Culture as an Object of Ethical Governance in Aids Prevention

Bibliographic Data

ID7433146
AuthorsAdam M Geary (corresponding author)
Year2007
Volume21
Issue4-5
Pages672-694
Publication date2007-06-19
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueCultural Studies (JOURNAL)
Journal identifiersISSN: 0950-2386 • E-ISSN: 1466-4348
PublisherRoutledge (PUBLISHER • GB)
DOI10.1080/09502380701279028
OpenAlexW1977701194
LanguageEN
Citations received9
References cited41

This paper analyses AIDS-prevention therapeutics as ethical technologies of governance relative to the experience of culture. As a number of AIDS scholars have noted, the concept of ‘culture’ has been a powerful rubric for organizing evidence about HIV-transmission behaviours and their modification in prevention research and programming. Indeed, culture has been one of the most important concepts in AIDS-prevention knowledge through which danger is problematized, or organized as a specific problem that can be entered into strategies and techniques of governance and reform. This is to say that ‘culture’ functions in AIDS prevention as an object and target of government, toward which instruments, knowledges, and programmes are directed with the goal of transforming the behaviours and meanings said to put individuals at risk for HIV transmission. I argue that culture is experienced in prevention therapeutics as an element of the self toward which one is to form oneself as an active and ethical subject of one's own health. In AIDS-prevention pedagogies, individuals encounter ‘culture’ as a potentially dangerous element of the self, a force or drive within oneself that will overwhelm one's free and responsible decision-making capacity unless one forms a deliberate and authoritative relationship to it. These pedagogies cultivate in subjects techniques for constituting an authoritative relationship to culture, seeking to guarantee responsible behaviour and decision-making about HIV risk by constituting individuals as authoritative subjects of their cultures. As such, AIDS prevention is best understood as what Foucault called an ‘ethical’ governing strategy that forms individuals as active and responsible subjects of their cultures. Keywords: AIDSculture/theory ofgovernmentalityethical governancetherapeutic educationself-relation Acknowledgements My thanks to the following people for comments and suggestions on earlier versions of this article: Teresa de Lauretis, Steve Johnstone, Karen Kim, Marcos Becquer, and members of the History and Gender dissertation group at the University of Arizona. Notes 1. Parker (2001 Parker , Richard ( 2001 ) ‘Sexuality, culture, and power in HIV/AIDS research’ , Annual Review of Anthropology , vol. 30 , pp. 163 – 79 .[Crossref], [Web of Science ®] , [Google Scholar]) argues that the concept of culture is being superceded by a less unified analysis of power relations in AIDS ethnography (paralleling the dissolution of the concept more broadly in the discipline of anthropology [cf. Helmreich 2001 Helmreich , Stefan ( 2001 ) ‘After culture: Reflections on the apparition of anthropology in artificial life, a science of simulation’ , Cultural Anthropology , vol. 16 , no. 4 , pp. 612 – 627 .[Crossref], [Web of Science ®] , [Google Scholar]]). My sense, however, is that while this may be true in ethnographic research, it is decidedly less so in primary prevention programming. On the uneven linkages between ethnographic or epidemiological knowledge and prevention programming, see esp. Schiller (1992 Schiller , Nina Glick ( 1992 ) ‘What's wrong with this picture? The hegemonic construction of culture in AIDS research in the United States’ , Medical Anthropology Quarterly , vol. 6 , no. 3 , pp. 237 – 254 .[Crossref] , [Google Scholar]). 2. See Hacking (1983 Hacking , Ian ( 1983 ) Representing and intervening: Introductory topics in the philosophy of natural science , Cambridge , Cambridge University Press .[Crossref] , [Google Scholar]) on the epistemological priority of intervention and problem-solving for scientific representation and theory-building. 3. I was introduced to Strathern's text only after having completed the research and analysis of this article and was encouraged to note the many moments that my conclusions echoed her reading of the contemporary experience of culture, though her analysis is conducted at a level of greater abstraction. I have attempted to weave her analysis into this text primarily where it provides conceptual or rhetorical clarity. 