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his short intervention builds upon research work I have been conducting in several European cities around (HIV-positive) gay migration as well as my personal experience with (bareback) sex, HIV-prevention, PrEP (Pre-Exposure Prophylaxis, i.e. the taking of a prescription drug to prevent HIV-infection), the rise of homonormativity and many other relevant topics most gay men of my age have routinely faced in Western Europe. As widely acknowledged by feminist and queer scholarship (e.g. Di Feliciantonio, Gadelha and DasGupta, 2017; Rose, 1997), I think positioning myself is a crucial preliminary step in underlining the political concerns driving this intervention. I grew up and lived for most of my life in Italy, a country characterized by a strong homophobic discourse and violence, my sexuality shaped by the hegemony of discourse around personal responsibility and being a ‘good gay’ to promote safe sex, thus avoiding the infamous association with HIV-AIDS. Since early 2016 I have lived in Ireland where, like Italy, PrEP is not available yet, although many people get it through informal channels or by buying it online. Both countries feature a universal free public health system that can be accessed by anyone (although cuts in the name of austerity have been severe), this being for me an extremely important political issue. So the concerns with some recent positions expressed by prominent queer theorists such as Paul Preciado (2013, 2015) and Tim Dean (2015) that I am going to discuss here need to be located in the experiences of a working class young gay man who has always needed to rely on public services (health, education) and for whom the desire for and practice of bareback sex was experienced as a kind of ‘evil’ provoking a deep sense of guilt (and it still does sometimes).

Since 2014 in my research on gay migration towards ‘gay Meccas’ (such as Barcelona and Berlin in Europe) I have started deepening the role of HIV-positivity in driving the decision to migrate, paying attention also to the role of PrEP in fighting HIV-related stigma, thus improving the everyday sexual experiences of HIV-positive people. I have been regularly collecting information on the popular Facebook page of the group “PrEP Facts: Rethinking HIV prevention and sex”, currently featuring more than 17000 members (May 2017). Through this page I have encountered hundreds of personal narratives highlighting the persistent moral panic around HIV-AIDS and the related sense of guilt when practicing bareback sex. Consider for instance the following ones:

Was with a couple guys and I just masturbated. One of the guys had his finger up inside another guy and then tried to insert in mine. Digital sex/fingering. I guess its called. Im scared of the risk factor even though im on prep and have taken it every day for month and half. Would some one be kind enough to educate me on this ? thanks so much. [..] What about rectal fluids? I still am having a hard time relaxing and being comfortable with sex while on prep (posted on February 2016)I have always know how important it is to protect myself. So I voluntarily abstain from sexual encounters of any kinds till now. I am in my early-mid 20s now. In my county 1 in 4 gay men is positive. But I feel like such abstinence gives me a lot of depression (posted on January 2017)

These statements give us a sense of how moral panic, anxiety and personal discomfort around HIV-AIDS are still widespread despite the great improvements in cures and HIV-positivity no longer representing a death sentence in medical terms. In defense of the role of PrEP as a possible tool to open new collective political possibilities centered around the re-appropriation of sex by gay men, the remainder of the intervention discusses two main critical points related to the work of Preciado and Dean around PrEP and the “pharmaco-capitalist” regime: (i) the possibility of breaking the process of subjectification as shaped by this regime; and (ii) the need to re-assign a central importance to the configuration of the welfare regime.

Following feminist scholarship on social reproduction and welfare regimes (e.g. Bakker, 2007; Brush, 2002; Katz, 2001), issues related to sexuality and health need to be included when examining the changing dynamics of social reproduction under late neoliberalism; in fact as argued by Katz, “social reproduction encompasses daily and long term reproduction, (...). At its most basic, it hinges upon the biological reproduction of the labor force, both generationally and on a daily basis, through the acquisition and distribution of he means of existence, including food, shelter, clothing and health care” (2001: 711). Given the increasing visibility and recognition gained by gay men in specific job markets (exemplified by the success of models and policies around ‘diversity,’ ‘tolerance,’ and ‘creativity’) and in the public sphere, it is not acceptable anymore to conceptualize social reproduction in heteronormative terms. If we follow the multifaceted definition of social reproduction provided by Bakker, the issues discussed in this intervention fit with the third ‘aspect’ of social reproduction, i.e. “the reproduction and provisioning of caring needs that may be wholly privatized within families and kinship networks or socialized to some degree through state support” (2007: 541). Referring to ‘welfare regimes’ as I do here aims therefore at accounting for the level of de-commodified services available in a specific country/city and how access to services is made possible. Like any other aspect of social and political life under neoliberalism, welfare systems have gradually changed towards a governmental model, autonomy and self-responsibilization becoming key-principles shaping subjectivities (e.g. Brown, 2006). Reflecting upon PrEP, bareback sex and the configuration of the welfare regime calls therefore into question the process of subject formation and the possibilities of rupture we envisage.

