Early this year the federal government announced it was buying in a contact tracing app that hadn’t worked in Singapore. The ‘CovidSafe’ app uses a wireless protocol to connect with nearby phones that are also running the app, to record an encrypted ID for each person the phone’s owner had contact with. The government refused to wait until Apple and Google had released an update that solved key problems, such as the way iOS shuts down apps that aren’t in use, particularly when the phone is locked. It claimed the app would allow us to exit lockdown and return to public life, so long as at least 60% of the population downloaded and installed it on their phones. However, total downloads stalled around 25-30% of the population, with the public perhaps remembering the privacy fiasco over the MyHealthRecord. The state governments that actually do the contact tracing reported it was of no use, and it was quietly dropped.

The app was meant to compensate for a human flaw — the difficulty of remembering where we’ve been and who we’ve met, going back up to fourteen days from exposure through to viraemia and finally immunity. Indeed, we don’t know who we’ve met on public transport, or in the queue for the supermarket. The design aims to take the human agent out of the picture altogether, instead relying on cool, hard technology to capture encounters with machinic precision. Yet the design and implementation embed and reflect the all-too-human vices of hubris and impatience, and what Evgeny Morozov called ‘solutionism.’ 

The problem that needs solving

It was also a gigantic missed opportunity to design an app that could have solved a long-lasting problem for citizens and governments alike. Imagine, instead of assuming humans are incapable, we designed something that could support and enhance our capability. We are deluged with information about the outbreak and limited in the time and effort we can devote to processing it. Reflect for one second on how you get your information about the outbreak: daily press conferences top the list, followed by media coverage of them and social media conversations about them. The situation is dynamic and right now, restrictions are changing almost daily. The amount of information that we need to process and respond to can be overwhelming, even for English speakers —and as far as I’m aware, no government translates them into other languages. 

I want to single out one issue: indications and requirements for testing. Each day, governments release a list of locations and times. If you were at the Apollo Restaurant in Potts Point on August 28th between 11AM and 9PM, please… go straight into quarantine? Seek testing? And then what — stay home until you get a negative result, or go about your day-to-day life? Misunderstandings about these requirements have become a matter of national scandal, fuelled by governments shifting blame for the outbreak onto ‘individuals doing the wrong thing.’ But their communication is haphazard. I just got a swab at a respiratory clinic and received no instruction to isolate until I got a result. And apart from the difficulty of remembering when you were there, this approach relies on people catching a momentary reference to the restaurant in media coverage. 

’If you were on the 8.12am service departing Central to Sydenham, please seek testing…’ Was I on that service? I caught a morning train at Museum, who knows what time it departed Central. Nah, probably not.

What the app should do instead

A few years back I was a bit startled, but basically pleased* to discover the Google Maps app had been tracking every trip I made, every day. (* This is pretty creepy but quite useful if you’re an ethnographer like me.)

Screen captures for my Sunday adventure from the Google Maps app

So just do that: remember where I’ve been, for me. In the second image, Google Maps is asking if I was at my usual morning café Warren & Holt.

If NSW Health announces there’s a case or cluster associated with that location, the app should notify me. If I take a long train journey and NSW Health later discovers one of the other passengers was a case, they can publish that information in a machine-readable format. The app checks that information for updates and if it matches my own data, it can notify me. In this vision, the app would not ‘phone home’ and notify anyone else. This is an approach to contact tracing that empowers the user, providing a precious resource — tailored information — and trusting them to act on it.

Edit 6 Aug — writing late at night, I sometimes forget to mention my main point. In this case: if I am traced as a contact or I get a positive test result, I can use the app to remember and relate details of my travels and encounters. I don’t need to send any data to the contact tracers other than by having a conversation with them, which allows the contact tracer themselves to use their own practice wisdom and personal intuition to ask questions an app could never answer.

This suggests a second function. I’m a reasonably educated guy, I can follow a complicated recipe, I’m literally a regulatory scholar, and I still find some of the advice on testing, isolation, and quarantine requirements confusing. The app should just tell me, here’s the nearest Covid-19 testing clinic. Here are their opening hours. Here’s a link to make an appointment. You should go home and stay home until you’ve had that test and got your result. If you need it, here’s a link to apply for a cash payment in case you have no income or paid leave. These details vary from one jurisdiction to another. The information should be supplied by governments in a format the app can parse and present to the user.