4. These questions re-phrase the four analytical categories that Foucault (1990/84, pp. 26–28) proposed for describing specific ethical formations: (a) the ethical substance is that part of the self about which one will focus one's concern; (b) the mode of subjection is the manner in which one understands oneself to be obliged to submit to the ethical programme; (c) the ethical practices are the work one undertakes on oneself in order to form or transform oneself; and (d) the telos is the goal or subject-formation one hopes to attain. 5. On the problematization of governing as a question of freeing the active-ness and self-interest of individuals, see Rose (1996 Rose , Nikolas ( 1996 ) ‘Governing ‘advanced’ liberal democracies’ , in Foucault and political reason: Liberalism, neo-liberalism and rationalities of government Andrew Barry , Thomas Osborne and Nikolas Rose , Chicago , University of Chicago Press , pp. 37 – 64 . [Google Scholar]). 6. See the tiered, structural analysis of risk in Soskolne and Shtarkshall (2002 Soskolne , Varda & Shtarkshall , Ronny A. ( 2002 ) ‘Migration and HIV prevention programmes: linking structural factors, culture, and individual behaviour – an Israeli experience’ , Social Science and Medicine , vol. 55 , pp. 1297 – 1307 .[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), esp. as they organize the analysis into a chart on p. 1298. 7. For an excellent analysis of ‘negotiated safety’ among gay men as an ‘ethic’ in the Foucauldian sense, see Race (2003 Race , Kane D. ( 2003 ) ‘Revaluation of risk among gay men’ , AIDS Education and Prevention , vol. 15 , no. 4 , pp. 369 – 381 .[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). 8. Adkins (2002a Adkins , Lisa ( 2002a ) ‘Reflexivity, risk and the (neo-liberal) politics of sexuality’ , in Revisions: Gender and sexuality in late modernity , Buckingham and Philadelphia : Open University Press , pp. 103 – 123 . [Google Scholar]) argues that the ‘responsibility’ of the general public is not stabilized by the discursive division between it and ‘irresponsible’ Others (e.g., gay men, inner-city youth, prostitutes). She uses the phenomenon of repeat HIV testing among low-risk heterosexuals as a case study for arguing that responsibility is established performatively through ethical practices. Adkins argues that repeat HIV testing among low-risk heterosexuals, rather than being motivated primarily by confirmation of HIV status, is enacted as a performance of responsible self-care. One can see, however, how the undefined norm of responsibility in AIDS-prevention public health (and more broadly) provided a new line of attack in the discourse on ‘drug use’, as well as a justification for the confused pathologization of ‘promiscuity’. Drugs do not need to be dangerous to the body to be dangerous to the self, because they interrupt responsible self-formation. Contemporary anti-marijuana commercials make it clear that its primary danger is to responsible and controlled decision-making, which the commercials collapse together rhetorically with physical danger. The continued pathologization of ‘promiscuity’ also rests on the equation of health and danger with responsible decision-making. One might engage in safer sex practices with many partners, but the very fact of ‘being promiscuous’ already marks one as irresponsible, and therefore a danger to yourself and others. These two lines of attack have been directed at gay men for nearly twenty-five years (Bolton 1992 Bolton , Robert ( 1992 ) ‘AIDS and promiscuity: Muddles in the models of HIV prevention’ , Medical Anthropology , vol. 14 , nos. 2–4 , pp. 145 – 223 .[Taylor & Francis Online] , [Google Scholar], Vandenbroucke 1989 Vandenbroucke, J. P. 1989. ‘An autopsy of epidemiological methods: The case of ‘poppers’ in the early years of the acquired immune deficiency syndrome (AIDS)’. American Journal of Epidemiology, 129(3): 455–457. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]); intersect with and reinforce the pathologization of poverty, especially in its racialized form (Cohen 1999 Cohen , Cathy J . ( 1999 ) The boundaries of blackness: AIDS and the breakdown of black politics , Chicago , University of Chicago Press .[Crossref] , [Google Scholar]); and increasingly define the regulation of adolescence carried out under the banner of AIDS prevention (Patton 1996 Patton , Cindy ( 1996 ) Fatal advice: How safe-sex education went wrong , Durham , Duke University Press .[Crossref] , [Google Scholar]). 