Douglas A. Feldman, ed. AIDS, Culture, and Gay Men. Gainesville: University Press of Florida, 2010. 285 pp. $75.00 (cloth), ISBN 978-0-8130-3431-7.

Reviewed by Michael Connors Jackman (York University)
Published on H-Histsex (November, 2010)
Commissioned by Timothy W. Jones (University of South Wales, & La Trobe University)

Understanding Men's Sexualities as the AIDS Epidemic Continues

As the face of the AIDS epidemic changes, sexual activity remains the primary means by which HIV is transmitted. Though gay men were never the only group affected by AIDS, they have always been conceptually tied to the epidemic. In assessing HIV-related issues among men who have sex with men (MSM), a group much broader than simply gay men, research on the culturally-specific sexual behaviors among MSM remains a critical and necessary area of exploration. Douglas A. Feldman's edited collection AIDS, Culture, and Gay Men draws together a broad range of cross-cultural research on the changing issues faced by MSM. Feldman describes the text as an analysis of the cultural dimensions of gay male behavior. Each chapter deals with culture and behavior, though some focus more exclusively on one than the other. While most of the chapters deal with realities faced in the United States, four draw on findings from Australia, Greece, and Belgium.

The cultural contexts in which MSM live are broad and must be considered central to an analysis of how to understand HIV/AIDS. In this volume, Frederick Bloom, Jami S. Leichliter, David K. Whittier, and Janet W. McGrath (chapter 2) identify stress brought on by changes in social environments like gay communities as a key factor in HIV transmission. These environments encompass not only social networks and community institutions, but also the more fluid contexts inhabited by MSM, which Miguel Muñoz-Laboy and Richard Parker (chapter 10) call "erotic landscapes." These comprise interactions among three factors: sexual venues, socialization context, and the desired gender of sexual partners. By studying these erotic landscapes we can see the plurality of relationship structures and sexual practices, as well as their change over time. Yet contexts encompass not just the sexual activities of men, but the institutions that shape and discipline their lives as well. Laura Stanley's excellent contribution (chapter 3) makes an argument for the support of choices that honor individuals' sense of control and self-preservation in the face of biomedical institutional control, even when those choices may be commonly defined as bad.

As sexual identities take shape within contexts that vary cross-culturally, they are distinct from sexual behavior. As Scott Clair and Merrill Singer (chapter 8) write, for Latino MSM in Connecticut, pervasive homophobia can work in tandem with ethno-racial and socio-economic factors as barriers to HIV prevention. Latino men's attitudes toward homosexuality inform their perception of risk, condom usage, and tendency to disclose HIV status. Brian Riedel's (chapter 13) historical overview of gay rights activism in Greece documents the continuing structural divide between gay activism and AIDS activism, where resistance to same-sex identity and a loosely developed sense of gay identity meant that from the outset the target population of AIDS activism was broader than just those who identified as "homosexual." In each instance, the authors show how culturally held beliefs about behavior versus identity had practical implications for HIV prevention work.

In addition to exploring behavior, an emphasis on cultural meaning runs throughout the book. In chapter 4, William Leap and Samuel Colón call for a closer analysis of the "talk" of gay men, which involves looking not only at context, but also at the way men position themselves and others within the narratives they construct. This would foreground gay men's use of language to articulate feelings of shame, blame, desirability, and perceived risk. How men negotiate and construct meaning is further explored in chapter 12 by Sean Slavin and Jeanne Ellard who discuss the cultural meanings of unprotected sex among gay men. The authors challenge the view that choosing unprotected sex arises from individual pathology. Locating decision-making about risk within a framework of cultural meaning, they suggest instead that notions of kinship and shared substance make the exchange of semen a culturally significant symbol of intimacy and underscore the importance of understanding symbols of love in the lives of MSM.

A common challenge in HIV prevention work is the task of promoting safer sex practices without casting moral judgement. The question of morality enters into the piece by Marcelo Montes Penha, Michele G. Shedlin, Carol A. Reisen, Paul J. Poppen, Fernanda T. Bianchi, Carlos U. Decena, and Maria Cecilia Zea (chapter 9) who draft a set of ethical guidelines for fieldwork on sexual risk among Latino MSM. The authors find that when doing field research with Latino men researchers should avoid communicating their own sexual orientation and avoid drinking alcohol or having sexual encounters with informants. While these concerns may allow for efficient research, one wonders whether this prohibitive stance unnecessarily precludes a more in-depth exploration of men's sexualities. In a similar vein, Thomas Lyons (chapter 7) makes a case for the potential of self-help group Crystal Meth Anonymous as an approach to HIV prevention. While Lyons notes the influence of honesty, spirituality, and sobriety in changing sexual activities, it remains questionable whether a program that incorporates a Higher Power and insists on remaining single during the first year of involvement would be a beneficial and non-judgmental HIV prevention strategy. This tendency to moralize is absent from John Vincke, Ralph Bolton, and Rudi Bleys's contribution (chapter 14), which describes current trends in MSM and HIV infection in Belgium. The authors advocate focusing on the most risky practices of MSM, which involves developing strategies to handle negotiated safety to target MSM in contexts where anonymity is common. Instead of implementing prevention campaigns that address all sexual activities as risky, the authors support harm reduction directed at context-specific risk behaviors.

Two contributions are notably less ethnographic and might be considered extraneous to a discussion of MSM and culture. Charles Collins and Camilla Harshbarger's (chapter 5) review of effective behavioral interventions in HIV prevention identifies a need for the strategic diffusion of interventions. While this chapter offers recommendations on intervention partnerships with MSM-service agencies within gay communities, it offers little commentary on the lives, experiences, and practices of those men who would benefit from these approaches. Also, chapter 11 by Mary Spink Neumann, Jeffrey H. Herbst, and Carolyn A. Guenther-Grey, a comparative analysis of HIV/AIDS behavioral literature on MSM in the United States and Australia, identifies a stronger focus in Australian research on the application of findings in the design of prevention intervention as compared with the United States, which favors interventions that account for gaps in research and changes in the epidemic. Though these two chapters may interest AIDS researchers concerned with trends in research itself, the lack of ethnographic insight offers little to readers concerned with actual realities facing MSM.

Lastly, Feldman's (chapter 6) piece reminds us of the need to remain politically engaged as the epidemic continues. His personal account relays his central involvement in founding AIDS Center of Queens County (ACQC) and offers a historical outline of struggles against right-wing groups when starting the center. Also, he describes his own experience of being ousted from the organization through administrative attempts to centralize and depoliticize AIDS service organizations--an administrative shift felt in AIDS organizing elsewhere as well (see chapter 14).

In summary, the volume is an excellent collection of new work on the changing cultural contexts in which MSM live and deal with the realities of HIV/AIDS. While there is a blatant omission of research on MSM in the global South and the culturally-specific needs of men from those regions, this book is an exemplar text and required reading for anyone concerned with HIV/AIDS and the ongoing struggle of MSM as a group affected by the epidemic.

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Citation: Michael Connors Jackman. Review of Feldman, Douglas A., ed., AIDS, Culture, and Gay Men. H-Histsex, H-Net Reviews. November, 2010.
URL: http://www.h-net.org/reviews/showrev.php?id=30930

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