In November 2004, Warning conducted an interview with American activist Eric Rofes. For a small splinter-group spun off from Act Up-Paris, it would become a major turning-point for us. Act Up’s pessimistic culture had instilled in us a moralizing attitude towards sexuality founded on a fundamental wariness of male homosexual behaviour. Added to this was a hypercritical take on medical treatments, which, though indispensable, are considered products of large capitalist corporations profiting off the backs of HIV positive people. Eric convinced us to look at “gay health” more holistically, considering gay male health and wellness as a whole. An intense period of reflection, reading, and research into the presuppositions of gay health (both the ideas and the approach) then followed. We went from moralizing to a more open-minded notion of gay men’s sexuality and “lifestyle”. Abandoning condom-absolutism, we instead argued for a more diversified approach to prevention that placed more trust in people’s agency. Gone was the behavioural dictat of “good gay sex” and in its place a willingness to provide information that could be adapted to real-life practices. We came to understand that the struggle against HIV had to be framed in a holistic approach to overall personal health. We examined the culture of health and pleasure exhibited by still-unformed and embodied identities (gays, lesbians, circuit queens, bears, and others) and described our observations and analyses in the treatise Santé Gaie (L’Harmattan: 2010). And here we are: the battle has just begun.

Ten years later, when PrEP became available in the USA, we instantly grasped the opportunities that this newfound prevention tool might hold. Instead of only seeing PrEP as yet another encroachment of capitalist control over individual health, we saw this prevention pill as congruent to a deep-seated pattern in sexuality itself. The massive influx of pharmaceutical products to treat erectile dysfunction has greatly improved the sex lives of people of a certain age – even allowing for a sexual rebirth. Concurrently, we know that effective anti-HIV treatment reduces transmission (aka TasP, “treatment as prevention”) further emancipated the sex lives of HIV positive people; similarly, PrEP restores freedom of choice and control over prevention to HIV negative people. The identity issue, previously proposed by Guillaume Dustan for HIV positive people, now rears its head again, this time for HIV negatives.

So once again we saw an upsurge in debate over gay desire, but this time against HIV negatives. Truvada Whores, those [naughty] HIV negatives who choose to foreground their desire, are stigmatized. Seriously though. The stigma machine is once again geared up: and what about STIs? We should double-up on protection, etc. etc. Because, obviously, HIV negative people asking for PrEP are dangerous. HIV negative people using PrEP are claiming their rights to construct a pleasure-based identity that is true to themselves, that escapes old-fashioned notions of State sanctioning, and that frees their sexuality from a lifetime of relying on condoms as the be-all and end-all of safe sex. Above all, we notice that the fight for the preventive (pre-exposure) pill outlines the very territory male homosexuals occupy politically. It goes without saying that PrEP was conceived by medical research using the iPrEx, Proud, and Ipergay studies as primarily for men who have sex with men.

Two major outcomes ensue: on the one hand, while condoms were always the universal solution, i.e. equally applicable to straight and gay men, PrEP was conceived for use primarily by gays. As a noteworthy aside, women in the US have started using PrEP now. The other major outcome has been that discourse around the preventive pill has brought together almost all LGBT subcultures (gays, bears, queers, lesbians, bisexuals of genders), highlighting intersections between groups that may turn out to be useful for political action, since transgender and intersex people, or people whose identities are intersectional (FTM or intersex bears, for example) are all taking part in the discussion as they perceive it equally relevant to themselves.[1]  Whether it’s about the contraceptive pill, hormones, PrEP, or various classes of antianxiety and antidepressant medications, contemporary pharmacology calls for people take part in the brave new world, which in itself is a major aspect of the new biopolitics in action.

Sooner or later, it is certain that women, particularly immigrant women, will also wish to start using PrEP, further blurring the political and identitarian boundaries established by the state apparatus. One might compare the struggle for the preventive pill to the fight for same-sex unions in France (the debate over same-sex marriage having been resolved a decade ago in Canada, and in 2015 in the US) The original contract that was fought for by LGBT activists – to provide legal protections for same sex couples similar to marriage – ended up taking the form of a universally available contract that is now accessible to gays and straights. And both groups now avail themselves of it. Even if PrEP is currently being fought for by gay men, we at Warning believe it should be available to all those who desire it.

Hence the preventive pill becomes a political tool for putting identities of diverse types into the same boat, talking about the same topic. There is a unity that overrides the diversity here which will likely disturb those who have tried for many years to divide and compartmentalize various identity struggles and political discourses.

The struggle for PrEP, i.e. for the preventive pill, is not over. In Canada, the maker of Truvada has just submitted a formal request to Health Canada to allow it to be prescribed specifically as a pre-exposure prophylactic.[2] This will likely spark a logical next question of how the provinces will react in terms of drug coverage: will they try and limit access? In Québec, will we start clamping down on informal Truvada use as PrEP? Meanwhile, in France, the “temporary recommended use” clause that would have widened access to PrEP has not been decided, and some say Health Minister Marisol Touraine is likely to block it. What we see now is a resurgence of the same backlash that women have experienced. There are now a profusion of committees and expert testimonials to do whatever they can to impede access to PrEP. The push-back is coming just as heavily from certain AIDS organizations and LGBT groups as from governmental agencies. This is because these NGOs and agencies know all too well that the preventive pill will clear the chessboard and re-engage people in a reflection on their sexuality in a way that is outside the box and unhindered by presuppositions.

We at Warning have decided to step into the fray, to get dirty, to rid ourselves of yesterday’s and today’s moralizing, and throw all of our political and activist power into furthering this struggle.

Our bodies, our health, our sexuality: all ours.

The original title of this article by Georges Sidéris – published before WHO’s recent position – was Identité pilulaire.

Traduction : Séro.Syndicat // Blood.Union – BUSS Montréal

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[1] We could mention specific specialized Facebook PrEP user group as an example.
[2] « Regulatory applications for Truvada for PrEP were filed in South Africa in 2013, in Thailand and Brazil in 2014 and in Australia and Canada in 2015. At the request of the French National Agency for Medicines and Health Products Safety (ANSM), Gilead also has provided data to permit an assessment of Truvada for a PrEP indication, which could result in a recommendation for temporary use in France«