Reluctant Subjects: The Place of Gay Men in Canadian Media Discourse on HIV by Jaime Cristian Rangel A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Department of Sociology University of Toronto © Copyright by Jaime Cristian Rangel, 2018 Reluctant Subjects: The Place of Gay Men in HIV/AIDS Canadian Media Discourse and HIV Prevention Jaime Cristian Rangel Doctor of Philosophy Department of Sociology University of Toronto 2018 Abstract This dissertation maps the struggles for gay men’s inclusion into the national and global health imaginaries of HIV/AIDS over the past three decades. I order to do so, the author analyzes three instances of public discourse on vulnerability and risk, and their representation in the continuum between individual and collective victimhood and responsibility in the aftermath of the HIV/AIDS epidemic, as reported in Canadian media. The central claim is that national and global health discourses are underpinned by the double helix of biopolitical and humanitarian imaginations, which I argue, require the production of morally worthy subjects for anchoring political and material responses to the pandemic. This is the case because biopolitical and humanitarian imaginations nurture specific ways of collecting, understanding, reporting, and responding to epidemiological data. Equally important, these ways of imagining morally worthy subjects nurture the symbolic, that is, political and cultural moves that inform priority setting and shape resource allocation for different populations. ii Acknowledgments This work is the product of individual and collective efforts that include the work of members of my committee and other peers through extensive conversations and critical reviews. A direct outcome of these contributions are two co-authored articles based on the current work. This dissertation is equally important, the outcome of the intellectual and emotional support of my family and friends. I want to express my deepest gratitude to my partner, Dr. Vikram Malhotra. iii Table of Contents Acknowledgments iii Table of Contents iv Introduction 1 Why study HIV/AIDS? 2 Setting the Context: Situating Gay Men in HIV/AIDS’s History 4 Communities of Care and HAART 5 Reluctant Subjects: Gay Men and MSM at Different Points of the HIV Pandemic 7 Dissertation Structure 10 Chapters Synopsis 10 Methods: Data Type, Sources and Analytical Approach 13 Chapter 1: Media Production of Gay Male Belonging in the “Canadian Public” from the Tainted Blood Scandal to the Present 15 Introduction 15 Methods 19 Instituting a Canadian Vital Public 20 iv Delineating Lines of Responsibility and Innocence 22 The Production of a Moral Order 25 A Parallel Discourse: Vying for a Place Within the Boundaries of Responsible Citizenship 28 HIV Risk and the (Im)possibility of Assimilation Politics 32 Conclusions 36 Implications of Findings 38 Chapter 2: The Humanitarian Production of Morally Worthy Subjects in the Global AIDS Pandemic 41 Introduction 41 Case Selection and Justification 43 Structure of the Chapter 45 Literature Review 46 4.1 The Transformation of the Epidemiological Profile of HIV in the 1990s 46 4.2 Compassionate Politics 48 4.3 Media and the Production of an Imagined Moral Community 50 Methods 51 5.1 Justification for the Selection of Media Sources: Mainstreaming HIV and the Gay Public 52 5.1.1 GM: Collecting the Data 53 v 5.1.2 GM: Descriptive Analysis 54 5.2 Other sources of Data 55 5.2.1 AIDS Day Guiding Documents 55 5.2.2 Xtra Magazine 56 5.3 Discourse Analysis for All Data Sources 58 5.4 Limitations of Case and Data Source Selection 58 Analysis 59 6.1 Part I: Setting the Context for Populations at Risk 59 6.2 Part II: Media Representations 64 6.2.1 The Early Years: 1987-1997 64 6.2.2 Shifting Epidemiological Profile: Women and Children 65 6.2.3 The Production of Workable Subjects of Compassion 68 6.2.4 The Middle Years: 1997-2004 74 6.2.5 The Later Years: 2006-2015 82 Discussion 90 Conclusion 94 Chapter 3: Everyday Moral Reasoning in the Governmentality of HIV Risk 97 Introduction 97 Governing Risk 99 Methodology 101 Responsibility as Individualised 103 Responsibility as Relational 108 vi Shared and Unshared Responsibilities 111 Moral Reasoning and Multiple Subjectivities 117 Moral Subjects in Late Modernity 119 Conclusion 121 Conclusion 124 Gay Men and MSM as Reluctant Subjects 124 The Production of Vulnerability and Agency: Moral Imaginaries and Epidemiological Profiling 127 Stakeholders: The Production of Unintended Moral Orders 129 Slippages of (Neo)liberal Citizenship 133 Future Research 135 Limitations 136 References 138 vii Introduction This dissertation explores the following question: Who are the morally worthy subjects produced in the Canadian biopolitical and humanitarian