Sexuality, control and the shaping of subjectivity

The introduction and rapid diffusion of PrEP, offering the possibility of unprotected (‘bareback’) sex without the fear of getting HIV, is producing a massive return of ‘slut shaming’ discourses from those opposing bareback sex within gay communities. The return of these discourses is of increasing interest among scholars (e.g. Carlo Hojilla et al, 2016; Spieldenner, 2016). Prominent critical queer scholars such as Preciado and Dean have contributed to this debate building upon Preciado’s conceptualization of an emerging “pharmacopower” regime, originally introduced in Testo Junkie (2013) and furthered in Pornotopia (2014).

In Testo Junkie Preciado argued that the introduction and diffusion of the birth control pill during the mid-20th century marked a shift from a regime of control represented by the Foucauldian panopticon to a “pharmacopower” regime: power no longer relies on an external architecture but infiltrates and occupies the body (originally the female one) through molecules. This way we see how Foucauldian ‘biopower’ does not work only through the mechanisms of identification but also materially through the pharmaceutical substances we ingest.

According to Preciado the introduction of PrEP--notably the use of Truvada as prophylaxis against HIV--marks an extension of the “pharmacopower” logics to the male body (but he forgets that the pioneer studies on PrEP involved West-African women, see Peterson et al, 2007) and the management of HIV-AIDS (although he makes a similar argument for the previous introduction of Viagra). In an editorial published in the summer 2015 entitled “Free sex, but with drugs” Preciado attacks PrEP stating that “it is modifying your sexual ecology: where, when, how and with whom” (my translation). His main argument against PrEP builds a comparison with the biopolitical role played by the birth control pill; in fact he states that “the birth control pill and Truvada share the same way of functioning, they are chemical condoms aimed at preventing ¢risk¢ during sexual intercourse. It matters little if this risk is an unwanted pregnancy or HIV transmission” (ibid).

So, Preciado argues that like the pill, PrEP marks the shift towards a sexuality controlled by pharmaco-pornographic dispositifs, giving a sense of autonomy and sexual freedom to the user. In Preciado’s words, the main aim of PrEP is not “improving consumers” life but optimizing their exploitation, feeding the fiction about their freedom and emancipation” (ibid). The new process of subjectification occurs through these molecular technologies that the subject puts within their body under the illusion of living a ‘free’ sexuality.

Building on this work as well as Preciado’s previous work on the emergence of a bareback subculture that opposes the hegemony of homonormativity sanitizing sex (2009), Tim Dean has recently deepened this framework, although openly stating that he’s not advocating against PrEP (2015). In Dean’s analysis, Truvada/PrEP highlights the role of “pharmacopower” in shaping contemporary imageries around ‘raw’ and ‘bareback’ sex since “it promises to deliver on the magical idea of invisible condoms” (p. 239). In general terms this shows how

Our sex is hypermediated by technologies—pornographic as well as pharmaceutical—that give biopower full access to our bodies and their desires in the service of economic profit. Provoking our lust, this constellation of power relations operates by making us want it. Here, power works by prompting a libidinal investment that encourages us to feel our deepest satisfaction lies in embracing it. Far from imposed, it is desired (ibid; emphasis in original).

While I share some of Preciado and Dean’s concerns around the increasing role of technologies in shaping subjectivities and desires, I aim here to highlight two political concerns that I consider of primary importance when discussing about the introduction of PrEP: changes in sexual practices and the increasing diffusion of ‘bareback’ sex.

Which political horizons lead our efforts?

My first concern with such kinds of theorizations is around their reading of the process of Foucauldian subjectification, depicted as somehow inescapable and unidirectional, making subjectification synonymous with subjection. In this respect, they appear to me as heavily influenced by the Agambenian perspective; indeed, for the Italian philosopher (e.g. 1993, 1998) being subjects means being always subjected to multiple power relations, de-subjectification emerging as the only way to escape power relations (conceived for instance when theorizing the “whatever being”). As a queer activist engaged in different collectives and social movements, I find such a positioning deeply problematic in political terms, leading me to pose a series of important questions for a “world-making” politics (Muñoz, 2009):

Should we think the subjectifcation as inherently singular? Or completely inescapable? Is the only alternative represented by “de-subjectification” as in Agamben? What does it mean for queer politics under “pharmaco-capitalism”?

