Between hope and abandonment: black queer collectivity and the affective labour of biomedicalised HIV prevention

Abstract

This paper investigates how current transformations in HIV prevention in the USA are intensifying a logic of viral containment rooted in biomedicine and behavioural science, in order to curb the recent rise in new HIV infections, predominantly among young African-American ‘men who have sex with men’. Based on fieldwork in Baltimore, I examine how this paradigm shift is translated into concrete prevention activities that focus on HIV testing and treatment. By attending to the affective labour performed by members of Baltimore's Ballroom scene – a kinship system of black queer youth structured around competitive dance and performance – I show how the emergent ‘Test & Treat’ approach becomes a polyvalent object that attracts a host of optimistic investments in collective and individual prosperity, which nevertheless threaten to remain unrequited. Finally, I argue that the current move towards a biomedically mediated model of viral management depoliticises the struggle against HIV by suggesting that we can treat our way out of an epidemic that in fact remains intricately interwoven with racialised violence against the queer, the poor and the otherwise dispossessed.

Cet article explore comment les transformations de la prévention du VIH aux États-Unis renforcent une logique de confinement viral, ancrée dans la science biomédicale et comportementale, et visant à freiner l'augmentation récente des nouvelles infections par le VIH, prédominantes parmi les jeunes hommes africains-américains qui ont des rapports sexuels avec d'autres hommes (HSH). En m'appuyant sur un travail de terrain à Baltimore, j'examine comment ce changement de paradigme se traduit en activités concrètes de prévention centrées sur le dépistage et le traitement du VIH. En me penchant sur le travail affectif exécuté par des membres de la Baltimore Ballroom – un système de «parenté» entre jeunes de race noire et queer, et structuré autour de concours de danse et d'interprétation – je montre comment l'approche récente «Dépister & Traiter» devient un objet polyvalent qui suscite un énorme investissement optimiste lié à l'espoir d'obtenir la prospérité, tant au plan collectif qu'individuel, mais qui néanmoins menace de ne jamais offrir de contrepartie. Enfin, je soutiens que le mouvement actuel vers un modèle de gestion virale introduit par la science biomédicale, dépolitise la lutte contre le VIH en suggérant que nous pouvons éradiquer cette épidémie, qui pourtant demeure intrinsèquement entremêlée à la violence à caractère racial envers les queer, les pauvres, sinon les autres personnes socialement dépossédées.

En este artículo se investiga el modo en que las actuales transformaciones en la prevención del VIH en los Estados Unidos están intensificando una lógica de contención viral que tiene sus raíces en la biomedicina y la ciencia del comportamiento, a fin de reducir el reciente aumento de nuevas infecciones con el VIH, especialmente entre los hombres jóvenes afroamericanos que tienen relaciones sexuales con hombres (HSH). Basándome en un trabajo de campo en Baltimore, examino cómo se traduce este cambio de paradigma en actividades concretas de prevención que se centran en las pruebas y el tratamiento del VIH. Prestando atención al trabajo afectivo realizado por miembros de las salas de bailes de salón en Baltimore –un sistema de parentesco de jóvenes negros gays estructurado en torno a danzas y espectáculos competitivos– muestro cómo el nuevo enfoque de ‘Analizar y Tratar’ se convierte en un objeto polivalente que atrae a una plétora de inversiones optimistas en la prosperidad colectiva e individual, que sin embargo corren el riesgo de no encontrar un resultado. Para terminar, argumento que el actual movimiento hacia un modelo mediado desde una perspectiva biomédica del tratamiento viral despolitiza la lucha contra el VIH al sugerir que mediante el tratamiento podemos evitar la epidemia que de hecho sigue estrechamente ligada con la violencia racial contra los gays, los pobres y otros desposeídos.

Keywords:

• HIV prevention
• Test & Treat
• homosexuality
• race
• USA

Notes

^1. ‘Testing & Linkage to Care Plus’ is a programme recommendation that resulted from a think tank convened in Washington, DC, in December, 2009, where a multi-disciplinary group of HIV/AIDS experts met to consider whether a Test & Treat strategy should be integrated into the NHAS (Project Inform 2010). The name, abbreviated to TLC+, omits the term ‘treatment’ in order to avoid the negative connotations that a Test & Treat programme evokes within communities of people living with HIV/AIDS. Yet, as the authors of the document admit, this is largely a cosmetic measure and treatment forms a crucial element in HIV care and prevention.

^2. I use quotation marks for the term ‘care’ here, both to indicate its frequent vernacular use among service providers and outreach workers and to point to its relative inadequacy. While ‘care’ sounds generous and assuring, it mainly denotes the regular monitoring of a patient's viral load and T-cell count, as well as referrals to ancillary services – which usually have extended waiting lists. See note 7.

^3. See http://ideha.dhmh.maryland.gov/apps/HIV for an application that lets users navigate a map of Baltimore containing information about the number of HIV infections in different areas of the city.

^4. AIDS Action Baltimore does run two peer-based behavioural interventions, yet these only serve a very small number of (returning) participants. Another CBO that organises behavioural interventions is Black Men's Exchange (BMX), a nation-wide organisation promoting wellness among black ‘same gender-loving’ (SGL) and bisexual men. At the time of writing, it is developing its own strategy to tackle the epidemic in Baltimore, with an emphasis on educating young black SGL men to love and respect themselves and their heritage. The presence of BMX has generally received a lukewarm response from the city's HIV-prevention establishment, particularly due to its radical pro-black stance.

^5. This paper is part of a larger research project on the relationship between sexuality, intimacy and citizenship in lesbian, gay, bisexual, transgender and queer urban life.

^6. This research has been approved by the Homewood Institutional Review Board of Johns Hopkins University.

^7. A number of case managers, working at a primary healthcare provider in Baltimore, informed me about their excessive caseloads. One case manager lamented that once he reached 160 cases he realised that he was basically a ‘paper processor’. He also indicated that this work pressure contributed to a process of triage, in which case managers are indirectly encouraged to spend most of their time helping clients who are eligible for insurance recertification, while disregarding ‘those who are pretty much lost causes’ (i.e., the homeless and drug addicted).