The Dearth of the Clinic

This is an extended version of an essay that originally appeared in Compact.

Just what is it that makes the QR code so different, so appealing?

Tap your card to check in. Scan your QR code to verify your vaccination status. Use our app to report your symptoms. Receive your results by text message within 48 hours. We’ll notify your recent contacts on your behalf. These sequences became familiar to all of us in 2020. But to the many thousands of mostly gay men accessing sexual-health services in some of London’s busiest clinics, they have been routine for years. In 2022, such ‘management’ of sexual health looks like the perfect rehearsal for the generalized biopolitics which has become the norm for all. Gay men’s observance of the clinic’s commandments has undoubtedly contributed to bringing the rates of HIV and other sexually transmitted infections under control. It has also made sex feel more consequence-free than ever. But this comes at a cost: Monkeypox exposes the catastrophic trade-off between technocratic biopolitical rule and our own, compromised ability to act as moral agents. Will the affected populations do as they’re told and queue up for the pox jabs in exchange for the illusion of moral certainty as billions did during Covid?

Even though the World Health Organization is now crowd-sourcing a new name for the disease to “avoid offense”, Monkeypox once again raises the tension between control of populations and individual behaviour. Should risk-taking gay men be expected to take specific precautions or to curtail their sexual behaviour, particularly given that the Monkeypox vaccine is in short supply? Entire populations were commanded to obey extremely restrictive rules in the name of the vulnerable during Covid, yet there has been a reluctance to openly consider the same logic when it comes to gay men. 

The state has proved it is not above applying draconian social and psychological pressure on subjects to conform, even where evidence for the value of such conformity is severely lacking. When the British government consulted its behaviour sciences expert unit in March 2020, its advice was to increase “the perceived level of personal threat” from Covid, advice which the body’s members later described its work as “unethical” and “totalitarian”. But because these interventions were justified as crucial to protecting the vulnerable, any kind of psychological manipulation seemed acceptable. But we are far more squeamish when it comes to the ways in which people express their desire. Why?

People have sex. They have a lot more sex than one may imagine, and they likely have even weirder sex now than Kinsey captured in his Reports in the 1940s. The recognition of this fact gave rise in the twentieth century to numerous social technologies that sought to regulate it. The high cost of unwanted pregnancy, for example, meant that avoiding sex before marriage was common sense prior to the introduction of contraception but not since. The lack of recognition of the variety of human sexuality, on the other hand, has sparked plenty of conflicts because even in the most restrained of societies, breaches of the sexual protocol are commonplace. 

Unregulated sex continues to carry other costs, with the alarmingly high rates of teenage pregnancies in the UK at the turn of the century one example. It also brings about an escalation in the spread of sexually transmitted diseases, some of which, like Chlamydia, have become so commonplace that they are both easy to ignore and a threat to antibiotic resistance. Others, like HPV or even HIV, have become largely preventable for developed healthcare systems. But like every new outbreak, Monkeypox tests the efficiency of the technical preventive and treatment protocols in tension with the fading moral basis for social interventions into the private lives of others. To keep up, new social and biological technologies for mitigating emergent risks are continuously being invented.

Photo: NIAD

With teen pregnancies, the state’s intervention depended mostly on moral imperatives propagated through sex education. However, when it comes to solving either the more prevalent or the now more pharmacologically-controllable problems like HIV, the state’s apparatus relies on a libertarian paternalist ‘nudge’. The nudge aims to make an individual’s interaction with the healthcare regime simple and convenient, if not ritualistic. 

This text was published in Compact behind a paywall.

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Main image: Richard Hamilton, Just what is it that makes today’s homes so different, so appealing?, 1956