Finally, a third function. When regulations and services change, governments should be able to push out notifications to app users based on their location. This should be systematic but sparing, to avoid overwhelming app users. And — fucksake — governments should translate this information into languages other than English. If government is announcing new restrictions that can create criminal liability, it’s a matter of basic human rights that it translates the announcement into the languages in use in the whole community. It shouldn’t be left to communities of people trying to cope with the cops showing up and locking down their residential towers to make their own translations on the fly. The app should provide easy access to updates on the current situation in multiple languages, easily shareable via chat apps and social media. 

Who should do it?

Google, with input from Apple. The federal government dropped the ball. State and territory governments will take forever and develop their own separate apps with varying degrees of functionality. And none of these apps will have access to the location data Google already collects — the routes taken and the database of premises, transport routes, etc. Google should define the machine language and establish a secure API for accredited government users. It has existing expertise in interface design, user testing, security, hardware integration and regulatory compliance.

The key to this approach is that it coordinates the strengths of different actors: Google for apps and platforms, governments who determine regulations and provide information, and users, who almost always want to do the right thing if they are supported to do so. The last is a foundational principle for both adult education and social marketing — people see themselves as independent actors and respond best when you respect their agency and empower them to act.

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I am everything that Katherine Wolfgramme loves to poke at on her social media: lefty, non-binary, and a lover of queer theory. Because I am those things, I am concerned about the recent letter campaign against her. The campaign calls on Katherine to stand down — or be stood down — from her positions as an Associate of the Mardi Gras Board and an Ambassador for the Gender Centre. (In these comments I am only writing about the open letter to Mardi Gras published in early December 2019.)

Although this piece is forthright about the problems of that campaign, I am writing it as a call to dialogue. There are material issues raised on both sides, and our communities can benefit from talking through them. But that conversation cannot happen in the situation as it presently stands. It both highlights the need and presents an opportunity to develop accountability processes that go beyond callouts and cancellation in response to conflict and misconduct.  

I’m going to delve briefly into the substance of the campaign, mainly to highlight the important issues that are in play, the problems with unchecked interpretation, as well as the high stakes involved. But I’m focusing mainly on the accountability of the process, and I’m calling for the Sydney queer community to develop effective and non-violent accountability processes. This is a matter of fair process, transparency, understanding our history and being aware of different kinds of power. This is not about defending Katherine — it’s about the consequences for our community if we don’t find a way to raise and resolve the issues, which affect us all. Demands for accountability must themselves be accountable.

Continue reading “Beyond cancellation: accountability and the Sydney queer community”

The most common form of oral PrEP is daily dosing — but it’s not the only game in town. In guidelines launched at the recent International AIDS Society conference in Mexico, the World Health Organisation endorsed what it calls ‘event-driven’ PrEP, and the CDC has endorsed ‘consistently’ taking at least four pills per week. While the evidence supporting non-daily PrEP is rock solid, the language we use to talk about it remains unsettled.

Through my work on the Rinse and Repeat campaign, I have first-hand experience of the language challenges posed by non-daily dosing, and with this post I want to raise them for discussion in the global HIV prevention community.

My perspective in this post reflects the communities I work with and belong to — queer people, trans folks, gay and bisexual men and other men who have sex with men (GBM), and people from migrant and refugee backgrounds (and all of these categories overlap all the others).

(Sidebar: I personally identify as a queer nonbinary person who does ‘gay male’ drag when it helps me connect with the communities and colleagues I’m working with. I’ve felt that disconnect since 2004, and this is my coming-out post. My gender is Daniel, my pronouns: just call me Dan.)

Two kinds of non-daily dosing

There are two approaches recognised by the WHO.

• Taking two pills at least two hours before sex, and then another pill every 24 hours after that, until two days after your last sexual encounter. The WHO calls this ‘event-driven PrEP’ and ‘2+1+1.’
• Taking a pill on the same four days each week, e.g. Tues & Thurs & Sat & Sun. (Someone needs to make that a t-shirt.) Also known as ‘T&S’ dosing. This is implicitly endorsed by the CDC but not endorsed by name.

Event-based PrEP

This approach is called different things in different places. It has been called on-demand, event-based or event-driven, intermittent or episodic, ‘disco dosing’ and 2+1+1. The approach was first proven to work by the IPERGAY study in Paris and Montréal, and in French, it’s ‘on demand’ PrEP. That’s what it’s commonly called in the UK as well.

Recently, with funding from Dynamix and help from some creative mates, I developed a resource that illustrates the first approach. The dosing schedule is surprisingly complicated — we often describe it in a single sentence, but when you diagram that sentence out (nerd alert), it involves more than seven discrete pieces of information, some of them relative to each other.