Taken together, Preciado and Dean’s reflections appear to me as a way to re-affirm death as the only way for the subject to break the process of subjectification, this being a serious political concern. In this respect, I’m close to Muñoz (2009) in the search of a queer utopia that has to be imagined and built collectively, so for me the political scope is to imagine how to build collective possibilities to reverse the process of subjectification involved by “pharmacopower,” starting from the tensions within any process of subjectification. To realize this I here stand with the recent contribution of certain post-workerist thought, notably the work of Judith Revel (e.g. 2015, 2016) who, in opposition to the Agambenian perspective on desubjectification, has shown how the tension between subjection and subjectification can be solved through the deconstruction of identity consisting in rejecting the idea of a unitary objectification as well as the idea of the subject as the product of a dialectical and infinite relation between subjection and “free” subjectification. In The Subject and Power (1982), Foucault defined such a process as agonism between power and freedom, between subjectivity through objectivation and autonomous subjectification. However it is important to remember that this process cannot lead to the erasure power since power can never be fully escaped. So this process leads to “building the selves as subjects” that materializes the counter-face of objectification within the process of subjectification. In the same work (1982), Foucault defined it as “invention of the self”, “transforming the chiasm of the process of subjectification in a way that the ¢new¢ subject cannot be anymore absorbed by the procedures of objectification” (Di Feliciantonio, 2016: 1211).

Highlighting the tensions inherent to the process of subject formation, and thus avoiding inescapable perspectives, is in line with the analytical and political effort to challenge binary understandings of social reproduction and highlight both contradictions and potentialities. In the case of PrEP, existing contradictions concern not just the role of biopower in shaping desires and conduits as highlighted by Dean and Preciado, but also the political economy of this drug, currently guaranteeing huge profits to the pharmaceutical company having the patent (even in those contexts where access to it is free for users). At the same time this approach offers the potential to think about the re-appropriation and the rediscovery of a new comfort about sex for gay men, achieved collectively thanks to the use of Truvada. To give an idea of the political importance of PrEP and the possibilities it opens, I here quote Bruno Maia, a well-known Portuguese activist (part of the Portuguese Pink Panthers). Maia has launched a public campaign supporting PreP. In an editorial explaining his choice he writes:

I’m from the 'condom generation'. (…) We grew up thinking about sex and AIDS, AIDS and sex, without separating them. (…) I’m from the 'condom generation' and this means that I’m one of those always perceiving sex as 'danger'. (…) I’m not iron-made nor always perfect. We do not get infected because we have several unprotected intercourses--we get infected because we have just one unprotected intercourse. Just one time is enough, a summer night or a drink. (…) This fear makes us vulnerable and steals us the full pleasure of an essential part of our lives: sex. (…) PrEP gives us back dignity and power over our bodies. (…) PreEP is a unique and personal responsibility so it gives as autonomy and self-determination over our choices. (…) I started getting PrEP because it represents a revolution in the sexual life of each of us. To end with fear, get autonomy and gain dignity (my translation).

Advocating for PrEP requires necessarily a critical reflection about the political economy of pharmaceutical transnational corporations and the management and cure of HIV-AIDS. In this respect, I think Preciado’s work is extremely important in critically questioning the ways our sexuality is shaped by “pharmacopower.” However as a leftist activist struggling for social justice, I think it is important to question how access to Truvada and HIV-AIDS cures works and to fight for improving their conditions of accessibility transnationally. Here stands my second main criticism with Preciado and Dean’s work: their complete lack of engagement with the question of accessibility and the configuration of the welfare regime. For me this a main political (and intellectual) priority: what are we advocating for? What is our aim when denouncing the mechanisms of “phamacopower”? Preciado and Dean’s political priorities remain difficult to understand and share for me because I do not find in their work a serious engagement with thinking the ways differential access to PrEP could reshape the sexual politics of homosexualities of the last decades built upon moral panic, HIV-fear and stigma. For me erasing the focus on the welfare regime and how access to PrEP works is a very risky political and theoretical choice because it leaves the subject more alone and isolated than ever, while also missing the opportunity to contribute to a more diverse, inclusive and non-heteronormative understanding of social reproduction.

