Wild Self-Care Rethinking ‘Risky’ Health-related Practices Among Members of the Gay Community Simon Clay, BA (Hons), BSSc A thesis submitted for the degree of Doctor of Philosophy at the University of Otago, Dunedin August 2020 Abstract Gay and queer men tend to experience higher rates of mental health issues, STIs/HIV, suicide, substance dependency, and poor well-being than other demographics. Despite sustained public health efforts internationally, many of these issues continue to disproportionately affect members of the gay community. This thesis presents a new approach to the health issues gay and queer men face. It examines how ‘risky’ health-related practices including condomless sex and the use of illicit drugs might be legitimate ways of performing self-care and pursuing well- being. In order to address this aim, I conducted 16 interviews over a 12-month period in New Zealand and Australia using a constructionist grounded theory approach and a theoretical framework that draws upon the work of Judith Butler, Elizabeth Grosz, Michel Foucault, Homi Bhabha, Kane Race, Nikolas Rose, and Pierre Bourdieu. My participants and I explore a wide range of topics including the performative nature of sex and the notion of ‘play’, how pleasure and the emotional significance of sex might be related to self-care, the ways in which space might influence sexual practices and experiences, and to what extent having sex outside the home might be a form of self-care. I also cover safer sex practices and the experience of disease, how PrEP has radically changed the way gay men approach sex, the way drugs are bound up in self- care practices, and the relationships between self-care and community. The concept of ‘wild self-care’ emerged from these interviews and describes how practices or behaviours which appear risky, dangerous, or unhealthy can also be seen as legitimate ways of caring for the body and the self. I demonstrate how my participants used creative, unexpected, i and alternative methods of caring for themselves using substances or ‘risky’ forms of sex and describe the way self-care is communal nature rather than a solitary practice. I also present the notion of health-as-process. This concept allows researchers to approach health as an ongoing process rather than a state of being that might be achieved. This speaks to the emotional and personal way that risk is constructed and experienced. All these facets come together to articulate the deeply complicated ways that people care for themselves. ii Acknowledgements There are a number of people who helped me with the writing of this thesis and making this process possible. First and foremost, my amazing supervisors, Chris and Gareth. Your patience as I went on long tangents, careful guidance, deep understanding of my project, and our fun ‘family meetings’ have been invaluable. You helped to develop my thinking in some profound ways. Thank you. To my participants: this project would not have been possible without you. Thank you for your belief in my project, enthusiasm, vulnerability, and insight. Getting to meet each of you was a wonderful and enriching experience and your stories have already made a significant impact. To Natasha, Helen, and Bronwyn who always managed to brighten up my day, make me giggle, supply me with ground coffee, and help me through PhD life. Without you all, I would not have made it this far. To my fellow postgraduates Cassandra, Laura Starling, Laura Schilperoort, Josh, Peyton, Bell, Karl, and Poppy. Thank you for the wonderful conversation, endless cups of coffee, laughter, and advice. I’d also like to thank the rest of my departmental colleagues, particularly Rebecca and Fairleigh, who patiently listened to me and offered sage advice. To my beautiful partner, Fio, whose support, enthusiasm, and love made the final two years so wonderful. I love you dearly. To my parents who provided unwavering support and generosity. And finally, to Lily. Without your love and kindness, I doubt I would have been able to finish this thesis. iii Acronyms ART Anti-retroviral therapy, the current standard of care for HIV treatment. CLAI/R-CLAIC Condomless Anal Intercourse/Receptive Condomless Anal Intercourse with Casual Partners. GBMSM Gay and Bisexual men, and Men who have Sex with Men. GHB/GBL Gamma-hydroxybutyrate (GHB) is used primarily by gay men in a club or sexual setting. A potent central nervous system depressant and provides a sense of euphoria, sexual arousal, with analgesic properties. Gamma-butyrolactone (GBL) is the chemical pre-cursor to GHB and is the more concentrated form of the two substances. NZAF New Zealand AIDS Foundation PAIC Protected Anal Intercourse PEP Post-Exposure Prophylaxis is treatment available to people who have been in direct contact with HIV to prevent infection. It is administered within 72 hours of exposure and involves ‘Truvada’ alongside two or three other