Lisa Jean Moore, PhD

Center for AIDS Prevention Studies, UCSF


Producing Safer Sex: Knowledge, Latex Technologies and Sex Workers in the Age of AIDS


On the eve of the twenty-first century, diverse communities are facing a future of managing the AIDS epidemic. Behavior modification has become the primary method to curb the transmission of HIV and safer sex has emerged as a collection of practices and ideas deployed to combat the spread of AIDS. My dissertation, upon which this presentation is based, investigates the creation and permutations of safer sex represented throughout the past decade.
Using qualitative research methods, including grounded theory, ethnography, and content and discourse analyses, my work demonstrates that there are multiple meanings of safer sex. Data from three groups which produce safer sex information are analyzed: the Centers for Disease Control's public service announcements, sex manuals and sex workers' narratives. My focus shifts to center on analysis of 27 interviews conducted with people in the sex trade. Since sex workers make it their business to exchange sexual services for economic compensation, many have become sophisticated in their innovations and expressions of eroticism using safer sex techniques. Sex workers are one of a group of key knowledge producers focused on elaborating safer sexual practices. Their worlds are metaphoric laboratories for empirical studies of emergent sexual practices.


There are three objectives of this research. First, the project describes the invention, deployment, and maintenance of safer sex as knowledge and technology situated in everyday life. Second, it identifies some consequences of using safer sex for individuals' self-perception. Sex workers experience transformations of professional identity when appropriating, inventing and transmitting safer sex practices and innovating tools for their work. Third, the project analyzes and criticizes some current prevention messages and reveals underlying ideologies which sustain these messages.


Knowledge and technology are produced through social interaction of multiple sets of actors. This dissertation demonstrates how hidden or unacknowledged communities of production, indigenous knowledge producers, can appropriate existing forms of knowledge and participate in creating new practices and technologies including transmitting this information to others. Again, this dissertation is an investigation into one consequence of the international pandemic: That is, the production of systems of knowledge by particular groups of experts who claim and practice competency in their everyday lives (Aronson 1984).
In the remaining time for my presentation, I am going to present a sketch of my dissertation highlighting what I feel might be some of the contributions of my work to scholarship about knowledge production, identity transformation and technology innovation and use.

KNOWLEDGE


In order to begin my dissertation on the knowledge of safer sex, I started collecting information about safer sex from different knowledge producers. It is important to understand the construction of safer sex in these different social worlds because they have simultaneously represent particular social relations and encourage a specific constellations of social relations to thrive.
If knowledge about safer sex is not viewed as connected to ideologies and agendas of these actors, we can lose site of the stakes in producing the messages and practices. In other words, safer sex is produced in a world that already exists with power differentials. Certain types of safer sex messages and knowledges supports these power arrangements, certain messages attempt to dismantle them, leaving new ones in their place. Although the production of safer sex is done by different actors with different agendas, some of the resulting messages are similar. For example, all rely on constructing the individual as potentially ultimately capable of doing safer sex. It is up to each individual person. But something in is certainly missing in this construction. By relying on the construction of the individual as a flexible risk manager, the individual is often taken out of the social context. We do not all reside in places where control and information are so readily available.


First, the CDC's PSAs have an anticipated large audience. These messages establish dichotomous constructions of safer sex as entailing either a commitment to abstinence or an unproblematized adoption of consistent and correct condom usage. These messages are aimed at a presumably young (18-25 year old), heterosexual, ethnically diverse audience. Within these short, slick, precautionary advertisements, safer sex is a prevention tactic to avoid a deadly virus. It is not presented as an extension of one's sexuality, as in sex manuals and by sex workers. Rather, choosing between two alternatives is the simplistic message of the PSAs without regard to the mitigating circumstances within which we live our lives.