One of the few pieces of communication psychology everyone knows is the 7±2 rule — i.e. most people struggle to hold more than 5-9 pieces of information in their head at one time. And that’s just to remember them; the dosing schedule requires you to process them.

So in the Rinse and Repeat resource, we broke down the dosing schedule into six easy steps that anyone can follow. The short film introduces the broad concept and people can visit the website to find the six easy steps.

In that project, after a fair bit of discussion, I went with ‘event-based’ PrEP. It’s not catchy at all and that’s physically painful to me. The main alternative was ‘on-demand’ and that wording is both catchy and agentic.

And my concern is that people hear the name ‘on-demand’ and think they understand how it works. When I talk about the project, people who weren’t familiar with EBP often said ‘so you only take a pill when you have sex?’

In this case, on-demand means as-needed, but in everyday usage ‘on-demand’ usually means at-will, i.e. whenever you feel like it.

Educators are already telling me they are hearing from people who have messed up the dosing schedule because they didn’t understand it clearly when they started.

The WHO has gone with event-driven instead. They didn’t consult me. Again. (It’s okay, I’m fine, I’ll get over it. Eventually.)

But they also went with 2+1+1. I understand this label comes from PrEP roll-out workshops and focus groups with heterosexual folks and people in low-income countries. Again, it’s catchy and it gets the idea across… kind of. It leaves out the timing, which is pretty important information.

I have the same concern that someone might hear it and think they understand it without further research. In the Rinse and Repeat campaign, I went with the slightly jargon-y ‘event-based’ naming because I want people to google it up before they try it out.

The other problem with 2+1+1 is that it embeds a very heterosexual model of sexual life. Sex once a week on Friday after the kids have gone to bed, one and done. It leaves out people who have more than one encounter (or more than one day of encounters).

With EBP, you take a startup dose of two pills, then a follow-up dose every day, around the same time, until two days after your last encounter. Calling it 2+1+1 obscures the fact that if you keep taking a daily follow-up dose, event-based PrEP can protect you for a week, a month, or a whole season of sex. (Shout out to my peeps enjoying summer in Montréal!)

Anticipation, not planning

In my home country of Australia, campaigns about PrEP have universally focused on daily dosing. I’ve argued that ‘take the pill every day’ has become the new ‘use a condom every time.’ The evidence shows it isn’t required — in the iPrEx trial, nobody seroconverted if they were taking at least four tablets per week. But some people are just uncomfortable thinking about sex outside of a prescriptive normative framework.

So while we knew from the IPERGAY study that event-based PrEP is a thing, people talked about it in a very specific way that implied it’s dubious or only marginally relevant. They say it’s only suitable if you can plan your sex life in advance.

And everyone wants to think of themselves as spontaneous.

The Rinse and Repeat campaign emphasises the flexibility of EBP — the tagline is Whatever comes your way, ‘from an occasional fuck to the occasional fuckfest, event-based PrEP has got you covered.’

And instead of talking about planning, we talk about anticipation — if you’re feeling frisky and you think you might be getting some later today, take a startup dose now. If sex doesn’t happen, no harm no foul.

Exactly the same meaning, without the disparaging connotation. EBP was first tested among sex pigs in France. Les cochons were having a lot of sex. They certainly weren’t scheduling their fucks in dainty little date books. During the IPERGAY study and since, there have been no seroconversions among GBM doing event-based PrEP in France.

Cis women and trans folks

This is really tricky and I want to take a moment to put my remarks in context. In the late 80s and 90s, HIV social researchers described how the epidemiology of AIDS was challenging what Michael Warner has called the ethnic model of LGBT civil rights movement — the notion that ‘gay’ or ‘lesbian’ is comparable to an ethnicity, a relatively self-contained community defined by a common identity and shared culture.

Except there were people being diagnosed with HIV, who identified as straight men and were having sex with men. Or lesbian women who were having sex with gay men. And trans folk, whose lives were not and still are not (IN! TWENTY! NINETEEN!) reflected in epidemiological questionnaires.

The lesson from that was: talk about sexual practices, not identities. (If heterosexual people learned one thing from sex ed, it was “AIDS affects everybody.” Well-meaning but a gigantic distraction from the fact HIV impacts hardest on oppressed and underserved communities.)

