Bio‐power and biohazards: A projective system reading of gay men's community‐based HIV prevention

Abstract

This paper describes some of the more prohibitive aspects of HIV prevention among gay men in England. It argues that much current HIV prevention work assumes that prohibition is the most appropriate means of governing gay male sexual practice—most particularly in relation to the treatment of unprotected anal sex or bare‐backing. The prohibitive approach constructs an opposition between the good gay citizen who privileges health maximisation and the evil irresponsible bare‐backer who embodies the transgressive pleasure of unprotected sex. It becomes impossible to represent bare‐backing outside of this cycle of prohibition and transgression without being re‐inscribed within it through the sickness of low self‐esteem.

Keywords:

• Psychoanalysis
• psychodynamic
• self‐esteem
• bare‐backing
• transgression
• gay

Notes

A bible for gay men's community‐development when it was published by the English Health Education Authority in 1994.

The results of this ‘community‐based random‐controlled trial of cognitive behavioural work with gay men’ were presented at the second national CHAPS conference (February 1999). Places on a train‐the‐trainers style weekend were then sold to HIV prevention workers at £450 a time. After 2 days training, each of the 16 participants becomes ‘accredited as a Hard Times Group Work Facilitator’ (GMFA ‘HT Training’).

In England, the old district health authorities have recently being by primary health care trusts (PCTs), which are supposed to be more responsive to local needs, although the most immediate impact appears to be a loss of ring‐fenced money for HIV prevention, treatment and care. For example, Brighton and Hove PCT recently decided to combine HIV, Sexual Health, Physical Disability and Learning Disability into a single commissioning post, without any consultation with its stakeholders (Best 2004).