HIV/AIDS and the Public Health Paradox

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Abstract

Three decades of public health and health promotion policies and programs, in Nova Scotia, have aimed to reduce the rate of new HIV infections. Yet, gay men in this province continue to experience the highest rates of HIV transmission and have the highest proportion of people living with this disease in Canada. In this paper, the authors employ a Foucauldian conceptual framework and a qualitative post-structural discourse analysis to examine the role of public health in HIV messaging and how this has shaped our knowledge and understanding of gay men in the modern age of HIV/AIDS. Seventeen HIV activists in Nova Scotia were interviewed, and the transcripts are the textual source of the discourse analysis. An investigation of local public health efforts can illustrate the impact of the often-unseen dimensions of power and also the unintended consequences of health messaging on target populations. The findings suggest that public health efforts aimed at HIV prevention and stigma reduction are neither apolitical nor neutral. Rather, while these public policy efforts are aimed at HIV prevention, by attempting to regulate sexual subjectivities, they have become a form of discourse that has entered into the subject experience of gay men. This paper explores some of the ways in which public health HIV discourse impacts the subject experience by examining the effects of mainstreaming HIV messaging, sanitizing messaging for public consumption, and avoiding candid discussions about gay men’s sexual practices in the context of public health.