In my PhD, I document the way in which the Australian health promotion response to HIV began targeting collective social forms, such as networks, sexual cultures, and communities from the late 1990s onwards. This followed (s l o w l y) after social research that identified particular practices, such as use of crystal methamphetamine, and the practice of fisting, are not independent causes of HIV infection; instead, they are markers of sexual cultures and interpersonal networks with higher HIV prevalence and increased (though quite nuanced) practice of unprotected anal intercourse. So I might refer to sex between men and gay culture in the same piece, talking about different things (a sexual practice, a cultural form) in each case.

When we wrote the first draft of the Rinse and Repeat, I didn’t want to single out trans people or cisgender women — because the diversity of people, bodies, lives and experiences isn’t reflected in those broad labels. Instead, we used positive language, saying that EBP offers protection from HIV transmission during anal intercourse only.

However, there’s now evidence that feminising hormones might affect the way the drugs in PrEP are metabolised, which could, in turn, mean that four pills per week are not enough to achieve protective concentrations. We also know that it takes a lot longer to reach protective concentrations in the urinary tract of people with vaginas/front holes, so EBP does not provide protection for vaginal or front-hole intercourse.

(In both cases, we recommend taking a daily dose for 28 days before having condomless intercourse, rather than doing EBP or T&S dosing.)

So I want to hear your thoughts on: how do we talk about these variations in the protection offered by EBP?

As a communications person, I think it’s simpler and therefore easier to understand if we say ‘we recommend daily dosing for trans folks and cisgender women.’ That’s a positive alternative recommendation and avoids a negative and exclusionary framing (e.g. EBP is not for …).

In this usage, the labels ‘trans folks’ and ‘cisgender women’ do not comprehensively identify all the bodies and practices that EBP won’t work for. In a short message (in a voice-over or across the top of a website) they may function as a sensitising device. If you were not assigned male at birth (AMAB), even if you don’t identify with either label, once you know that protection may vary by trans experience and cis-female embodiment, you know that some further research may be warranted before starting EBP.

(IDK, maybe all this dancing around is just me trying to avoid admitting that this is yet another medical innovation that only benefits cisgender men.)

Your thoughts, please.

Lately I’ve been thinking about forgetting. I’ve been writing hard on my dissertation, and a lot of stuff goes by that I’d love to blog about, but I try to stay focused. All the things that tug on my consciousness lately involve forgetting, so I am loath to let them go unmarked. This post is necessarily schematic — touching on things I wanted to note in passing, even though I can’t give them the full consideration I’d like to. (I welcome different perspectives in the comments.)

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#PrEP4All means patents for all

Earlier this year, PrEP4All, an off-shoot of ACTUP NYC, launched a campaign to demand the United States enforce the patent held by its National Institutes of Health (NIH) over the use of the drug combination TDF/FTC for pre-exposure prophylaxis (PrEP).

The pharmaceutical company Gilead Sciences holds the patent on the drug combination — for another year or three, at least — and has been targeted by activists over its practice of ransom pricing. Indeed, the campaign explicitly links outrage over greedy pricing and enforcement of the patent over PrEP. It demands the US government tax the profits Gilead makes when its drug is purchased for use as PrEP.

The campaign is quite explicit about calling back to the early days of ACTUP when activists fought the FDA over its sluggish approval process for AZT, and pharmaceutical companies over their patent and pricing strategies.

Peter Staley, the wealthy and photogenic activist who took part in those protests and features prominently in films like How to Survive a Plague, said the campaign reminds him of those early days and has described the epidemiologist James Krellenstein, one of his fellow instigators of the anti-Gilead jeremiad, as the future of the movement.

The history-making around AIDS demands heroic ‘leaders’, and leaders are assembled from archival footage without much reflection on who got filmed, who could afford to come out as HIV-positive and get arrested at protests, and who didn’t/couldn’t and for what reasons. This myth-making centres educated white men and erases both queer people of colour and ACTUP’s autonomous collective organising practices.

Forgetting isn’t negligent. Forgetting is enacted. Even in the brain, forgetting is an active process. In culture, forgetting occurs through selectively retelling some narratives instead of others, and letting some narratives and not others shape social action.

The foundational nostalgia of the PrEP4All campaign forgets the entire world outside of white, middle-class, educated New York. What frustrates me is the faith this activism places in the American legal system and intellectual property laws. It consciously forgets the utterly malign role patents played in making HIV treatments inaccessible in low-income countries.

The global patent regime was quite explicitly formulated and advocated by the pharmaceutical industry, prosecuted by the United States Trade Representative, and enacted through the creation of the World Trade Organisation and the Trade Related Aspects of Intellectual Property (TRIPS) regime (Harrison, 2004).