Second, sex manuals although less accessible to the general population, can more explicitly address safer sex. Although there are abundant differences in style and approach, these manuals rely on relatively similar standards to engage their readers: sex information, differentiated risk lists, advice regarding latex, including self empowerment and self esteem exercises and advice. Simultaneously, they represent a historical phenomena of late twentieth century American society. At a critical time of health care economic devastation, they promote crusades for perfect individual bodies and social reformation and in turn create new and bolster extant standards by which to judge our sexual practices, our corporeality and our political convictions.


Third, sex workers, probably the least accessible source of information about safer sex to a large audience, present the actual embodiment of safer sex within the work that they do. Safer sex is indeed part of a regimen of health awareness within sex work. Since sex workers must rely on their health for their financial compensation, they develop strategies to maintain their well-being while serving clients' interests. At the same time, safer sex has been appropriated as a specialized knowledge toward goals of professionalization. Sex workers advertise their aptitude and expertise, develop different strategies to incorporate safer sex within the sexual session and teach clients to become whore-educated guys. This safer sex in action, attested by these sex workers' accounts, encompasses a broad range of variation in activities. Safer sex is presented as an ongoing performance which varies from client to client. It is an enactment which is situated within specific conditions of immediate environments and not related to an absolutist message, like the PSAs.
What are some of the effects of these three sites of knowledge production about safer sex and our society in general? Despite their differences in presentation, method and messages, these sites are mutually constitutive forces in creating knowledge of safer sex. There are varying degrees of interaction between the three sites: sex workers call the CDC and read sex manuals, sex manuals cite sex worker practices and CDC information. Additionally, audiences have the potential of taking in information from all of these sources. Sex workers' knowledge about safer sex formed with and transmitted to their clients, and their clients' subsequent interactions beyond the work dyad, have the potential to filtrate this knowledge to other social worlds and larger arenas. The boundaries between these knowledge producers are porous, therefore audiences can develop their own cumulative and sometimes contradictory conceptualization of safer sex. In this vein, safer sex has become a complex system of information, produced by different sources with different agendas and available for consumption on television, the radio, through books and printed materials and interactions with others. Taken together, these three sources of knowledge production may filter into broader transformations in thinking about health and the human body in the time of epidemic. These messages, the proliferation of safer sex concepts, point to changes in how we view ourselves within contemporary arrangements of sexuality.


TRANSFORMATION OF IDENTITY: BECOMING A COMPETENT PRACTITIONER


My research then focused more intensely on my interviews with 27 interviews with 19 sex workers. You might be asking yourself, who were these sex workers that I interviewed.


Gender:
17 women and 2 men.

Sexual Identity:
4 heterosexual or ìbasically straightî
5 bisexual
1 fluid
2 ìpan sexualî
2 lesbian (ìlast country dykeî)
1 gay
1 not identify (ìI don't identify that wayî)
3 queer

Age range:
24-56 (most were in their mid to late 30s)

Length of time
6 months to 25 years average 5-8 years

Pay:
$250-300 hour and men $100-150

Racial/ethnic identity:
14 white/Caucasian--This was the least specified group. ("Irish", immigrants from European countries)
1 African American
1 "Mixed race, I am basically a mutt of many different things. Part Puerto Rican, part English."
1 "Half Native American"
1 "Half Rumanian"
1 "Part Cuban"

It is crucial to situate these informants within the conditions of sex work as these conditions foster a greater level of sex worker control; these workers set their own parameters regarding safer sex. These informants often compare their situation with the ìgirls and boys on the streetsî suggesting that the street environment is not as conducive to enforcing safer sex. My informants were aware of their high level of control of the interaction--based on their organizing the sexual encounter, often on their own turf. Further, their higher cost meant that a particular type of clientele responded to the ads. When discussing negotiation of safer sex, Gina explains, "I think that it is more problematic for sex workers who feel they don't have as much control or experience. And unfortunately the laws increase their risk because it is more difficult to spread information. And some of them are not feeling like they have any control. They are younger, more easy to intimidate. I guess I am also drawing a distinction here between professional prostitutes and those that are doing it for drugs or other stuff and not really a career." When thinking about negotiating safer sex and sexual encounters in general, Quincy asks "how empowered is somebody to think sexuality is under their control in the first place." In other words, my informants are working under specific conditions which enable them to negotiate safer sex in particular and controlled ways. Their age, their clientele, the price range, the location and work experiences enable them certain power to choreograph the sexual encounter.


