the main, people who took this view felt that having an HIV diagnosis conferred automatic responsibility for disclosure. *QUOTE There were MANY people who took this view, and it links in directly with what we already know about astoundingly high expectations that all future sexual partners will disclose an HIV positive diagnosis. That expectation has a lot to say about where such men feel responsibility for HIV transmission begins and ends. It clearly has nothing to do with themselves. It is all about „those other guys‟....‟the ones who have HIV‟.
13 This is a pretty individualised way of regarding the social dynamics of HIV. Where someone knows he has HIV...it is all down that other person to prevent it. It is also a viewpoint that tends to disregard all of the reasons why disclosure will not and does not happen (something that Adam will get into in a bit more detail in a moment), and one that disregards the fact that most people who are highly infectious in the earliest phase of their infection will not know they have it, so they have nothing to tell. It is frequently a view that overlooks the possibility that I might have HIV now, or I might have HIV one day in the future, because as I see it, HIV is all about other people.
You might have expected that the idea that „it is all about them‟ was pretty much about the blame for HIV infection resting with those who know they are infected. But one thing about blame is that it is flexible enough to support any position.
14 You will remember that about one quarter of the survey respondents said they did not think prosecutions were a good idea. Among that group, responsibility for HIV transmission loomed very large in their answers. There were two different ways that they talked about responsibility The first is a mirror image reflection of those in the previous slide. Many who disagreed with prosecutions argued that the person acquiring HIV has responsibility for his own actions, in particular, a responsibility to avoid becoming infected. So „they have no one to blame but themselves‟. *QUOTE This is an approach that, like the ones I described in the last slide, are sill seeking to locate blame.
What often strikes me in most of these responses is the way in which real life, with all of its messiness, unsureness, and guardedness, and hoping for the best that actually happens between people who are checking each other out – is cleanly swept away. This is the exactly the same kind of clean sweep that allows the men who support prosecutions to believe that taking responsibility for and acting on HIV disclosure should be such a snap for men with diagnosed HIV. Consider what this man has to say, for instance: *QUOTE
15 How truly realistic is that? Can we think of some situations where this might apply? Certainly – but this will mainly be happening where there is genuine trust between men who are looking to build a relationship. And yet so many of the men with the highest HIV prevention needs also lack the skills to build those sorts of relationships.
So, instead of taking about responsibility how it truly is shouldered (or neglected) in real lives, by real men, instead, the majority of those talking about responsibility describe a hot-potato model of passing blame onto others. Each is doing his best to ensure that he passes it on to someone else as quickly as possible, in order to avoid responsibility resting with him for too long. There is nothing productive about it. It doesn‟t help to meet HIV prevention need in any way that I can see.
I want to move on now to consider one final way in which a number of men talked about responsibility when they were answering these questions. In proportional terms, they represent the minority of those whose answers focussed on responsibility, but they talk about shared responsibility, making them the only ones who don‟t get caught up in blame while focussing on this topic, which is why they are of particular interest.
16 A noticeable difference when we compare the responses among those who regarded responsibility as shared, to those who thought it rested with others, is that these men left room to consider themselves within the scenario. They considerably widened the circle of responsibility. One that includes you and me. There isn‟t a sense of „them‟ here it is a sense of „us‟. *QUOTE-
Instead of seeing responsibility for HIV transmission as only being someone else‟s problem, it was bound up within their own sexual practices, and they felt it was something they actively had to work through with each sexual partner. *QUOTE
17 Sure, we can critique the shared approach by saying that it might be very idealised, and that openness and precaution by both parties can be a very difficult thing to achieve all of the time – yet it is the only way that men considered responsibility in these responses, that did not wield blame in one direction or the other. Here, that tennis match is not happening.
Shared responsibility is the approach most favoured by health promotion. It provides a language through which we can talk about responsibility, while at the same time avoiding the familiar trap of finger-pointing. And yet, so few men, when focussing on responsibility, reflected this perspective. Overall, what the data from Sexually Charged shows us is that responsibility is predominantly wielded as a weapon of blame– enabling men to defer their own concern for risk management to someone else. Only a few take this shared perspective. [Hand over to AB]
18 Just to give you a brief idea of what the RSII was about, for those who you who haven‟t already read it. The aim of the study was to explore the context and motivations for unprotected anal intercourse among gay men who had been diagnosed with HIV. We conducted 42 face to face interviews with men from across England and Wales (higher and lower HIV prevalence areas). To be eligible to take part they had to engage in sex with men, be diagnosed with HIV, and have engaged in UAI within the previous 12 months.
