This is my post for Bloggers Unite for World AIDS Day. It’s sponsored by AIDS.gov and BlogCatalog. A bunch of folks around the world are blogging about HIV and AIDS. My addition is a paper I gave last week in San Francisco about HIV, the Internet, and identity in San Diego.
If you were following my Twitters and/or my Facebook updates, you know that the weekend before Thanksgiving I was in San Francisco for the American Anthropology Association’s annual meetings. It is always wonderful to be in San Francisco, but I was so excited to be there, I tried to do too much, see too many people, have too much fun, and do what I was there to do: attend the darn meetings. And I ended up tired and cranky a lot of the time. Very tired. Very cranky. And then, on Thanksgiving morning, I woke up with a karma-rific cold. Still, I got one the best haicuts of my life from Joe, had an amazing dinner with Tom, had a couple beers with Mike, had an awesome dinner with Chia-Ning, went dancing here with Kevin, had several beers with a cheerful Jeff and several more with my fellow former New Yorker John. And I got to hang out with my sister-in-law Laura, who was also in town for a conference and with whom I shared a couple hotels rooms. (I stayed in three hotels in San Francisco that week. The Marriott is over-priced but damn nice. The Carlton is adorable and delightful. The Pickwick is a pit of despair.) Oh, yeah. And I did some anthropology-related things as well. I didn’t go to as many panels as I should have, but I networked up the wazoo, and ultimately, that will probably be more worthwhile.
And I gave a paper at a panel I organized with my friend Cage. The panel was called “Identities in the Clinic: conflicts, tensions, and critiques of self-concepts.” Here is the panel abstract:
Since Mauss’s essay on the person and Hallowell’s analysis of the self in its behavioral environment, anthropologists have attended to various ways in which certain kinds of social statuses and self-concepts organize social structure, perception, motivation, and action. In recent years, however, despite a new proliferation of articles on hybrid, fluid, or cyborg identities, and the play and tension of subaltern identities, much of this analysis remains at the level of the political and symbolic. The papers in this panel seek to ground and critique current ideas of identity and self, to elucidate the processes of identity as commitment to certain ways of being and certain moral ideals, as well as certain ways of perceiving, attributing, and interpreting signs of health, illness, sentiment, and morality, particularly as applied to issues of mental and bodily health, through explicitly psychological models. The papers herein examine the ways in which patients and health care providers negotiate conflicting identities: as agents of the state, as “systems based providers”, as documented/undocumented, as members of sexual or ethnic minorities, as simultaneously physician and scientist, or as a person with an illness negotiating multiple epistemological orientations in religious and cultural identities.
Could you be more excited? I didn’t think so.
For my World AIDS Days Bloggers Unite post, I’ve pasted the paper below the jump. It’s very much a working paper, and it should be treated as such.
“If you don’t like the fact that I am POZ, hold on and I’ll change profiles”¹: Identifying as HIV+ on the Internet in San Diego
Unlike the rest of this panel, I have not yet begun my formal fieldwork. So, this morning I will be sharing with you my observations from my pre-field research. I am planning on studying the subjectivities of gay men targeted by public health campaigns in the San Diego area, focusing on discourses of risk and rationality. Conveniently, as I am a grad student in my fourth year at UC-San Diego, I have been living in my field site for some time. Today, I would like to talk specifically about a key issue in my field site, which is how HIV+ gay men in San Diego self-identify on the Internet and the roles that competing political and medical discourses seem to have in these identity constructions.
First, let me share an anecdote: On Election Day, I was passing out fliers at a polling place in San Diego with a young gay man named Patrick. We were discussing Prop 8, the gay marriage ban that we were trying to stop. After he told me that a co-worker of his had married his partner of 20 years, Patrick said, “They got together before the Internet. How did they meet? With queer carrier pigeons?” We laughed, not only because the time before the Internet seems like ancient history but also because the Internet has become the taken-for-granted mediator of gay sex and romance.
