Negotiating HIV Prevention: the Talk, Test, Trust Story and Beyond
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Negotiating HIV Prevention: The Talk, Test, Trust Story and Beyond. Justin W. McNab A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy University of New South Wales, 2009 PLEASE TYPE THE UNIVERSITY OF NEW SOUTH WALES Thesis/Dissertation Sheet Surname or Family name: McNab First name: Justin Other name/s: William Abbreviation for degree as given in the University calendar: PhD School: National Centre in HIV Social Research Faculty: Arts and Social Sciences Title: Negotiating HIV Prevention: The Talk, Test, Trust Story and Beyond. Abstract 350 words maximum: (PLEASE TYPE) In May 1996 the AIDS Council of NSW launched Talk Test Test Trust …Together (TTTT), an HIV prevention campaign aimed at decreasing risk of infection within gay men’s relationships. The rationale behind TTTT was ‘negotiated safety’: that it was safe not to use condoms for anal sex in primary relationships if specific steps were followed. TTTT generated contestation within AIDS Councils in Australia and New Zealand, but also amongst researchers, policy makers and gay communities. Arguments about TTTT and negotiated safety appeared logical and reasonable and did not fall neatly along an Australia/New Zealand divide. This study used a qualitative approach to interview key HIV educators in New South Wales who were involved in the development of TTTT and New Zealand educators who did not promote negotiated safety. This thesis argues that in order to understand the contestation around negotiated safety and TTTT it is necessary to understand the broader social and historical factors that shape HIV prevention contexts and practice. These include factors arising from the epidemic itself (which, to some extent, were responsible for the difference between Australia and New Zealand) such as the increasing complexity of gay men’s risk reduction strategies, the rise of a positive voice, and impact of treatments and factors associated with and the broader context such as the rise and continuing history of a gay political and social movement and associated identity and community formation, and later, fragmentation, changing concepts of love, intimacy and relationships and of risk and the uncertainty, anxiety and fear from living in a complex individualised detraditionalised world. This approach will show that a focus on a dynamic epidemic, and the broader social and historical context can shed light on arguments made about negotiated safety and TTTT. Further, applying Bourdieu’s formulation of the complex interaction of habitus, fields and practice (1977) makes sense not only of the arguments made about negotiated safety and TTTT, but of educator practice and of HIV prevention, of the broader HIV and AIDS sector, and of how societies continue to learn to live with and adapt to the epidemic. Declaration relating to disposition of project thesis/dissertation I hereby grant to the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or in part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all property rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstracts International (this is applicable to doctoral theses only). …………………………………………………………… ……………………………………..……………… ……….………… Signature Witness …………...……. … Date The University recognises that there may be exceptional circumstances requiring restrictions on copying or conditions on use. Requests for restriction for a period of up to 2 years must be made in writing. Requests for a longer period of restriction may be considered in exceptional circumstances and require the approval of the Dean of Graduate Research. FOR OFFICE USE ONLY Date of completion of requirements for Award: THIS SHEET IS TO BE GLUED TO THE INSIDE FRONT COVER OF THE THESIS COPYRIGHT STATEMENT ‘I hereby grant the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all proprietary rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstract International (this is applicable to doctoral theses only). I have either used no substantial portions of copyright material in my thesis or I have obtained permission to use copyright material; where permission has not been granted I have applied/will apply for a partial restriction of the digital copy of my thesis or dissertation.' Signed ……………………………………………........................... Date ……………………………………………........................... AUTHENTICITY STATEMENT ‘I certify that the Library deposit digital copy is a direct equivalent of the final officially approved version of my thesis. No emendation of content has occurred and if there are any minor variations in formatting, they are the result of the conversion to digital format.’ Signed ……………………………………………........................... Date ……………………………………………........................... ORIGINALITY STATEMENT ‘I hereby declare that this submission is my own work and to the best of my knowledge it contains no materials previously published or written by another person, or substantial proportions of material which have been accepted for the award of any other degree or diploma at UNSW or any other educational institution, except where due acknowledgement is made in the thesis. Any contribution made to the research by others, with whom I have worked at UNSW or elsewhere, is explicitly acknowledged in the thesis. I also declare that the intellectual content of this thesis is the product of my own work, except to the extent that assistance from others in the project's design and conception or in style, presentation and linguistic expression is acknowledged.’ Signed …………………………………………….............. Date …………………………………………….............. 3 To Dr. Nancy Bowers (1928 – 2006), a friend and mentor. Abstract In May 1996 the AIDS Council of NSW launched Talk Test Test Trust …Together (TTTT), an HIV prevention campaign aimed at decreasing risk of infection within gay men’s relationships. The rationale behind TTTT was ‘negotiated safety’: that it was safe not to use condoms for anal sex in primary relationships if specific steps were followed. TTTT generated contestation within AIDS Councils in Australia and New Zealand, but also amongst researchers, policy makers and gay communities. Arguments about TTTT and negotiated safety appeared logical and reasonable and did not fall neatly along an Australia/New Zealand divide. This study used a qualitative approach to interview key HIV educators in New South Wales who were involved in the development of TTTT and New Zealand educators who did not promote negotiated safety. This thesis argues that in order to understand the contestation around negotiated safety and TTTT it is necessary to understand the broader social and historical factors that shape HIV prevention contexts and practice. These include factors arising from the epidemic itself (which, to some extent, were responsible for the difference between Australia and New Zealand) such as the increasing complexity of gay men’s risk reduction strategies, the rise of a positive voice, and impact of treatments and factors associated with and the broader context such as the rise and continuing history of a gay political and social movement and associated identity and community formation, and later, fragmentation, changing concepts of love, intimacy and relationships and of risk and the uncertainty, anxiety and fear from living in a complex individualised detraditionalised world. This approach will show that a focus on a dynamic epidemic, and the broader social and historical context can shed light on arguments made about negotiated safety and TTTT. Further, applying Bourdieu’s formulation of the complex interaction of habitus, fields and practice (1977) makes sense not only of the arguments made about negotiated safety and TTTT, but of educator practice and of HIV prevention, of the broader HIV and AIDS sector, and of how societies continue to learn to live with and adapt to the epidemic. 5 Acknowledgements First, I would like to thank my research participants for freely giving their time and insight, without which this project would not have been possible. I would also like to thank my supervisor Associate Professor Heather Worth and co- supervisor Dr Robert Reynolds for their comments and support through the writing of drafts and through the production of the final document. The Consortium for Social and Policy Research on HIV, Hepatitis C and Related Diseases provided support in the form of a three-year scholarship. I am grateful for this financial assistance. Likewise, the National Centre in HIV Social Research provided post-graduate support and accommodation, and also library and computer resources. I would like to thank the National Centre for making this project possible. Finally, I thank Brendon Gembitsky and Sarah Oxenbridge for proof reading the manuscript, and thanks also to my friends and family who supported