These conditions of sex work provide the scaffolding upon which networks and resources can be built. Sex workers can and do communicate through casual connections, community based organizations and political organizing. Responding to the social organization of AIDS has created a "shock of identityî (Treichler 1988a) in which there have been subtle and dramatic shifts in how these individuals formulate, understand and adjust their identities. When one is in the business of human sexual interaction, achieving and selling competency in safer sex is imperative to livelihood. How is it that these sex workers become competent professionals within safer sex and maintain this competency with changing conceptions of AIDS/HIV? What are the basic social processes that enables these transformations of selves?


In general, latex device failure stories follow the emotional and physical retrospective reactions of the sex worker to the realization that a device has slipped or broken. Blame for the break or slip is usually not placed on the individual sex worker in the session, and clients may be blamed initially. It is eventually concluded that several other factors may lead to latex deterioration. Primarily latex device failure stories have to do with condoms. Some fall off after strenuous sexual activity. Condoms break either because of contact with oil-based products (i.e. massage oil and Vaseline) as Anne describes: "I was doing a massage and some of the oil must have gone from my hands to the condom." Condoms also break because of faulty material construction: "it just wore out."
In the following excerpted interview transcript of a 35 year old, six year veteran prostitute, Michelle describes to me what she did and felt about herself in two different condom failure situations. Her self-portrayal reveals a transformed self emerging from one situation to the next. There is a shift from the inexperienced self to the experienced self, from the "freaked outî and hysterical self to the calm and composed self.


During this section of the interview at Michelle's home and work space, we had been discussing latex devices and passing them back and forth between each other. She held up a condom and said, "Not even these are all safe. I had one or two breaks."

Lisa: When it broke what did you do?
Michelle: Freak.
Oh no, you know, I can't...

4-6 Abstract
I used to freak in front of clients.
The first time one broke on me,
actually it didn't break it fell off.
I was having,

7-10 Orientation
I was working with my girlfriend doing a double
I was just learning the ropes
and it was doggy style

11-20 Complicating Action
and the condom got lost inside of me
and the guy ejaculated inside of me
I...was...ahhh...just...shattered.
So I'm in the bathtub, you know,
trying to clean myself up,
I am crying
and I was screaming.
She's made the customer leave.
She's trying to console me,

20-51 Evaluation
and of course, I just hated that guy at that point,
I hated his guts,
I wanted to kill him.
And the reason that I felt hostility towards him is
because usually if something happens, if something happens a lot of times
the guy is largely responsible for it.
He's either getting too rough,
too rambunctious,
he's getting pushy or bossy,
"I want it in this position,
no, roll over, do this,"
you know, something like that,
um, or he's really trying to get way too much for his money.
Like he wants to fuck you for a half an hour
before he comes,
that sort of thing.
And so you're putting up with it,
and putting up with it
because on some level you put up with a certain amount all the time,
I mean you know,
I'd love it if they'd just give me $250
and talk to me
and left,
so on some level, you know, I'm enduring a certain amount of interaction.
And then it becomes that
you have to catch yourself
to make sure you don't start connecting more than you should,
and sometimes it's a real judgment call,
you know, where's that boundary.
So in this particular case
I was just still trying to feel things out,
I didn't know what I was doing.

52-58 Result
And now when I do doggy style
I usually always put my hand back there,
I will not let go of the base of the penis
because I keep ahold of the condom
because I cannot --
I have no control what they're doing back there
and from experience I know

59-61 Coda
there's just too much chance of pulling out of the condom
and leaving the condom stuck in me
and then now you know, it's dripping all over the place, no thank you.
Lisa: So when it broke...