imaginations of the HIV/AIDS pandemic? In order to answer this question, this dissertation maps the struggles for gay men’s inclusion into the national and global health imaginaries of HIV/AIDS over the past three decades. This map is the product of selected moments of public discourse on vulnerability and risk, and their representation in the continuum between individual and collective victimhood and responsibility in the aftermath of the HIV/AIDS epidemic, as reported in Canadian media. The central claim is that national and global health discourses are underpinned by the double helix of biopolitical and humanitarian imaginations, which I argue, require morally worthy subjects for anchoring political and material mobilizations. This is the case because these imaginations nurture specific ways of collecting, understanding, reporting, and responding to epidemiological data; but also nurture the symbolic, that is, political and cultural moves that inform priority setting and shape resource allocation for different populations. The question that this work addresses is of central import for sociologists, practitioners within the medico-pharmaceutical and public health assemblage, and activists alike (Rose, 2009). This question reveals the unintended consequences of the mobilization of epidemiological profiles underpinned by socio-political identities, in particular, sexuality and gender, for resource allocation in the HIV/AIDS pandemic. The cartography of biopolitical and humanitarian imaginations nurturing HIV/AIDS discourse, traces the ways in which subjects at risk of HIV/AIDS are located in distinct moral orderings or hierarchies of deservedness that underpin collective mobilization. Drawing from the rich framework offered by scholarship on biopolitics, it is argued that this moral ordering reflects a continuum between the construction of proper citizen-subjects of advanced liberal societies in the West on the one hand, and the morally and medically worthy subject of the global health and humanitarian enterprises on the other. In this analysis, gay men and men who have sex with men (MSM) emerge as reluctant objects, but also 1 as individually responsible citizens, within both the national and global public health imaginaries. Why study HIV/AIDS? HIV/AIDS is perhaps one of the most poignant biopolitical events of the second half of the 20th century. Its heavy toll on human lives, initially concentrated amongst young gay men in the West, and its risk of mass infection and casualties amongst the general population, ignited the public’s imagination by drawing from the collective history and fears of pandemics and civilizational decay (Sontang, 1989). The abrupt and dramatic rise of HIV/AIDS as the impending final pandemic of the 20th century fed fears of a double contagion; this fear was equal parts biological and moral as it seemed to express itself in the conflation of homosexual desire and lethal disease (Altman, 1986; Gilman, 1988; Patton, 1986; Sontag, 1989; Treichler, 1987). The extreme risks associated with HIV drew together important sectors of the public health and biomedical professions to curb and eventually eradicate the HIV threat. (Epstein, 1995; Rasnick, 2003; Rose, 2009). At the same time, the gravity of HIV/AIDS galvanized sexual communities of practice, in particular, gays and lesbians, to organize and respond to the immediate individual and collective needs of the first wave of casualties (Epstein, 1995; Gamson, 1989; Silversides, 2003). HIV/AIDS can therefore be seen as an axis of health-making political mobilization (Epstein 1995; Brown & Zavestoski, 2004). It simultaneously drew together gay men and their communities, as they found expression in AIDS Services Organizations (ASOs), and private and public actors, in the form of state institutions and the medico-pharmaceutical sector, into an uneasy but productive political and health assemblage (Epstein, 2007; Petryna, 2013; Rose, 2009). Equally important, as the epidemic progressed, it drew into the fold global health and non-governmental actors, like the World Health Organization (WHO), the United Nations (UN), and a host of humanitarian players acting both locally and globally to curb, cure and eradicate the medical, social and political effects of the virus (Altman, 2003; De Cock et al., 2002). 2 As an event, HIV/AIDS has created spaces of creative tension between practitioners of biomedical sciences and invested political actors. These tensions have produced a collective although contested imagination on population risks, state and individual responsibilities towards people at risk, and a classification system of moral deservedness that expands from local to global populations. The creative tensions amongst these sets of actors,