To conclude I want to assert the need to include gay and queer sexuality in our framing of social reproduction since it questions hegemonic dichotomies such as private/public, normative/transgressive, healthy/sick. What if we conceptualize the act of taking PrEP as a form of social reproductive labor operating both individually and collectively? Individually it gives the subject the possibility of staying healthy and being part of the workforce, while empowering them in terms of sexual and personal comfort. Collectively it offers the possibility to reproduce communities of gay men that socialize and invent themselves through sexual practices, while challenging the stigmatization they have faced in the last decades. However these potentialities do not erase the need to denounce the speculation-driven character of the pharmaceutical industry and the role of patents in guaranteeing huge profits to transnational companies; indeed, like any other good or aspect of life under late neoliberalism, PrEP presents fundamental contradictions. However I think that as leftist queer activists we should engage and try to surf those contradictions, focusing on the possibilities of collective empowerment and subjectification based on the re-appropriation of our sexuality from biomedical discourse and moral censorship while continuing to denounce the inequalities and injustice raised by patents and the current configuration of the pharmaceutical industry. 

References

Agamben G (1993 [1990]) The Coming Community (trans M Hardt). Minneapolis: Minnesota University Press.

Agamben G (1998 [1995]) Homo Sacer: Sovereign Power and Bare Life (trans Heller-Roazen D). Stanford: Stanford University Press.

Bakker I (2007) Social Reproduction and the Constitution of a Gendered Political Economy. New Political Economy 12(4): 541-556.

Brown W (2006) Edgework: Critical Essays on Knowledge and Politics. Princeton: Princeton University Press.

Brush L D (2002) Changing the Subject: Gender and Welfare Regime Studies. Social Politics 9(2): 161-186.

Carlo Hojilla J et al (2016) Sexual Behavior, Risk Compensation, and HIV Prevention Strategies Among Participants in the San Francisco PrEP Demonstration Project: A Qualitative Analysis of Counseling Notes. AIDS and Behavior 20(7): 1461-1469.

Dean T (2009) Unlimited Intimacy: Reflections on the Subculture of Barebacking. Chicago: University of Chicago Press.

Dean T (2015) Mediated intimacies: raw sex, Truvada, and the biopolitics of chemoprophylaxis. Sexualities 18(1/2): 224-46.

Di Feliciantonio C (2016) Subjectification in times of indebtedness and neoliberal/austerity urbanism. Antipode 48(5): 1206-1227.

Di Feliciantonio C, Gadelha K B and DasGupta D (2017) Queer(y)ing Methodologies: doing fieldwork and becoming queer. Special issue of Gender, Place & Culture: A Journal of Feminist Geography 24(3).

Foucault M (1982) The subject and power. Critical Inquiry 8(4): 777–795.

Katz C (2001) Vagabond Capitalism and the Necessity of Social Reproduction. Antipode 33(4): 709-728.

Muñoz J E (2009) Cruising Utopia: The Then and There of Queer Futurity. New York: NYU Press.

Peterson L et al (2007) Tenofovir disoproxil fumarate for prevention of HIV infection in women: a phase 2, double-blind, randomized, placebo-controlled trial. PLoS Clin Trials 2007;2(5): e27.

Preciado B (2013) Testo Junkie: Sex, Drugs, and Biopolitics. New York: Feminist Press.

Preciado B (2014) Pornotopia. An Essay on Playboy’s Architecture and Biopoliitcs. New York: Zone Books/MIT Press.

Preciado P (2015). Condoms chimiques, Libération 11(06).

Revel J (2015) L’Italian Theory e le sue differenze. In: Gentili D and Stimilli E (eds) Differenze italiane: Politica e filosofia: mappe e sconfinamenti. Rome: Derive Approdi, pp 47-58.

Revel J (2016) Between ethics and politics: the question of subjectivation. In Cremonesi L,  Irrera O, Lorenzini D and Tazzioli M (eds) Foucault and the Making of Subjects. London: Rowman & Littlefield, pp 163-174.

Rose G (1997) Situated Knowledges: Positionality, Reflexivity and Other Tactics. Progress in Human Geography 21(3): 305–320.

Spieldenner A (2016) PrEP Whores and HIV Prevention: The Queer Communication of HIV Pre-Exposure Prophylaxis. Journal of Homosexuality 63(12): 1685-1697.