Niamh Stephenson

Escape routes : control and subversion in the twenty-first century

Acknowledgements List of figures Prologue I THE POLITICAL CONSTITUTION OF THE PRESENT 1. Sovereignty and control reconsidered 2. Escape! II A CONTEMPORARY ITINERARY OF ESCAPE 3. Life and experience 4. Mobility and migration 5. Labour and precarity References Index

Between Individual Agency and Structure in HIV Prevention: Understanding the Middle Ground of Social Practice

When HIV prevention targets risk and vulnerability, it focuses on individual agency and social structures, ignoring the centrality of community in effective HIV prevention. The neoliberal concept of risk assumes individuals are rational agents who act on information provided to them regarding HIV transmission. This individualistic framework does not recognize the communities in which people act and connect. The concept of vulnerability on the other hand acknowledges the social world, but mainly as social barriers that make it difficult for individuals to act. Neither approach to HIV prevention offers understanding of community practices or collective agency, both central to success in HIV prevention to date. Drawing on examples of the social transformation achieved by community action in Australia and Brazil, this article focuses on this middle ground and its role in effective HIV prevention.

Meaningful evaluation of sex and relationship education

Effective sex and relationship education promotes agency and targets sexual practice as it is socially produced. The aim of evaluation therefore is to contribute to good sexual health through identifying when and how education is promoting agency and changes in sexual practice. Good evaluation takes account of the complexities of the specific object being addressed—sexual practice—which is fluid and essentially social. Innovative study design and the use of rigorous and transparent methods enable evaluators to track and understand the slow, unsteady and sometimes unpredictable mechanisms of change. The data gathered (both quantitative and qualitative) require interpretation, and interpretations inform the development of sex and relationship education programmes. Randomised controlled trials do not meet these criteria of meaningful evaluation, nor do evaluations of one‐off interventions. This paper considers the role of cross‐sectional and longitudinal surveys, in‐depth qualitative studies, and reviews in evaluating whether education works, how it works, how its messages are being actively taken up and transformed by the target population, and in informing the development of future education.

Risk, Insurance, Preparedness and the Disappearance of the Population: The Case of Pandemic Influenza

The Australian response to the threat of pandemic influenza is part of a broader shift in public health and governance. This shift in approach to risk – from insurance to preparedness – has been triggered by the emergence of incalculable, global, catastrophic risks. Familiar, insurance-driven approaches to governing risk work by intervening at the level of the population. However, incalculable risks of the scale posed by pandemic influenza exceed the scope of insurance. Now preparedness driven approaches are coming to the fore in public health. Preparedness focuses on protecting infrastructures and on guaranteeing the continuity of the political and economic order, and it entails discontinuous, temporal and localised expert responses. Importantly, this approach suggests that there is no need to look at the socio-historical contexts of disease; the population is of little direct concern. This, we suggest, raises doubts about how public health strategies which unfold in accordance with preparedness will recognise and tackle inequities. Finally, we consider the imperative to ‘secure the nation’ that preparedness brings to public health.

Living history, undoing linearity: memory‐work as a research method in the social sciences

If we accept that social research is not simply a matter of representation, but involves actively intervening in and constructing our current social and political conditions, we are then presented with a set of problems about representation and intervention. The methodology, memory‐work, is introduced here as one specifically developed for the purposes of undertaking politically engaged social research. In this paper, I describe the rationale and method of memory‐work, emphasizing the ways in which it involves undoing the subject of linear, causal, biographical narratives and a notion of the subject as collectively constituted. I elucidate the method by drawing on an example from research about HIV subjectification in which the notion of individual responsibility arose as a problem for memory‐workers—it simultaneously enables and constrains actively working on oneself and ones world. Discussing this research leads to a consideration of the ways in which the methodology needs to be adapted to reflect the specific concerns of ones time and place. I conclude with a discussion of the important but limited notion of history entailed in the original conception of memory‐work.