9. Abstinence education would be the most visible example. For instance, Emenike (1997 Emenike , Ifeanyi ( 1997 ) ‘Sexual abstinence: A viable option for young adolescents in HIV/AIDS prevention’ , in Confronting the AIDS epidemic: Cross-cultural perspectives on HIV/AIDS education . Davidson C. Umeh , Trenton, NJ and Asmara, Eritrea , Africa World Press, Inc., pp. 317 – 327 . [Google Scholar]) argues that abstinence education is a far more effective alternative for AIDS prevention among adolescents than disease prevention through condom promotion. He states, ‘abstinence education may be a very wise choice; it protects [young people] from the dangers of situations in which they may lose sexual control, and it guarantees that they will indeed have many years in the future for safe and fulfilling sex’ (p. 325). How abstinence education can guarantee these future years or fulfilling sex is not discussed. 10. H. Epstein (2003 Epstein , Helen ( 2003 ) ‘AIDS in South Africa: The invisible cure’ , The New York Review of Books , 17 July , pp. 44 – 49 . [Google Scholar]) describes ‘loveLife’, a programme for South African youth that is supposedly dedicated to AIDS prevention but does not discuss any form of prevention, or even AIDS. It focuses, instead, on developing ‘a positive lifestyle’ and positive visions of the future. 11. Uganda's ‘A.B.C’. approach has been extremely fashionable, especially among conservative, U.S. commentators (Rosenberg 2003 Rosenberg , Tina ( 2003 ) ‘On capitol hill, ideology is distorting an AIDS success in Africa’ , The New York Times , 29 April , A30 .[PubMed] , [Google Scholar], H. Epstein 2005 Epstein , Helen ( 2005 ) ‘God and the fight against AIDS’ , The New York Review of Books , 28 April , pp. 47 – 51 . [Google Scholar]). The programme is organized by a very Pauline morality in which the people of Uganda are encouraged first to practice abstinence; barring abstinence, to have monogamous sex within marriage; and if all else fails, to use a condom. H. Epstein (2005 Epstein , Helen ( 2005 ) ‘God and the fight against AIDS’ , The New York Review of Books , 28 April , pp. 47 – 51 . [Google Scholar]) argues, very persuasively, that the A.B.C. programme actually represents the dismantling of the prior, successful, ‘No Grazing’ policy in Uganda, which worked within the local tradition of concurrent, polygamous relationships. 12. My focus on the instrumentalization of ‘culture’ challenges the trend in certain forms of cultural critique to treat epidemiological knowledge as representative of scientific, AIDS discourses (cf. Singer 1994 Singer , Merrill ( 1994 ) ‘AIDS and the health crisis of the U.S. urban poor: the perspective of critical medical anthropology’ , Social Science and Medicine , vol. 39 , no. 7 , pp. 931 – 948 .[Crossref], [PubMed], [Web of Science ®] , [Google Scholar], Schiller 1992 Schiller , Nina Glick ( 1992 ) ‘What's wrong with this picture? The hegemonic construction of culture in AIDS research in the United States’ , Medical Anthropology Quarterly , vol. 6 , no. 3 , pp. 237 – 254 .[Crossref] , [Google Scholar], Kane 1991 Kane, S. 1991. ‘HIV, heroin and heterosexual relations’. Social Science and Medicine, 32: 1037–1050. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar], Vandenbroucke 1989 Vandenbroucke, J. P. 1989. ‘An autopsy of epidemiological methods: The case of ‘poppers’ in the early years of the acquired immune deficiency syndrome (AIDS)’. American Journal of Epidemiology, 129(3): 455–457. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Although I will not examine it in detail, I suggest that this position is both analytically inadequate and misleading. Not only has scientific knowledge about HIV, risk, and transmission emerged from multiple discursive locations (not all of which are officially scientific [S. Epstein 1996 Epstein , Steven ( 1996 ) Impure science: AIDS, activism, and the politics of knowledge , Berkeley, Los Angeles and London , University of California Press . [Google Scholar]]), but conceptual categories have not translated directly across discursive domains. This is very evidently true in the case of ‘culture’ (Schiller 1992 Schiller , Nina Glick ( 1992 ) ‘What's wrong with this picture? The hegemonic construction of culture in AIDS research in the United States’ , Medical Anthropology Quarterly , vol. 6 , no. 3 , pp. 237 – 254 .