In much of the industrialized world, and especially in the United States and Western Europe, the locus of gay culture is no longer the gay bar; it is the Internet, specifically gay chat sites like Manhunt, Adam4Adam, gay.com, and gaydar.net. In cities like Boston, Tampa Bay, and San Diego, the Internet has been blamed for the mass closings of bars. At any given moment, the number of people in San Diego logged onto gay chat sites is at least the capacity of all of the gay bars in the county combined. At 6 pm on a recent Sunday, there were 1854 people in San Diego logged on Adam4Adam, 182 on Manhunt, and 125 on gay.com. The increasing importance of the Internet in gay culture occurred simultaneously with the transition – in the US and Western Europe at least – to the post-crisis era of the AIDS epidemic, as new drugs allowed the HIV+ to live longer, if not full, lives. However, as HIV/AIDS shifted from the modern leprosy to a postmodern condition, it nevertheless kept its stigma – a problematic, no longer agreed-upon stigma, but a stigma nonetheless.
What does this have to do with identity? Let me give you my theoretical position: As Hallowell theorized in the middle of the last century, the self is a product of the behavioral environment. We maintain our self-awareness through basic orientations to the world. He listed five such orientations, but of particular concern for me here is “normative orientation.” “Values, ideals, and standards are intrinsic compounds of all cultures,” Hallowell wrote. “Without normative orientation, self-awareness in man could not function in one of its most characteristic forms – self-appraisal of conduct… The outcome of this appraisal is, in turn, related to attitudes of self-esteem or self-respect and to the appraisal of others” (1955: 105-6). The problem for HIV+ gay men in San Diego – and in much of the United States – is that what normative is, to say the least, contested.
Love, desire, and sexuality are central concerns for gay men and for building gay male identities, and, as Foucault so clearly showed, even such intangibles are socially and historically constructed through complex power relations. When the Goods wrote about the political ethos, they pointed out that “the state, along with other modern social structures … play a profound role in organizing emotional life and in defining legitimate interpretations of affective behaviors” (1988: 59). The Goods wrote this in reference to discourses of grieving in totalitarian Iran. There was very little resistance. In the contemporary United States, there are (at least) five competing discourses concerning the right way to be a gay man – to love, desire, and have sex.
1. Since before Stonewall, the leadership of the gay community has tried to define and dictate the correct affective behavior for gay men in order to make the community more palatable and politically acceptable to heterosexual America. Especially after AIDS threw gay sexual practices into relief, gay leaders – in politics and the media – have carefully crafted a discourse about the gay community that presents gays and lesbians as stable, family-oriented simulacra of “American Gothic.” The No on 8 campaign’s website is a good example of this, as the images roundly depict middle and upper-middle class gay and lesbian couples as smiling widely and “looking like everyone else.” [Slide 4]
2. The reach of biomedicine is now broader and deeper than ever before, and the expanded use of surveillance, testing, and risk identifiers, in addition to the enormous commodification and valuation of health, has produced new biologically defined segments of society – creating, in the gay community, two opposing groups, the HIV+ and the HIV-. And the state has been deeply involved in this process through public health communication. Many of these new identities are self-defined through “technologies of the self,” or self-governance (Clarke, et al. 2003: 165). Since the advent of AIDS, federal and state agencies and NGOs have been trumpeting responsible sexual behavior, equating morality with safe and safer sex, rational choices, and monogamy. This past spring, for instance, California covered gay neighborhoods in the state with billboards, posters, and even coasters that showed strung out – if handsome — men saying, “I lost me to meth.” The message was clear: Using meth will take away your identity and your dignity and it will give you HIV.
3. Meanwhile, the medical imaginary has produced new ideas about truth and science, all of which intensify our progress-based opinion of medicine. “Enthusiasm for medicine’s possibilities arises not necessarily from material products with therapeutic efficacy,” Mary-Jo Good writes, “but through the production of ideas with potential but as-yet-proven therapeutic efficacy” (M.-J. D. Good 2007: 367). The experience of medical positivism seems to erase, or ease, the interior moral battles of health seeking. There is no conflict, just a desire to be healthy and a belief that medicine can do anything. Good calls this the “biotechnical embrace.” This embrace is clear not only in the belief that being HIV+ is no longer “a big deal,” but also in the discourse of HIV medications. The ads for Atripla, say “Atripla can help you stay on top of your HIV” – you can control this virus.