That victory was only overcome, and overcome only temporarily, by the concerted effort of activism encapsulated in the Doha Declaration (2005). The TRIPS regime means that a patent granted in the United States can be enforced around the world. Combined with investor state dispute settlement (ISDS), it means Gilead could sue for expropriation if the United States only enforced the patent in the US itself. Patent enforcement is all or nothing.

It also forgets the trade war and the American exceptionalism that are the official policy of the White House. The ultimate target of the campaign is Trump himself — who has already shown a willingness to appropriate HIV prevention in his political messaging. In the context of a trade war, he is more than capable of announcing plans to enforce the patent worldwide within his favoured rhetoric of ‘making others pay their way,’ as he constantly does with Mexico and has done with NATO.

At a time when we are furiously trying to expand access to PrEP in high-prevalence countries — not all of which are low-income countries eligible for the exemption laid out in the Doha Declaration — encouraging the US government to enforce a patent over PrEP is deeply misguided.

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Better than a condom, but undetectable is unmentionable?

My next two case studies are drawn from Australia. This week we saw a poster stuck up in urban Melbourne, announcing that PrEP works better than condoms. It cites a CDC estimate of condom efficacy as a range from 72-91%. This, too, involves a conscious forgetting of the experience of condom use over the nearly 40 years of the HIV epidemic in gay culture and queer communities.

A friend who was involved in Australia’s first gay community HIV prevention campaign ‘Rubba Me’ mentions that gay and bisexual men took up condoms before any studies had shown they worked. We knew they worked, he said, because we were having plenty of anal sex with condoms and we kept testing negative. Prof Kane Race calls this a commitment to ‘intimate experiments,’ a willingness to take risks and embrace uncertainties. (Just like the first people to try PrEP.)

Condoms work when they are used correctly. There are countless men who have sex with men who have been HIV-negative for decades, because they used condoms correctly and personally felt no problem with condoms.

I personally hate condoms. I advocate PrEP and use it when I need it, but I strongly prefer U=U. However, condoms are cheap and they are everywhere, and the same cannot be said for PrEP and even HIV treatment, particularly in low-income counties and countries. Telling people that condoms don’t work is bad prevention strategy.

The CDC estimate was calculated by averaging out studies that included populations in which incorrect use of condoms is common. Just as we report on the 99% efficacy of PrEP when used correctly, we should report condom efficacy on the same basis.

In the 1980s, Prof Juliet Richters studied condom use in three cohorts: heterosexuals, gay and bisexual men, and sex workers. This was a rigorous study — participants were asked to save condoms after use and they were inspected by the researchers. (Talk about intimate experiments.) In a six month period, Richters and her colleagues did not find a single breakage among gay and bisexual men and sex workers.

The study was the original source of a claim that circulated widely in the 1990s — asserting that condoms are only 90% effective. It was cited by homophobes and even by some public health experts as an argument against gay men having anal sex at all. It was based on the failure rate of condoms among Richters’ heterosexual study participants. In other words, the circulation of that claim enacted an erasure of queer people and sex workers, and our skills and creativity in protecting ourselves. So I am extremely troubled to see a similar logic being used to promote PrEP.

Crucially, those posters also forget to mention that U=U is even more effective than PrEP. U=U means ‘undetectable equals untransmittable.’ If a positive person has undetectable viral load, they cannot pass on the virus through sex.

That’s an important message at a point in time where people are saying “PrEP 4 PrEP” in their profiles on hookup apps. As Alexander McClelland points out in a recent feature, the widespread uptake of PrEP has, to some extent, severed our shared membership, whether positive or negative, in a community living with HIV. He writes:

I’ve heard this from guys many times: that my viral undetectability is of no interest. They are on PrEP, so it doesn’t matter what’s going on with anyone else. (…) The moment to have a bonded connection over our shared relationship to HIV, negative or positive, is no longer on the table. For some of us who have lived with HIV for a long time, this can be refreshing, and for others, disconcerting. 

McClelland (2018)

As both Bruce Richmon and Damon L Jacobs have argued, in order to avoid these new prevention technologies deepening the ‘serodivide’ in our communities, it is essential that we always talk PrEP and U=U together.

On a more technical note, the poster says ‘PrEP Works, one pill per day’. This completely ignores non-daily dosing strategies like event-based PrEP and T&S dosing, even though the World Health Organisation just came out saying both are just as effective as daily PrEP.