Interrupting Neo-liberal Subjectivities

... [I]t is fatal for anyone who writes to think of their sex. It is fatal to be a man or woman pure and simple ... It is fatal for a woman to lay the least stress on any grievance; to plead even with justice any cause; in any way to speak consciously as a woman. And fatal is no figure of speech; for anything written with that conscious bias is doomed to death. It ceases to be fertilized ... it cannot grow in the minds of others ... The whole of the mind must lie wide open if we are to get the sense that the writer is communicating his experience with perfect fullness (Woolf, 1993/1929, p. 169).

Compliant, complacent or panicked? Investigating the problematisation of the Australian general public in pandemic influenza control

This article examines how pandemic influenza control policies interpellate the public. We analyse Australian pandemic control documents and key informant interviews, with reference to the H1N1 virus in 2009. Our analysis suggests that the episodic and uncertain features of pandemic influenza give control measures a pronounced tactical character. The general public is seen as passive and, in some cases, vulnerable to pandemic influenza. Communication focuses on promoting public compliance with prescribed guidelines, but without inspiring complacency, panic or other unruly responses. These assumptions depend, however, on a limited social imaginary of publics responding to pandemics. Drawing on Foucault, we consider how it is that these assumptions regarding the public responses to pandemics have taken their present form. We show that the virological modelling used in planning and health securitisation both separate pandemic control from its publics. Further, these approaches to planning rely on a restricted view of human agency and therefore preclude alternatives to compliance-complacency-panic and, as we suggest, compromise pandemic control. On this basis we argue that effective pandemic control requires a systematic dialogue with the publics it seeks to prepare in anticipation of the event of pandemic influenza.

Living with HIV and negotiating psychological discourse

Since the introduction of antiretroviral drug treatments, there has been increased interest in the psychological aspects of living with HIV and a growth of related research and therapeutic literature. While there has been concern about the ‘remedicalization’ of HIV, there is apparently less concern about its ‘psychologization’. This article considers how the expansion of psychological discourse about HIV impacts on the lives of HIV-positive people in the era of contemporary treatments. Through analysis of group discussions with HIV-positive gay men, we examine how psychological strategies and terminology are adopted or reworked to cope with the uncertainties of living with HIV. We consider both the enabling and constraining effects of psychological modes of regulation, as they are taken up and reworked by HIV-positive people. Our analysis suggests a need for greater scrutiny of the ways in which psychological techniques are employed as solutions to the ambiguities of living with HIV.

Emerging Infectious Disease/Emerging forms of Biological Sovereignty

Public health responses to emerging infectious disease (EID) rarely try to interrupt the mobility of goods and information. Rather, designed under the rubric of ‘‘public health security,’’ they extend the rationale of free circulation through efforts to intensify movement and communication between international agencies, national health (and defence) departments, and the pharmaceutical industry. In this way, public health security extends postliberal modes of transnational regulation. This article examines an unfolding scenario which is testing public health’s fidelity to the ethos of international trade agreements: Indonesia has withdrawn from the World Health Organization’s (WHO) ‘‘virus-sharing’’ scheme because WHO has facilitated the use of Indonesian samples of H5N1 for the commercial development of potentially profitable vaccines without consultation with the Indonesian labs in which they originated. It has been argued that the Indonesian move is one that contests the current securitization of global health. However, I argue that what we are witnessing is the process of emergence of a distinct form of biological sovereignty in the form of rival global health security aggregates, each working to inject a new form of postliberal sovereignty into the field of global public health.

Sidestepping questions of legitimacy: How community representatives manoeuvre to effect change in a health service

Empirical studies of community participation in health services commonly tie effectiveness to the perceived legitimacy of community representatives among health staff. This article examines the underlying assumption that legitimacy is the major pathway to influence for community representatives. It takes a different vantage point from previous research in its examination of data (primarily through 34 in-depth interviews, observation and recording of 26 meetings and other interactions documented in field notes) from a 3-year study of community representatives’ action in a large health region in Australia. The analysis primarily deploys Michel de Certeau’s ideas of Strategy and Tactic to understand the action and effects of the generally ‘weaker players’ in the spaces and places dominated by powerful institutions. Through this lens, we can see the points where community representatives are active participants following their own agenda, tactically capitalising on cracks in the armour of the health service to seize opportunities that present themselves in time to effect change. Being able to see community representatives as active producers of change, not simply passengers following the path of the health service, challenges how we view the success of community participation in health.