63 Abstract
Michelle: This guy did not ejaculate,

64-67 Orientation
he didn't ejaculate the whole time he was here,
but, and he wasn't one of those guys whose like a oozy, lots of pre- ejaculate,
in fact I never saw any pre-ejaculate with the condom on,
but I'm sure there was pre-ejaculate in the condom
once it had been on for awhile.

69-75 Complicating Action
He, for some reason, had a hard, hard time coming...
Lisa: Did he know when it broke?
Michelle: I don't think so.
I think his dick was just numb. (laughter)
It was just hard and numb.
For all I know he probably did a popsicle on me,
like stick some coke on it before he got here.

76-79 Result
Because that thing -- it wouldn't go off,
I couldn't get -- and I did everything.
And the reason the condom broke in my opinion is because he just, it , it =
Lisa: =Wore it out.
Michelle: Yeah, it reached the end of its life.

81-97 Evaluation
And what I learned from that
it was the first time those condoms had broke,
and I kind of had the feeling those particular brand was invincible,
I wasn't sure they could break.
Now I know they can,
given the right circumstances,
And I also --
you know, again, every so often we take chances
or get sloppy about our work.
You know, you might leave your money laying out,
might turn your back on a client,
might let him bring in a briefcase or a backpack or something.
And then you have a close call
and you realize -- remember to be careful.



In this excerpt, Michelle is telling two stories. In the first story, the condom fell off and got lost inside of her as she was "learning the ropesî with a doubles partner. During this recounting of a previous experience, she expressed a lot of emotion. She admits that "I didn't know what I was doing." The evaluation was to change her physical ritual in sex acts and to re-evaluate her level of trust. She learns how to work with clients' bodies and the need to keep emotional distance. In the second story, the condom broke but the client didn't come--the condom just wore out. She was calmer and more in control. Michelle views this latex failure as a wake up call to "remember to be carefulî in everything that she does including several factors in her list of occupational hazards. In the first story, she blames herself as being too inexperienced and vulnerable being manipulated or controlled by clients. She is out of control and cannot direct the situation. She used to freak but does not any more. In her more recent story, she blames the client for complicating the situation in a nefarious way and the limited life span of the device itself. Her own identity, always in the process of becoming through this transformation of self, must remember that if you get sloppy about work, then you may increase your chance of certain risks. AIDS/HIV is one of a list of risks sex workers confront.

Refining one's self concept as a safer sex worker may involve a "scaryî experience in which individuals internalized standards of safety are violated. Practice over time and
"scaryî turning points both encourage sex workers to shape themselves into competent, experienced and empowered safer sex workers. "Scaryî experiences of latex failure can be more easily integrated into the work scenario instead of "freaking out in front of clientsî and routines can be relied upon as skillful illustrations of one's professionalism.

Becoming a competent sex worker is a complicated process requiring the alignment of many conditions. These informants individually and collectively (as a profession) stake a claim in safer sex competency. This claim staking takes place though the continuous reflexive evaluation of the sexual biography, the combination of previous and ongoing sexual interactions with clients and lovers. In order to practice safer sex, these sex workers must be able to take charge in the sexual session, deploy latex devices, and set boundaries in client-worker relationships. Safer sex becomes a practice, a component of embodied identity and series of meanings applied to particular situations. It can be transmitted to others and used to continuously reconfigure the self. Sex workers are amazingly adaptable people developing skills and internal mechanisms to figure out how to remain working in a dangerous environment. One way to maintain safety within dangerous environments is through the manipulation, innovation and incorporation of latex devices within sexual sessions.

TECHNOLOGIES

Tools of the trade: "It's like you use pots and pans to cook. It's the tool."
Male Condom
Female Condom
Gloves
Dental Dams/Saran Wrap

What I found through my interviews and playful discussions about each latex devices is that these devices emerge in the interactive work of communities of practice. There is not one singular individual who invented and innovated these devices. Rather there are collectivities of users who generate applications and meanings of these devices through their imaginative work practices and work sharing. Some devices are fairly stable, like the use of male condoms in sexual intercourse. However, sex workers have interesting relationships with other latex devices.