19 The findings from the study were quite complex – very insightful – but far beyond the scope of today‟s seminar to go into in any great detail. There‟s some copies of the report on the table if any one is interested to learn more about it. What I wanted to draw out though was the ways in which responsibility as a concept was discussed or addressed within the study. How the men we interviewed thought about responsibility, how they tried to behave „responsibly‟ or otherwise – and all the other complex interplay within that.
** Catherine just talked us through how men in the Sexually Charged study often felt that it was the responsibility of those who are diagnosed positive to keep others safe. It is their responsibility to protect others from harm. And the men in the Relative Safety study felt that responsibility, they felt that burden. They knew they posed a risk to others and they absolutely – CATEGORICALLY - wanted to avoid being the cause of onward HIV transmission.
“I was HIV positive and the last thing that I wanted to do was put somebody through, you know, infect somebody and let them go through what I had just been through. Of oxygen masks, intensive care and being intubated and all that. I didn‟t want to inflict that on anybody” [Early 40s, low prevalence area, diagnosed 8 years]
There was also the sense from the men that in certain situations, or with certain people, I need to be even more responsible. I need to be more sensible, more in control, because I have a greater duty to others. This was often the case with regular or romantic partners – they felt an even greater burden of responsibility to have safer sex. With casual partners it was different because they didn‟t have that level of relationship built up. It wasn‟t that they didn‟t feel responsible for them – but more that it was a different level of responsibility. A few of the men also talked about feeling a particular responsibility towards younger sexual partners, who may be naive about the risks of HIV transmission. It‟s almost like there‟s a static amount of responsibility and I am apportioning it differently depending on the situation or interaction I‟m faced with.
20 ** As a further reflection of the responsibility they had assumed, when we asked them what they understood by „bug chasing‟ or „gift-giving‟ they all stated that it was absolutely not something they would ever wish to be involved with.
“And we were having sex and I was fucking him [without condoms] and he was saying „I want you to make me positive‟. And I instantly lost all interest and I couldn‟t get out of their quick enough” [Early 40s, high prevalence area, diagnosed 2 years]
** Even though they often felt that sex could be better, more fun, more exciting or more intimate, without condoms, they felt that they should still wear them because it was the responsible thing to do. The costs of infecting another person far outweighed the benefits of having sex without condoms. In a way, being responsible is going to cause a harm to me (and my sexual enjoyment) but I‟ll try and put up with that.
** A feeling that ran through out many of the interviews was this sense of wanting to be more responsible than the person who infected me. It wasn‟t so much that they always blamed someone else for their infection (most readily assumed some degree of responsibility), but it was common for them to report wanting to be more responsible than perhaps the previous generation. Often it was receiving a positive diagnosis that encouraged individuals to reflect on their behaviour, to consider their new circumstances and to a assume a more controlled and responsible identity. They accepted that they may have behaved in a risky or „irresponsible‟ manner in the past, but now things would be different.
“It‟s not good news to become positive but in a way it seems like a chance to regain self-control ... Not just sexually, but also in a more general kind of way” [Late 40s, high prevalence area, diagnosed <1 year]
21 When it came to enacting that „new‟ responsible identity however, the men were faced with many choices and many issues to overcome. What actually constitutes responsible behaviour? They had to negotiate what they felt was „right‟ and what was wrong.
** Now in recruiting for the RSII study we specifically wanted to speak to men with diagnosed HIV who had engaged in UAI within the last year. There were a great many reasons why UAI occurred – some had seroconcordant regular partners and valued the intimacy and eroticism of condomless sex; whileome unintentionally didn‟t use condoms because of a whole host of situational factors – such as being drunk, or feeling powerless or horny or whatever. They‟d meant to use condoms but it just hadn‟t happened. A few used risk-reduction strategies such as withdrawing before ejaculation or they attended to the modality of sex – i.e. If they were the receptive partner they were less likely to transmit HIV.
** However, most completely rejected the notion that risk could be „reduced‟‟, instead feeling that the only responsible thing to do was to eliminate risk, by either using condoms (which for them was black and white issue – they didn‟t like to consider the notion of condom failure) or by having UAI only with other positive men. Withdrawing, only being the receptive partner, or basing your risk decision on your current viral load was too much of a grey area for most, and not something that a „responsible‟ individual would involve himself with. In relation to the Swiss statement and whether or not that influenced the sex he has, one of the guys said:
“it makes no difference if your virus is 50 or it‟s 4,000, you‟re still going to pass it on” [Mid 20s, diagnosed <1 year, high prevalence area].
