Sexual health technologies in context Dr Mark Davis School of Political and Social Inquiry School of Population Health Seminar The University of Queensland Tuesday 9 July 2013 Overview • More on sexual health technologies • Social, economic and technological factors • Reshaping of sexual health • Unexpected effects • Disclosure technologies Sexual health technologies • Pre- and Post Exposure Prophylaxis • HIV self-testing (Frith 2007). • Online contact-tracing for syphilis (Klausner, et al. 2000) • E-dating profiles (Levine and Klausner 2005) • Barebacking websites (Davis 2009) Sexual health’s technological imaginary • Assemblage of knowledge production, relationality and material life in such a way as to exercise improved control over the transmission and treatment of STIs • Hybrids of diagnostic and social media tech with ramifications for sexual decision-making Social and economic contexts • Surveillance medicine in affluent countries (Armstrong 1995) • Increased lifespans + chronic disease (Aronowitz 2009) • More diseases and disease states are being discovered (Webster 2007) • Increased expectations/costs Self-management • • • • • healthdirect.org.au medibank.com.au healthcoach4me.com (Glaxo) lumigenix.com genetrackaustralia.com New kinds of clinics • • • • Outreach clinics for sexual health, 1970s Cindy Patton’s Rebirth of the clinic (2010) Qld geographic and social outreach PCR testing for chlamydia Unexpected effects • Catherine Montgomery’s research on clinical trials of vaginal microbicides in Zambia (2012) – microbicide emerged as a gender and relational technology • How can we keep up with populations? • What role can be played by social research? Disclosure technologies <David> ...I set up a new profile that said ‘‘Never’’ to safe sex and I was completely blatant about my HIV status—it was only alluded to in the former profile... <Davide> I had changed my old profile to use some of the euphemisms to allude to POZ status so I presume he did... <MD> what are some of the euphemisms... <David> ‘‘Positive outlook on life’’... <David> My uncompromising stance is less than 12 months old. <David> Yes. <MD> What uncompromising stance is that? <David> That I only have unprotected sex. <MD> What made u change? <David> Realizing that I much preferred it. <MD> What made u adjust yr profile <David> For the majority of the period since I was diagnosed I had had only protected sex. <MD> Can u expand? <David> Realizing that every man was out for the most pleasure HE could get—why should I not have the same rule? <MD> So is this a way for you to get pleasure while reducing HIV risk? <David> It is also only in the last 15–18 months that I had realized there was such a large subculture of POZ men having unprotected sex. <MD> What made u realize that? <David> I think that the number of profiles on gaydar explicit about that has risen markedly in that period. <MD> How do you feel about being open about yr status on the net? <David> I think it is important (Davis et al., 2006: 166-167) • www.letthemknow.org.au Wel com e t o Let Th em Kn ow Ho m e 3:03:53 Home 8 / 0 7 / 1 2 6 :0 3 PM Time to Let Them Know STI Let Them Know A Service of Melbourne Sexual Health Centre Doctor Info Partner Info Feed Back Welcome to Let Them Know Ways to Let Them Know This website has been developed by Melbourne Sexual Health Centre to help people who have been diagnosed with Chlamydia, Gonorrhoea, Mycoplasma genitalium, Syphilis and Trichomonas to tell their sexual partners that they might also be at risk. It also provides local service information for NSW health residents, this is supported by NSW STI Programs Unit . Ensuring partners are tested and treated is an important way of controlling the spread of this infection. As well as frequently asked questions, this website includes examples of conversations, emails, text messages (SMS) or letters you can use in informing your partner. It even allows you to send an SMS or email to your partner directly from the site, either personally or anonymously. Or, if you prefer, you can ask your doctor to help. Letter SMS Email Talk STI Fact Sheets Chlamydia Gonorrhoea Mycoplasma genitalium Syphilis Trichomoniasis Doctor Letter Treatment letters FAQ on STIs WARNING: Some people may react badly to being told they are at risk of an STI. If you think one of your partners could become abusive on hearing this news, do not tell them yourself. Instead, use our anonymous email, SMS or letter or ask your doctor. Home | STI | Let Them Know | Doctor Infomation | Partner Information | Feed Back Copyright © 2010 Melbourne Sexual Health Centre Chlamydia Gonorrhoea Mycoplasma genitalium Syphilis Trichomoniasis SMS “A message from letthemknow.org.au. [Name of recipient] u may be at risk of Chlamydia. Pls have a sexual health check. See website or phone [Telephone number supplied] PLEASE DO NOT REPLY.” Conclusion • Sexual health technologies have a social and economic history • Sexual health clinic is moving outside its walls • Such contexts point to socio-technical systems; serendipity; complexity • How can we expand our own conversation on sexual health’s new technologies? References • • • • • • • • • • Armstrong, D. (1995). "The rise of surveillance medicine." Sociology of Health and Illness 17(3): 393404. Aronowitz, R. A. (2009). "The Converged Experience of Risk and Disease." Milbank Quarterly 87(2): 417-442. Davis, M. (2009). Sex, Technology and Public Health. Houndmills, UK Palgrave. Davis, M., G. Hart, et al. (2006). "Sex and the Internet: gay men, risk reduction and serostatus." Culture, Health and Sexuality 8(2): 161-174. Frith, L. (2007). "HIV self-testing: a time to revise current policy." The Lancet 369(9557): 243-245. Klausner, J., W. Wolf, et al. (2000). "Tracing a syphilis outbreak through cyberspace." Journal of the American Medical Association 284(4): 447-449. Levine, D. and J. Klausner (2005). "Lessons learned from tobacco control: A proposal for public health policy initiatives to reduce the consequences of high-risk sexual behaviour among men who have sex with men and use the internet." Sexuality Research & Social Policy 2(1): 51-58. Montgomery, C. (2012). "Making prevention public: The co-production of gender and technology in HIV prevention research." Social Studies of Science 42(6): 922-944. Patton, C ed. (2010) Rebirth of the clinic: Places and agents in contemporary health care. Minneapolis, U of Minnesota Press, Webster, A. (2007). Health, technology & society: A sociological critique. Houndmills, Palgrave.