Speculation: imagining better queer health futures
Recently, the UK government has invested significant capital in AI modelling of ‘healthy futures,’ in an effort to get ahead of potential and unforeseen health risks. Social scientists have investigated the social biases and power dynamics within these models of risk, introducing the need for multiple interpretive methods for thinking about ‘healthy futures’. Engaging this qualitative trend of thinking critically about ‘healthy futures,’ my work questions if it is useful to think about marginalised ‘healthy futures’ among queer communities and if/how speculation might improve interactions between health practitioners and community members.
Using a wide range of visual case studies from the histories of health promotion – composed of professional public health campaigns, community art projects, film, television, and popular media – I follow health promotion practices as they visualise, negotiate, and contest how healthy futures are produced. In this process, I argue that healthy futures are produced largely through forms of contestation between practitioners and community members rather than through (or simply as a result of) data collection and epidemiological modelling. As such, my work attends to the social and cultural dimensions of imagining ‘healthy futures,’ particularly in creating conversations about ‘ending AIDS’ and new HIV transmissions. I theorise and assess how speculation – a process of thinking about the multiple potential futures desired by specific communities, particularly queer communities – enables critical conversations about desired social practices (e.g. sex with multiple partners) whilst maintaining disease prevention strategies.
Specifically, my work explores whether speculative imagery provides effective tools for working towards more equitable exchanges between practitioners and community members – allowing marginalised and subcultural queer voices to guide the conversation. To do this, I attend to the exchanges that occur between public health NGOs and governmental health campaigns and broader cultural and artistic projects that thematise the ‘end of AIDS’. I suggest that accounting for speculative inquiry within a wide range of health promotion practices helps both practitioners and community members to assess the social dimensions of health and the often unarticulated needs and desires of communities who use healthcare services. For instance, it enables questions about medical consumption practices, such as perceptions of long-term use of HIV pre-exposure prophylaxis among gay men, and thus provides researchers with opportunities to rethink how health and care are perceived by service users and the general population. It also critically engages concerns about what communities want and need from healthcare systems, governments, and other community members – and what kinds of social practices people wish to develop for the future.
In one case study, I examine how HIV intervention strategies are transformed to negotiate a world without AIDS in Leo Herrera’s creative web series The Fathers Project (2018-19). Herrera’s ‘sci-fi documentary’ envisions a world where HIV never existed, therefore allowing queer communities to imagine what kind of social, political, and cultural conditions might emerge to enable liberation and inclusion in broader society. Analysing Herrera’s speculative imagery, I interrogate how Herrera transforms HIV prevention practices to confront other STIs, including gonorrhoea and syphilis. In effect, Herrera uses speculative inquiry to foreground the need for a critique of pharmaceutical influence over queer communities and the potential to create more equitable social practices through grassroots health intervention strategies.
Image: A Sister of Perpetual Indulgence performing ritual. Reproduced from still from The Fathers Project by filmmaker and producer Leo Herrera. Project website: https://www.iftheylived.org/
In another case study, I look at the London-based sexual health clinic 56 Dean Street’s health education campaign The Grass is Always Grindr (2018-19) to reflect on how professional health practitioners encourage biomedical adherence (for example, using HIV medicines daily to treat infection) and how this shapes the perceived ‘end of HIV’ in London by aligning individual treatment with a larger desire to live in a world without AIDS. 56DS’s work displays standard narratives about treatment as prevention (e.g. characters taking HIV pre-exposure prophylaxis on screen) and institutional discourses about ‘ending AIDS’ (e.g. representing AIDS memorials that mobilise activist intervention in local communities). This work also contains images of desired futures – particularly new kinds of sexual practices, including open relationships and safer substance use during chemsex – in which the struggle to create a future without AIDS and living daily in a world with new HIV transmissions remain in tension.
Health promotion as collective struggle
At the core of my analysis, I suggest that institutional channels of health promotion – via government bodies, health NGOs, volunteer and community outreach programmes and mutual aid projects – must be brought into conversation with ‘non-institutional’ messages in film, literature, and art, which engages the idea of ‘healthy futures’ as a form of struggle. In doing so, practitioners can better attend to the experiences of living with and among HIV and other STIs. In other words, we should attend to the forms of struggle that occur between practitioners and community members in promoting ‘healthy futures’: recognising that multiple, overlapping and often diverging viewpoints emerge from critical conversations about what futures are imagined and how individuals and communities perceive enacting or at least working toward those futures.
In short, by exploring a range of health promotion materials, I argue for the need to attend the tensions between practitioners and community members. I invite scholars to reconsider the preconceived boundaries between professional health promotion and community perceptions of healthy futures. I suggest that this practice will provide greater nuance for understanding how healthy futures are produced, for which AI models cannot account. In broader context, though my work has focussed specifically on perceived futures of HIV/AIDS since the 1990s, these perspectives on speculative inquiry can be used to assess other experiences of health and illness, including, for instance, perceptions of life after or beyond specific health conditions such as cancer, dementia, Parkinson’s disease, and osteoporosis.
Chase Ledin is a PhD candidate in the Centre for Biomedicine, Self and Society at the University of Edinburgh. His research explores the social and cultural dimensions of ‘post-AIDS’ health promotion in the Global North. You can find him on Twitter @chaseledin.