22 And in relation to who is fucking who:
“You probably are reducing the risk but not as much as you could do [being the receptive partner]. Is not reducing the risk far enough. It‟s like playing Russian roulette but having one bullet instead of three”
** Some felt that only having sex with men of the same HIV status („serosorting‟) - was a responsible way to behave. One of the men used the term „responsibility‟ explicitly when he described his feelings about serosorting when he said:
“No it‟s the idea that you could sort of have… well unprotected sex isn't safe is it, but you could have like responsible unprotected sex (p. 17).
This guy constructed himself as a person who has „responsible‟ unprotected sex. He seemed very keen to stress to us that what he did should not be considered bad by other people. He may have unprotected sex on occasion, but the contexts in which he did so meant that he posed little risk to others. However, the majority of men shunned the idea of serosorting, partly because they didn‟t like the idea of limiting their sexual pool to other positive men – who they often viewed as promiscuous or interested in esoteric sex – but also because some felt UAI with positive men was irresponsible because of the other STIs you could catch, or superinfections.
“I mean that‟s fine for other people, they fuck people without condoms and that‟s up to them [...] but for me, I don‟t want to feel that I am having to put myself at more risk of being re-infected.”
23 ** Now, while the men we spoke to may have felt a burden of responsibility, they still believed that negative or untested men carried some degree of responsibility for their sexual health as well. They didn‟t like the idea that they had sole responsibility. I‟m going to answer that call to protect others, but that doesn‟t mean they should stop trying to protect themselves as well.
“But then I think that two people having sex, either partner is equally responsible. I think as much as I should be actively wearing a condom, the other person should be actively encouraging it”
** Sometimes though they observed other guys, people who they thought were probably negative (or at least untested), behaving in what they felt was an irresponsible manner; putting themselves or others at risk of infection. This, on occasion, led them to question why they were assuming the burden of responsibility when others were acting in such a risky manner. Why the hell should I carry all this burden?! Why the hell should I take all this on board if you‟re not going to look after yourself?
“And even going out cruising in lay-bys again there is unsafe sex on tap and you can go and have sex with two or three blokes... being fucked getting fucked, fucking them, shooting a load up your arse, you shooting your load up their arse, and then they will go and sit in a car and there is a baby seat and a wedding ring so.... its not even, its not just in the gay its in the bisexual as well, you know they are going back to their wife and child and they don‟t care.”
24 This guy is saying „if I see that you don‟t place much value on the harm that might come from your behaviour, why the hell should I place any value on your health and well-being?‟
** What many of the men did, or at least tried (and I‟ll come back to that point) to do, was to disclose their HIV status to their sexual partner. This helped them feel that they could share the responsibility for avoiding HIV transmission. Armed with appropriate knowledge, their sexual partner could decide what type of sex, if any, they wanted to have. It‟s about allowing them to make an informed choice. Disclosure was a way of levelling the playing field. If I tell you that I‟m positive then we jointly carry the can if everything goes wrong.
Some men also talked about how disclosure could help alleviate their feelings of guilt. They still felt guilty for having sex in the first place in knowledge of their infection and disclosing their status helped them to maintain some sense of moral integrity. „I‟m still being a good person because I‟m disclosing my status first‟.
25 ** However, that ideal of disclosing to all sexual partners was not the reality for most respondents. It simply wasn‟t always possible. While most wanted to be able to disclose their status to sexual partners, significant and repeated experiences of rejection made it really hard for them to be open about being having HIV. The last round of seminars we facilitated talked in detail about the role of stigma in HIV transmission risk behaviour, and we see it again here intersecting with men‟s desire and ability to be „responsible‟ citizens.
“I‟d say to someone [that I‟m HIV positive] and there would be a really strange reaction to it and I‟d have to leave that person‟s house. And you feel a bit like a pariah. Or people would, you know, get this horrible reaction to it”
Some men talked about their worries over the „right‟ time to disclose. When you first meet someone, and run the risk of them leaving straight away, or later on in a relationship when they have had a chance to get to know you better, but you‟ve also grown more attached to them and the impact of rejection would be even worse? There were many men we spoke to who had originally wanted to disclose before every time they had sex because they felt it was the „right‟ thing to do, but bad experiences of rejection by sexual partners had stopped them doing it. Truly shared responsibility is about taking a chance. You have to trust that the other person will meet you half way. Unfortunately though, this wasn‟t the experience of most of men in the RSII study when they disclosed their status. They tried to share responsibility by disclosing that they were positive, but the other person just ran a mile. So while many felt, at one time of another, that sexual partners had a right to know their status (to make an informed decision), they found you have to be very thick skinned in order to do it.