[Crossref] , [Google Scholar]). Epidemiological analysis does not justify the understanding of culture as an element of the self, as it appears in behavioural research, even if epidemiologists have at various times described the uneven accumulation of HIV risk to culture or cultural groups. The concept of culture has functioned discursively (Foucault 1972 Foucault , Michel ( 1972 ) The archaeology of knowledge and the discourse on language , trans. A.M. Sheridan Smith , New York , Pantheon . (Originally published 1969) . [Google Scholar]/69) in prevention discourses, linking together discursive domains (for instance, epidemiology and behavioural science) without necessarily reconciling or rationalizing them. (This might also be articulated in terms of ‘metonymy’ and ‘metaphor’: ‘culture’ functions metonymically to link discursive domains, rather than as a metaphoric appearance of epidemiology within behavioural science.) The point is that the importance of the concept of culture has been tied to what it does in discourse rather than on what it means. 13. For the classic, anthropological statement from which this understanding is derived (if in an altogether sub-theoretical manner), see Geertz (1974 Geertz , Clifford ( 1974 ) The interpretation of cultures , New York , Basic Books . [Google Scholar], p. 49): ‘There is no such thing as a human nature independent of culture. 14. Lupton (1995 Lupton , Deborah ( 1995 ) The imperative of health: Public health and the regulated body , Thousand Oaks, CA and London , Sage .[Crossref] , [Google Scholar], p. 125) argues that, whatever its actual efficacy, mass advertising is first-and-foremost a cost-effective way to demonstrate ‘care’ on the part of public officials. 15. On confronting oneself, particularly through writing, as an ethical technique, see Foucault (1983 Foucault , Michel ( 1983 ) ‘Self writing’ , trans. Robert Hurley, in (1997) Ethics: Subjectivity and Truth Paul Rabinow . Essential Works of Foucault, 1954–1984 (vol. 1) , New York , The New Press , pp. 207 – 222 . [Google Scholar]). 16. Not surprisingly, the overwhelming trigger is often sexual desire (Díaz 1998 Díaz , Rafael M . ( 1998 ) Latino gay men and HIV: Culture, sexuality, and risk behavior , New York and London , Routledge . [Google Scholar]). Interestingly, however, ‘love’ has begun to displace ‘desire’ as the overpowering danger (Ortiz-Torres et al. 2000 Ortiz-Torres , Blanca , Serrano-Garcia , Irma & Torres-Burgos , Nelida ( 2000 ) ‘Subverting culture: Promoting HIV/AIDS prevention among Puerto Rican and Dominican women’ , American Journal of Community Psychology , vol. 28 , no. 6 , pp. 859 – 881 .[Crossref], [PubMed] , [Google Scholar], Joseph et al. 1991 Joseph , K. Michel , Adib , Maurice , Joseph , Jill G. & Tal , Margalit ( 1991 ) ‘Gay identity and risky sexual behavior related to the AIDS threat’ , Journal of Community Health , vol. 16 , no. 6 , pp. 287 – 297 .[Crossref], [PubMed] , [Google Scholar]). In this understanding, love is real, passionate, and emotional sex, as opposed to mechanical, strictly pleasurable sex which the experts, at least, can imagine entering into with one's rational faculties in control. 17. This representation parallels the representation of ‘society’, particularly welfare society, in advanced liberal thought: as ossified in relation to the potential dynamics of ‘free’ economies, as a danger to the freedom of individuals, and as a de-moralizing force in relation to citizens (see Rose 1996 Rose , Nikolas ( 1996 ) ‘Governing ‘advanced’ liberal democracies’ , in Foucault and political reason: Liberalism, neo-liberalism and rationalities of government Andrew Barry , Thomas Osborne and Nikolas Rose , Chicago , University of Chicago Press , pp. 37 – 64 . [Google Scholar]). 18. See also, Houston-Hamilton and Day (1998, p. 102): ‘A successful culture is not static’; or Ortiz-Torres et al. (2000, p. 877): ‘We believe that for a culture to grow and regenerate it should fight for the elimination of double standards and inequality based on gender, class, sexual orientation, or any other categorization’. 19. On the dis-aggregation of the self as inter-changeable elements, with self-management as the ‘moral’ and ‘responsible’ response to this experience, see Strathern (1992, pp. 159–184). 20. Foucault (1984c, p. 284). 21. On ‘active responsibility’ as a moral and individualized norm in contemporary governance, see Rose (1996 Rose , Nikolas ( 1996 ) ‘Governing ‘advanced’ liberal democracies’ , in Foucault and political reason: Liberalism, neo-liberalism and rationalities of government Andrew Barry , Thomas Osborne and Nikolas Rose , Chicago , University of Chicago Press , pp. 37 – 64 . [Google Scholar], esp. pp. 57–61) and Adkins (2002b Adkins , Lisa ( 2002b ) ‘Risk, sexuality and economy’ , British Journal of Sociology , vol. 53 , no. 1 , pp. 19 – 40 .[Crossref], [PubMed] , [Google Scholar

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