Other devices are at varying points of coming to matter or being stabilized. Female condoms are at the earliest stage of integration into sexual practices. The novelty of the device, the expense and the difficulty of application make the device less well liked and less used. Dental dams and saran wrap have a mixed reception by this community of practice. The lack of scientific research and evidence about oral transmission of HIV in oral sex with women does not encourage workers to be vigilant about controlling vaginal secretions and saliva. Dams and saran wrap as devices are periodically used on a case by case basis and they are constantly innovated to make them easier to use and apply. For example, latex gloves are altered to create grips for use in oral sex.

Configuration of the user, that is creating new users of the technologies and thus practices of safer sex, is a multi-level process. At the same time that sex workers are configured by the latex technologies, in that they modify their practices to accommodate latex (putting condoms on with mouth), sex workers configure new users. Sex workers, through transferring technology and configuring new users are turning clients into abiding citizens of safer sex. Once themselves disciplined or configured by the technologies, they become the technologies or machine (in a sense) and further the discipline. Successful configuration has much to do with associating latex with pleasure and creating particular conditions in the interaction that enable the client to feel cared for. As Quincy states, associating latex with particularly pleasurable activity enables sex workers to more successfully integrate the device into an activity. "Using latex is a promise, using saran wrap is a promise, saying now this thing gets to happen. I like it as a sex signifier." Fulfilling the promise is one way sex workers configure users to safer sex.

Understanding the innovations and configurations of these devices and their users is not merely an academic area of inquiry. These devices are crucial components of the production of safer sex, featured in the messages and prevention rituals of safer sex. In the case of sex work, innovation of technology happens in sites where the innovators are not acknowledged, evidenced in the lack of history around some of the key devices. Configuration is a persistent process where the sex worker is a configured user and an innovative user at the same time and also configures other users. Each innovation requires further configuration of new users, the clients. By understanding the basic social processes of this innovation and configuration, we are able to explore how different social groups develop, re-negotiate, or discard particular devices based on certain criteria. These criteria have to do with cost, ease of application, level of scientific evidence about the device, contribution to pleasure and practice, and ease of integration into the sex act. Configuring users to these technologies further legitimates sex workers' practitioner and expert status at manufacturing and producing safer sex. These tools, innovated in the suggested ways, reside in the professional jurisdiction of sex workers. These sex workers are generous in sharing this highly specialized and crafted relationship with the technologies with new users as souvenirs and reminders of the professional experience.

In conclusion, I have explored the processes of producing knowledge about safer sex. Specifically, I concentrate on exploring certain groups' creation of and interaction with the cultural artifacts of safer sex, discourses and practical applications of the knowledge. I trace the development of safer sex as a series of both divergent and similar messages and ideological commitments. There has been an emergence of self-authorized knowledge producers each contributing to our social understanding of safer sex. In the process of learning about safer sex, there is also an expectation that we will conform to certain agendas of those producing the messages. The CDC, sex manuals, and sex workers have investments in our adherence to their versions of safer sex. My dissertation offers a sociological analysis of the crusade of each of these groups to reach us through the fabrication of profoundly important messages.

Meanings about safer sex will continue to go through moments of relative stability and flux. Within this dissertation, I have explored some of the knowledges, technologies, and identities emerging from the social construction of safer sex. In so doing, I have explored how safer sex is packed with our understandings of health, life, death, power, sexuality, expertise, and professionalism. Unpacking these meanings enables us to envision the complex of knowledge production. Perhaps through our acknowledging, critically evaluating and deploying this knowledge complex, we will be able to attend to the tasks of creating alternate models to transmit valuable information. These models, however, must be self-reflexive, temporary, and flexible to reinterpretation.

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