26 ** What we observed then was many, many instances of what we might think of as “implicit” disclosure. I‟ll kind of make it known to him that I‟m positive, but I won‟t say it in such an open or explicit manner. I‟ll tick the safe sex „needs discussion‟ box on gaydar, I‟ll say to him „you know we really should use condoms‟. Also quite common was having UAI only in sauna or bath house environments. Lots of the men described their belief that anyone having UAI in a sauna must be positive, so it‟s okay to do it there. And no one talks about HIV in saunas – they‟re the kind of places that people hardly talk at all. You just get down and dirty. In a somewhat bizarre fashion then, some of the men saw going to saunas as a way of dissipating the burden of responsibility they felt – the responsibility to disclose their HIV status (no one talks about HIV in a sauna) and the responsibility to ensure HIV transmission does not occur (they must be positive as well).
** Essentially, going to saunas and having UAI in this manner, or implicitly disclosing your status, or perhaps on very rare occasions withdrawing before you ejaculate was a way of being responsible „enough‟. They‟re ways of helping me think that I‟m still being a good person – I‟m still answering that call to be responsible and protect others from harm – but I‟m also doing things to protect myself. I don‟t want to be rejected all the time. I don‟t want to face that psychological or physical torment so I‟m going to tell myself that I‟m doing my duty that balances this all out. It‟s a way of protecting my moral sense of self.
27 Finally, it‟s important to emphasise that there were some occasions where the men felt themselves that they had acted irresponsibly – however they conceived of that. They had done things they weren‟t comfortable with, had sex with people they wish they hadn‟t, or taken risks – that either posed harm to themselves or others – or both. There are times I will hold my hands up and say „I did something I shouldn‟t have done‟.
What was interesting though was how when such events occurred the men would often try to absolve themselves of responsibility by externalising blame to other factors. Most often the excuse given was that they were drunk, or under the influence of drugs.
“If I have unsafe sex it‟s because, it‟s on the spur of the moment. So either because I get carried away or because I‟m under the influence of drugs or alcohol. I'd never knowingly… I'd never infect someone [...] I mean because you can't use drugs and drink as an excuse I suppose. But I am in a sense, if that makes sense”
We saw evidence of this throughout the Wasted Opportunities study as well – an investigation of problematic drug and alcohol use among gay and bisexual men. Men would describe having sex that they considered risky, that they felt was irresponsible, but were able to rationalise it to themselves by saying they were drunk or stoned. I behaved irresponsibly, but it wasn‟t really me. It was the drink, it was the cocaine, it was because I was powerless, it was because I was horny and overcome my primeval sexual desire. Or whatever. I‟ll externalise that blame and pin it on something else. That saves me from thinking about myself as a bad person.
28 So if we think of this all together, the RSII data introduces us to the notion that being responsible can take many forms. There are different actions you can take and what might be seen as responsible behaviour by some is considered irresponsible by others. Responsibility isn‟t black and white – many men pose it as all or nothing when there are actually many shades of grey.
Nearly everyone likes to think of themselves as being responsible – as being good people. It helps to bolster our sense of moral and social integrity. But in trying to answer that call to be a responsible citizen, many of the men we spoke to ran into all sorts of problems. Being „responsible‟ can cause all sorts of harm to myself and so I have to find a way of managing that. We build up stories to defend how we think about ourselves. We rationalise our behaviour by drawing on different cues in the environment (he‟s probably positive, it‟s okay because I pulled out before I came), and when we do something that even we might consider „irresponsible‟ – something perhaps that we regret – we often try to rationalise it by thinking about it as a transient moment of madness. It wasn‟t really me.
29 We wanted to leave you with a few visual images before we wrap up this talk.
Starting off with the findings from Sexually Charged – what it seems that many men are engaged in, is a Hot Potato approach to HIV and responsibility. Each individual does what he can to make sure that responsibility doesn‟t land with him, so he hands if off as quickly as possible to someone he regards as „them‟. The like goes: “If only „they‟ took more responsibility, we wouldn‟t all be in this mess.”