4. Running counter to these discourses of medical rationality and responsible citizenship is the discourse of sexual freedom – some would say hedonism – that was central to the gay movement from Stonewall to the beginning of the AIDS epidemic, and which remains deeply important, if politically problematic, today. The gay community often describes itself as responsible, subdued, and even boring to the voting (and discriminating) public. But in their ghettoes, in their own media, and in their own cultural products, gay male discourse is focused greatly on sex and pleasure.
5. Meanwhile, conservative, religiously oriented communities promote a discourse that describes homosexuality as a disease, contrary to Christianity, and a threat to traditional ways of life. This discourse is so strong and pervasive that the discourse of sexual freedom is dampened and the discourse of the gay “American Gothic” is hyped as counter measures. Those opposed to same-sex marriage in California had an official argument based in traditional, historically based definition of marriage and an unofficial argument based on disease, on the idea that homosexuality is a social contagion.
HIV has become a convenient pivot for these discourses. And I’m using “pivot” in the Vygotskian sense. Holland and her colleagues have pointed to one of Vygotsky’s late essays, in which he described how children, for the purpose of play, suspend the standard, everyday meaning of objects and ascribe different meaning to them (Holland, et al. 1998: 50), making the objects mnemonics for other behavior and other ideas. An object then becomes a “pivot,” which the child uses as a mediating device to transport himself into the play world. As the child grows older, the object may not be needed to enter the imaginary world, and games become less fantastical and more serious. But being able to travel to the land of make-believe is still needed to “play” in the culturally figured worlds of that people of like identities create. Figured worlds are not only thoroughly imagined (with roles given, defined, narrativized, and embodied), but also constantly practiced. All of this is done within structures of power and position that Bourdieu referred to as a “field of power” or “structure-in-practice” (58). The field is basically a game—it is performed, practiced, and played by better and worse players—and that is why Bourdieu referred to the habitus (see below) as the “feel for the game” (Bourdieu 1990 : 67). Every game has rules and game pieces, the latter of which Holland and her colleagues refer to as “artifacts”—or to use Vygotskian terminology, they are pivots. Declaring their HIV status, declaring their feelings about HIV and sexual practices – as gay chat sites ask gay men to do – pivots gay men into different figured worlds with specific morals and ethics and ways of self-presentation.
So, let’s look a few of the sites. Adam4Adam is more popular in San Diego than the other gay sites, probably because it is free. Manhunt charges for full access, but it offers more search options, so it is quite popular, especially in San Francisco, Los Angeles, Chicago, and New York. Like mainstream heterosexual dating sites such as Match.com, gay chat sites ask for standard information about physical looks. But the gay sites eschew questions about education, desire for children, or religion. Instead they ask about fetishes, role preference, and HIV status. Most men say they are negative.
A great many men on these sites do not list their HIV status or have “Ask me” as their answer to the question. While some negative men do this for political purposes – standing in solidarity against the question and therefore the stigma – it is assumed that most are positive men who want to better their chances at attracting men. They do not want to stigmatized by their status, do not want to be seen as irresponsible, diseased, or representative of a group of politically problematic gay men. However, negative men who are adamant about only dating or having sex with other negative men often say they know that not listing your status means that you are positive. Recently, I was at bar with a friend who holds such a position. I pointed out one man I thought was Charlie’s type. Charlie responded, “Oh, no. Not him. On Adam4Adam, he doesn’t say he’s negative. So, he’s positive.”
Most members click on their HIV status and click on whether or not they practice safe sex, but they do not expand further. Like other sites, the gay sites offer a free-form space, where the members can describe themselves or their desires in their own words. It is here that simple clickable categories are fully fleshed out. Many HIV+ members do offer details about what their status means to them. Many of these men are explicitly hedonistic, focusing their profiles on bareback, or condom-less, sexual practices. They clearly state that they only want to have sex with other positive men; if they do not state that they are looking only for positive men, if their profiles say “positive” and “anything goes” under whether they practice safe sex, their preferences are signaled to other members. In the sexual explicitness of their wording and, often, their pictures, these profiles seem only to communicate the sexual freedom discourse. It is as if they are saying, “I’m positive already, so I’m going to do whatever I want!” However, in clearly communicating that they self-quarantining in their sexual behaviors –known as “sero-sorting” – these profiles are also communicating that these men are responsible and respectable hedonists.
