The causal explanations for sexual risk-taking among gays are numerous, but the diversity of their conceptions of risk is often left in the shadows. Using a comprehensive approach, Gabriel Girard shows that the relationship between individuals and the homosexual community is a key to understanding their sexuality.
The enigma of maintaining risky practices among gays
At first glance, Gabriel Girard’s book may be disconcerting. It is not, as its title suggests, another book on risk factors followed by advice for a more effective prevention policy, a sort of manual of good conduct. From the outset, the author tells us of his ambition: to try to lift the veil on the enigma which has continued to haunt the history of prevention of HIV towards men who have sexual relations with other men: how is it that generally well-informed individuals, in the movement of a “ community » which could be described as exemplary, continue to behave in ways which expose them to risks of contamination by the HIV ? Over the years, the evidence of “ failures » widespread enough for contamination in the community to remain significant and even increase. Expert reports, political intervention, creation of an associative network, consultations, controversies, research into social, community, psychological risk factors, general or targeted prevention campaigns, field actions: nothing helps. Year after year, the results of prevalence surveys are cruelly repeated: the transmission of HIV continues at a high level among men who have sex with men.
In the 2000s, the assertion of intentionally unprotected conduct (“ bareback “) shakes up the debate. This statement undermines one of the foundations of the explanatory diagram of the high level of contamination among men who have sexual relations with other men. ; risk-taking cannot be reduced to occasional breaches of the norm (individual failures or inconsistent behavior of vulnerable groups on the margins of the community). The unthinkable imposes itself: there exists, at the very heart of the community, a group of gays who loudly proclaim their decision not to protect themselves during sexual practices recognized as risky.
Gabriel Girard draws on the controversy aroused by the asserted intentionality of risk-taking to question the enigma, still relevant today, of its high prevalence. Despite the arrival of effective treatments which have shaken up the standards of prevention, the fact remains that men who have sexual relations with other men still remain very exposed to contamination by the HIV. According to the latest report from the Weekly Epidemiological Bulletin (n° 9-10, 1er April 2014), it is even the only group in which the number of discoveries increases: +14% between 2011 and 2012.
On this widely explored, highly politicized and emotionally charged issue, Gabriel Girard constructs an original proposition.
Starting from controversies
To do this, it adopts a methodological position of humility in the face of the reality and complexity of individual reactions to risks. Starting from the observation of the instability and heterogeneity of “ moral economies “, he adopts “ a careful and critical positioning » vis-à-vis the controversies and methods of explaining prevention. He is wary of the panoply of explanatory factors in use. To the individualization, the normalization of homosexuality, the chronicization of HIVthe medicalization of sexuality, etc., hypotheses that he judges “ overhanging and homogenizing », he prefers the diversity of realities that he collects during interviews ; it rejects any preconceived definition of risk, “ in order to allow the interviewee’s conceptions of risk to emerge “.
But before honoring his project, he must take a long historical detour in order to distance the terms of the debates already examined. In the first part, the author relates in detail the emergence and evolution of controversies over AIDS prevention for gays. To do this, it examines the emergence and structuring of homosexual mobilization, the succession and spirit of the public policies implemented, the genesis of a prevention problem and the controversies which ensued until the arrival of the bareback », emblematic figure of the risk which brings the dispute to its climax and highlights the limits of the power of persuasion of public and associative actions. This highly publicized, yet minority, conflict over the existence of intentionally unprotected sexual behavior has the unforeseen consequence of making the reality of sexual practices without condoms among gays speakable and visible. A new controversy is being organized around community remobilization on the injunctive register of the reminder of the norm of condom use (promoted by Act-up) versus a so-called risk reduction communication (supported by Aides) which acknowledges the existence of unprotected practices and proposes, in this case, based on a hierarchy of risks, a range of conduct which, without eliminating it, minimizes the risk incurred.
Relationship with the community and perception of risk
The second, briefer part considers the influence of groups on the principles of action of individuals. What group, what community ? As everyone knows, the answer is far from obvious. The author shows the diversity and importance of community conceptions on the social constructions of homosexuality and gay identity. Moving from the group to the individual, he is interested in the feeling of belonging or distance to the community. He does not forget to underline the influence of community visions on the definition of prevention policies and therefore, ultimately, on the content and implicit morality of the messages developed towards gays. The author ends this overview with the presentation of the cultural analysis developed by Mary Douglas, which will serve as an analytical framework for her interviews. This approach proposes “ an alternative reading to a monolithic vision of human rationality: the understanding of individuals’ “good reasons” for acting is inscribed in social contexts. »
After this well-documented presentation on public controversies and conceptions of risk and prevention, the definitions of the individual characterized by a stigmatized minority sexuality and of his reference group, Gabriel Girard approaches the study of ordinary experiences of risk and shows how the perception of risk is shaped among the gays he interviewed. Whether it is about the construction of attitudes around a high risk (unprotected anal penetration) or, on the contrary, a low risk (unprotected fellatio), it highlights the tensions between the conceptions of “ self » of the individual and those of the “ We » preventive. This point of view allows him to describe fragmentary appropriations of information from expertise and the limits of the power of persuasion of community associations.
Through a detailed analysis of the interviews, the author shows that the perception of risk is a complex process which links the action of the individual with a mixture of knowledge resulting from expertise and experience. . Careful examination of the stories allows him to account for behavior that could be described as “ inconsistent » with regard to the precepts of risk prevention of HIV. This deconstruction sheds light on the way in which, based on the diversity of their trajectory and their experience of homosexuality, individuals develop their perception of risk. How gays, generally well informed, construct such diverse and contradictory responses from the same body of information.
In conclusion, although this book does not offer a condensed answer to the question of why the epidemiological category “ men who have sex with other men », maintains, within it, a high level of prevalence of HIVit leads us to take a more understanding look at the permanence of risky behavior within this group. The historical presentation of the doctrines that have clashed since the start of the epidemic highlights the limits of globalizing explanations. In addition to the difficulties and resistance that governed the definition of risk categories, public intervention and community action, there are complex interactions with the individual, their trajectory and their experience of homosexuality. These interactions are all the more delicate as it involves implementing behaviors to avoid a risk that affects the very private domain of minority sexuality involving, too often still, the experience of violence and homophobic insults.
In the current situation of emergence of new forms of epidemic, reading this book will be useful to appreciate the limits of an expertise which neglects the interaction between the global and the singular. As Gabriel Girard shows, the appropriation by individuals of expert knowledge, public and community preventive policy and the precepts of “ good behavior » that it implies, is far from being homogeneous and unambiguous.