drugs depending upon the type of HIV contact. PLWH People Living With HIV/AIDS. PrEP Developed by Gilead Sciences under the brand name Truvada, Pre-Exposure Prophylaxis is a new form of HIV treatment. Taken daily, it protects individuals against becoming infected with HIV. S/R/CDU Sexualised/Recreational/Chemsex Drug Use. iv SHC Sexual Health Clinic. SOPV Sex on Premises Venues. TasP Treatment as Prevention. This approach entails medicating an individual to prevent further infection of a disease. PrEP can be considered as a form of TasP as well as treating HIV-positive people so that they cannot pass on the virus. UAI/UAI-LC Unprotected Anal Intercourse/Unprotected Anal Intercourse with the Last Casual partner UVL Undetectable Viral Load. The aim of anti-retroviral therapy is to reduce the amount of HIV copies in someone’s blood to an undetectable level so that they cannot pass on the virus to others and can remain healthy. Many Positive folk may describe themselves as ‘undetectable’ if they have an undetectable viral load. v Table of Contents Introduction 1 Theorising Self-Care 2 Wild Self-Care 4 Primary Themes 8 Thesis Outline 11 Chapter 1: Methods and Methodology 16 Constructionist Grounded Theory 17 Queer Feminist Research 21 Project Planning and Information Gathering 25 Sample 27 Recruitment 29 Conducting Interviews 31 Data Analysis 33 Ethical Concerns and Risks 35 Risks of Drug Research 38 Conclusion 43 Chapter 2: Sexual Performances 45 Speaking About Sex 47 Playing Safe and Playing with Power 50 Playing the Part 58 Playing with Men 65 Conclusion 72 Chapter 3: Sexual Pleasure, Emotions, and Wild Self-Care 74 This Sex Which is Not One 78 Working for Sexual Pleasure 86 Friends with Benefits and Intimate Others 93 Conclusion 101 vi Chapter 4: Sex in Space 103 Third space and Heterotopia 105 Grindr: Romancing the Phone 108 The Thrills and Spills of Sex in Public 124 The Violence and Virtues of Saunas 131 Conclusion 137 Chapter 5: Disease, Desire, and Safer Sex Practices 140 Wild Self-Care and Health 142 Trust, Condoms, and Truvada 145 PrEP: A Blessing and a Dangerous Safer Sex Method 154 The HIV Experience 165 Conclusion 177 Chapter 6: Illicit Drugs Eliciting Care 180 Getting Healthy by Getting High 183 The ‘Gay Drug Problem’ 191 Drugs: Bringing People Together 197 The Trouble with Chemsex 208 Conclusion 219 Chapter 7: Communities of Care 221 Feeling into the habitus 224 The Dissolution and Illusion of Community 225 Problematic Identity Politics 233 Activism and Care 241 Erotic Political Action 247 Conclusion 254 Conclusion 257 Troubling Health Problems 258 Salient Themes 260 The Matrix of Care 263 Questions Answered and Questions Raised 266 Conclusion 268 vii Bibliography 270 Appendices 344 Appendix 1: Qualtrics Survey 344 Appendix 2: Participant Information Sheet 347 Appendix 3: Interview Schedules 350 viii Introduction I am using my Gaga Manifesto to push us further into the crisis, into the eye of the hurricane, deep into the heart of nonsense. - J. Jack Halberstam The germ of this thesis emerged one crisp evening at a bar in London. A forum series called ‘Let’s Talk About Gay Sex and Drugs’ had recently started at one of the iconic gay bars in Soho (now gone) where members of the gay community were encouraged to come forward and speak about their experiences with sex and drugs. Six men stood up on the small stage to talk about how sex and drugs have featured in their lives. Some were brief in what they had to say while others took the opportunity to implore their fellow queers to get regular health checks, seek out help, keep in touch with friends, practice safer sex, and use substances in moderation. With much of the research into gay men’s health depicting them as ailing, unable to cope with their sex lives and/or drug use, and struggling in general, the men who spoke at this forum demonstrated how distorted this depiction often is. This thesis presents an alternative way of approaching and understanding gay and queer men’s health and the health-related issues we disproportionately face. It asks the question: ‘What if the practices associated with poor health, particularly drug use and condomless sex, are actually ways that gay and queer men pursue well-being?’ I argue that contemporary discussions of gay men’s health omit some major elements that inform how and why gay men use substances and approach sex in ‘risky’ ways. Drug use and condomless sex are generally seen as among the most concerning health issues that gay men face, but this thesis explores how these ‘risky’ health-related practices might function as legitimate forms of self-care. 1 Why self-care? To argue that taking drugs, engaging in condomless sex, and other ‘risky’ practices are forms of self-care articulates a diverse range of approaches to health and how these practices are frequently grounded in the pursuit of improved health and well-being rather than the opposite.