Some are still wary about non-HIV STDS. One man, who says that he is “Mostly as insatiable bottom, but into anything that feels good,” also says, “Yes, safe only – just because I’m positive doesn’t mean I want the clap…”
The HIV+ men who are equally or more focused on romance as they are on sex describe themselves and their desires in complex ways that mix the discourses that I mentioned earlier. That is especially the case when the man is advertising his whole self, not just his sexual self. Some will say they “are not into hookups,” describe themselves as “balanced” or “honest,” have “old fashioned values,” are “striving to be a better person,” and are “Lookin’ for a more than a fare-weather Friend.” Some are defensive about their status and its cultural meaning
One man says, “I’m also POSITIVE. While being on here [Adam4Adam] I’ve met some pretty intolerant people…all because I’m POSITIVE doesn’t mean my good taste is gone.” One man writes, “If you don’t like the fact that I am POZ, hold on and I’ll change profiles.” Another says, “I’m positive – being 100% comfortable with it is a must.”
And another says that he is “Looking for other HIV enhanced or HIV+ friendly, courageous MEN who don’t let fear rule over them, ye who aspire to lead powerfully positive-minded lived with open-minded people.” Positive men will often point out that they are “POZ and healthy,” often mentioning that they are “undetectable,” meaning that their viral load is so low as to be unobservable in tests.
(On the other side, some negative men will say that they are “poz friendly,” but only if the poz man is healthy. One says, “Poz-friendly, but not stupid :).”)
HIV+ men are particularly rich subjects for studying what Claudia Strauss calls “cognitive heteroglossia,” or “multiple, often conflicting points of view” (1990: 315). The conflicting discourses of gayness in contemporary United States are leading to confusing, competing schemas. Strauss points out that in such situations – she was studying political discourses among working class men in Rhode Island – the schemas are not always contained in logical or healthy ways. Often the schemas are cognately separated, leading actors to espouse different, often contradictory beliefs in different situations. Rarer are integrated beliefs, which, Strauss writes, “are internalized in a single schema, or set of closely connected schemas, rather than in compartmentalized, distinct ones. They are equally easy (or difficult) to articulate and are expressed in a single consistent voice” (315). How, why, and in what form these discourse become self-schemas, and how they are contained and integrated, will be among the central questions of my research. How do these discourses affect (or infect) the identities, subjectivities, and mental health of gay men in San Diego? As I will be starting my fieldwork in the spring, any comments and suggestions from the panel and the audience would be greatly appreciated.
- Bourdieu, Pierre. The Logic of Practice. Palo Alto, CA: Stanford University Press, 1990 .
- Clarke, Adele E., Janet K. Shim, Laura Mamo, and Jennifer Ruth Fosk. “Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine.” American Sociological Review 68, no. 2 (April 2003): 161-194.
- Davis, Mark, Graham Hart, Graham Bolding, Lorraine Sherr, and Jonathan Elford. “E-dating, identity and HIV prevention: theorising sexualities, risk and network society.” Sociology of Health & Illness 28, no. 4 (2006): 457-78.
- Good, Mary-Jo Delvecchio. “The Medical Imaginary and the Biotechnical Embrace.” In Subjectivity: Ethnographic Investigations, edited by Joao Biehl, Byron Good and Arthur Kleinman, 364-377. Berkeley: University of California Press, 2007.
- Good, Mary-Jo Delvecchio, and Byron Good. “Ritual, the State, and the Transformation of Emotional Discourse in Iranian Society.” Culture, Medicine, and Psychiatry 12 (1988): 43-63.
- Hallowell, Irving. Culture and Experience. Philadelphia: University of Pennsylvania Press, 1955.
- Holland, Dorothy, Debra Skinner, William Lachicotte, and Carole Cain. Identity and Agency in Cultural Worlds. Cambridge, MA: Harvard University Press, 1998.
- Strauss, Claudia. “Who Gets Ahead? Cognitive Responses to Heteroglossia in American Political Culture.” American Ethnologist 17, no. 2 (1990): 312-28.
¹ All quotes and screen grabs here come from sites — and pages therein — accessible to the general public.