ABSTRACT
Few events in the modern history of public health have elicited social consequences comparable to those of the HIV epidemic, and even fewer have had such dramatic effects on the way we think about and discuss sexuality. The HIV crisis has brought about dramatic changes in sexual cultures (Martin 1987; Evans et al. 1989), while simultaneously having a powerful impact on the health and social sciences (Patton 1990; Treichler 1988; Rosenbrock et al. 1999), the arts (Crimp 1988; Gott 1995), the women’s and sexual diversity movements (Schneider and Stoller 1995; Jagose 1996) and the fields of both human and health rights (Mann and Tarantola 1998; Mann and Gruskin 1999; Petchesky 2003). As several authors have argued (Watney 1987; Patton 1990; Epstein 1996; Sendziuk 2003), these processes of change were anything but consensual, and implied a complex chain of dialogue, negotiation and struggle involving a large number of institutions and constituencies. The source of disagreement varied with time: from the cause of the crisis, to the best forms of HIV prevention and care, to the responsibilities of the individual and government. Also in tension have been different forms of knowledge, which, based on their specific origin, producers and loyalties, called for contrasting courses of action. Rich understandings emerging from the community response have often been in tension with the scientific evidence (Watney 1990; Escoffier 1999; Rofes 1998; Kippax and Race 2003) posing problems for the consensual integration of knowledge, and reflecting epistemological positionings that are impossible to reconcile (Kippax 2003). While the need to move forward has pushed for solutions and helped to bring about consensus, evolving contexts constantly pose new and often unexpected tensions. The goal of this chapter is to discuss how different epistemological positionings have determined specific forms of knowledge that have shaped the response to HIV, with a special focus on how this has affected both sexuality politics and the evolution of sexual cultures. We will also highlight a number of lessons learned from this analysis and suggest areas in which remaining gaps should be addressed to save time, energy and resources in the response to the epidemic and in the advance of sexual rights.