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Blood equality

Lastly, we are now seeing a movement for what it calls ‘blood equality’, advocating the right for men who have sex with men (MSM) to donate blood without exclusion periods. This argument is formulated in a few different ways.

One version argues that we’ve achieved marriage equality and this injustice is ‘what’s next’. This forgets many other more pressing needs, like the acceptance of queer people living in areas that overwhelmingly voted ‘no’ on Australia’s marriage plebiscite, or the fact that a significant minority of people living with HIV in Australia don’t have access to Medicare-funded HIV treatment.

Some versions have argued that it’s matter of human dignity to allow blood donation. When I last looked at this issue, in the mid-2000s, I used this argument myself. I drew on Richard Titmuss’ argument that people donate blood out of altruism, which in turn drew on Mauss’ theory of society as gift relationship. Now, I realise that human dignity has to be universal or it is just special pleading. In the case of ‘blood equality’, the claim based on human dignity forgets (or accepts) that people living with HIV are excluded.

A more recent formulation argues that even a 3-month exclusion period is intolerable and that behavioural screening should be enough. The idea is that we can just ask people about their recent sexual behaviour and decide whether to let them donate blood. This forgets nearly forty years of experience, which tells us that choosing partners (or donors) based on self-reported risk is not effective protection.

This claim also forgets the community and clinical experience of seroconversion, which doesn’t always happen overnight; in some people it does take up to 3 months after infection for viraemia to emerge and antibody production to occur. And PrEP actually complicates matters even further — even with resistance mutations, TDF/FTC can be enough viral suppression to prolong the seroconversion process, so any exclusion period less than 3 months is very unlikely.

Finally, this advocacy also forgets the sex-positivity that has always been central to the Australian community-based response to HIV/AIDS. As the law student, student politician, and Labor think-tank staffer Connor Wherrett recently wrote in the queer (sic) edition of Honi Soit,

“The fact is, blanket policies like this discourage healthy MSM giving blood. A same sex male couple, despite being together for a year and only having sex with each other, and being regularly tested, is treated the same way as a gay man who has multiple unprotected sexual encounters with different individuals a week.” (source)

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To reiterate: forgetting is not just a matter of not knowing, or letting something that was known slip away. It is produced through social action. Although in social movements we constantly bang on about Foucault’s notion of discourses, my analysis here draws on his conception of the archive — the collective repository of prior discourses and the practices that select which discourses operate in the present. These campaigns and interventions are among those practices.

My work draws heavily on Foucault, who is not typically interested in the role of specific actors and human agency in discursive practices. I ran these reflections in dot-point form past Theodore Kerr, a Brooklyn based writer, organizer, curator and artist, past convenor of Visual AIDS and collaborator in the ‘What Would an HIV Doula Do?’ collective. He reminded me that these acts of forgetting reflect the strategies and social placement of particular individuals — seeking to adopt positions of leadership in social movements, and taking perspectives that reflect their own privilege and their lack of meaningful engagement with the people, politics and lived experience of the Global South (or, indeed, the American South).

I recently re-watched Robin Campillo’s 120 Battements Par Minute (distributed in the Anglosphere under the title BPM). Just like the first time, I sat there in darkness, trying not to howl as all the moisture in my body evacuated via my tear ducts. It is a powerful evocation of the experience of HIV and AIDS in France in the early 1990s, shown through the lens of ACTUP Paris and its actions (and debates) over HIV treatments access. The closing image is of a die-in, on a cobbled street, at night, beside a church, calling on the French government to acknowledge the crisis, and the brutal fact of death and dying. It shows forgetting as a practice of abandonment: people in power knew and did not care.

Further reading

Alexander McClelland’s ‘Unprepared’ in Maisonneuve (Spring 2019)

‘I’m forty now. Some have said that the PrEP era means we are all “HIV equal,” dispensing with the negative and positive. This so-called new era can be confounding, at least to me.’

Meanwhile, Dion Kagan, Positive Images (IB Tauris, 2018) offers a reminder that remembering is complicated, too:

‘Making AIDS into history, as I suggested earlier, can act as a form of temporal estrangement, a kind of prophylactic distancing that disavows the present day conditions and urgencies of HIV. As [Theodore] Kerr writes, the poster campaign (‘Your Nostalgia is Killing Me’, Chevalier & Bradley-Perrin, 2013) was a protest against the negligence of nostalgia, expressing the feeling that the artist’s “current life chances as people living with HIV were being reduced by a focus on AIDS of the past. The stigma, health, and social realities that they experience were being ignored in lieu of a look back.”’ (p227)