And so on it is passed, from someone who has not recently tested for HIV...
30 ...to „those positive guys‟ who should be making sure that they disclose to all of their partners...
31 ...to the ones who know they are negative, and should bear all the responsibility for keeping it that way...
Obviously this is a simplification that I have constructed in order to make a point. I certainly don‟t want you to go away thinking that all the men with diagnosed HIV in this sample pilloried men who were acquiring responsibility – or the other way around, that all HIV negative or untested men exclusively blamed diagnosed guys for onward transmissions. And yet, among the majority of men talking about Responsibility who were involved in this game of passing on the blame...there certainly were distinct relationships between men‟s testing history and their views about the way in which others needed to step up.
In HIV prevention terms, men‟s strong beliefs about how people should behave toward one another informs their understanding of how people do behave.. Where respondents expect that every man with diagnosed HIV should tell their sexual partners about it, they will apply this expectation during the sex that they have. They feel that men who know they have HIV bestows them with a knowledge that also involves a special duty to tell. (What they don‟t say here, but what we know from years of doing surveys and interviews – is that in the main, the expectation of telling is most commonly held among men who will run a mile when anyone does say they have HIV). Where men expect that partners with HIV will disclose, it means that they are free from having to contend with a serious commitment to risk management themselves.
And we also have the flip-side, where men opposing prosecutions took the view that people acquiring HIV have no one to blame but themselves. This is a reflex reaction, and yet it is caught up in the same mechanics of blame. Again, when we translate this into sexual behaviour, men who hold these views will tend to assume that all partners should (and therefore do) actively attend to the risk of HIV transmission in each and every sexual encounter. Yet we know this isn‟t the case. For the vast majority, managing the risk of HIV largely amounts to deferring responsibility, defended by the hope that the presence of HIV will make itself known, and that it doesn‟t have to be attended to until absolutely necessary. That isn‟t a brilliant model of risk management from a health promotion perspective, but it is threaded throughout these discussions of responsibility residing with the other.
We talked about an alternative from the hot-potato blame game – men in both of the studies reflected on this idea of shared responsibility, and I want to turn to that now. 32 We first introduced the ideal of shared responsibility when covering data from Sexually Charged – where men (particularly those who thought prosecutions were a bad idea) figured that both partners need to equally share responsibility for the sex that they have.
As an ideal, this is pretty black and white. It can disregard the greys of a world in which people struggle with always „doing the right thing‟, for whatever reason. Yet it is an ideal that seeks to escape laying blame.
33 And yet, what we hear about the practicalities of sharing responsibility from the men taking part in the Relative Safety II study, is that there tends to be rather a LOT of blurriness in their accounts.
Also, one of the problems that we run into with this idea of „sharing‟ is that men believe there is some kind of fixed quantity of responsibility that is required in any sexual context. So, I walk into the room, I size up how much responsibility I think you might be bringing to the interaction, and this helps me to determine just how much I might have to contribute. So, if I think you are a twink who doesn‟t know any better, for instance, I might make sure that we use a condom if we do have intercourse.
34 But if I judge you to be a pretty hot guy who has been around the block a bit, I might figure that you know how to take care of yourself, and I will only bring as much responsibility to the party as this situation requires. The lines are very blurred, because the situation demands quite a lot of grey area in order for me to keep my moral centre intact.
Problems with this are:
I am likely to get my estimates of what you are doing very wrong – largely because you may be operating under the idea that it is up to others to protect you from HIV.
And, I do just enough, while also being mindful of the social and moral hazards I face if I try to take on „too much‟ of the responsibility burden. My „just enough‟ is hopeful that you are doing „more than enough‟ on your end.
35 The result, is something that might look a bit like this. Two individuals, doing what they think is „enough‟ with regards to responsibility – which is also based on a judgement of just how much the other party is responsible for – and it comes up short. The pieces don‟t fit, and HIV transmission becomes a much greater possibility if it is present in one of these men.
We wanted to end this part of the afternoon here, leaving you with some images that might help what we are saying rest in your minds a little differently.
We suggest that now is a good time for a BREAK, after which time we will have a response by {*NAME} and some time for questions and discussion from you about the things we have had to say this afternoon.
During the break, we are going to put up a rotating slide show with a few examples of printed campaigns that have dealt with the topic of responsibility, either directly or indirectly. We thought some of these would prompt ideas from you about where health promotion has traditionally come from on this topic.
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