Available online at www.sciencedirect.com

International Journal of Drug Policy 19 (2008) 417423

Review

The use of pleasure in harm reducsex

ty of Sygust 20

Abstract

The absen quentlattention to on prapleasure is g aults Hof pleasure w ction bpleasure, an ent thabetween stig ntaininpleasure in ty, carecurrent puni cal meapractices, an ynamipleasures. 2007 Elsevier B.V. All rights reserved.

Keywords: Harm reduction theory; Pleasure; Ethics; Drugs; Self-care; Moralism

Introducti

In this ause of pleas1990). I haharm reducCentre in HPleasures.to reflect csex, drugsplinary prafield of strFoucaultsof disciplin

The Hisframing sothe text is

Tel.: +612E-mail ad

0955-3959/$doi:10.1016/jon

rticle I use the History of Sexuality to discuss theure within harm reduction (Foucault, 1978, 1986,

ve used this text to structure a graduate course ontion theory and practice, based at the NationalIV Social Research, called Bodies, Habits andThe course was designed to encourage students

ritically on the social and political dynamics ofand public health; to develop skills in interdisci-ctice; and to frame their projects within a broaderuggle and intervention. To this end, I combinedwork with readings on sex and drugs from a rangees, including empirical social science.tory of Sexuality provides an excellent basis forcial research and education in this field. Althoughdense, historical and philosophical not the sort

9351 3662; fax: +612 9351 3556.dress: krace@usyd.edu.au.

of thing you are likely to hear much of in the mainstreamfields of public health, social policy and medicine it pro-vides one of the most trenchant and far-reaching analysesof the involvement of the medical and human sciences inthe social maintenance of categories of deviance, normalityand abnormality. It gives us a way of thinking through theregulative and coercive, as well as valuable and life-saving,aspects of health and medicine. This is important in the con-text of infectious diseases such as HIV and Hepatitis C, wheremedicine provides important resources, but can also func-tion as a source of oppression (Race, in press). Combinedwith concepts from the second and third volumes, such asthe use of pleasure and care of the self, the History ofSexuality provides a basis for conceiving how subordinatedgroups might make use of medicine in ways comparativelyless encumbered by the normalizing effects of psychologicaland medical discourses. Enormously influential within HIVactivism around sexuality (Halperin, 1995), the utility of thistext for broader practices of harm reduction and drug pol-icy is yet to be fully realized (Duff, 2004), and takes some

see front matter 2007 Elsevier B.V. All rights reserved..drugpo.2007.08.008from the history ofKane Race

Department of Gender and Cultural Studies, UniversiReceived 23 April 2007; received in revised form 15 Au

ce of pleasure in harm reduction discourse is more and more frepleasure might do. What is the value of pleasure for harm reductirasped, conceptually and methodologically. In this paper I use Foucithin harm reduction. I argue that Foucaults work suggests a distin

d that such a distinction is important for harm reduction to the extma and care in that the latter model raises the possibility of mai

terms of its social pragmatics helps to recognize practices of safetive political environment. It provides a basis for conceiving practid thus have more chance of being taken up. It also enables a more dtion: Perspectivesuality

dney, NSW 2006, Australia07; accepted 17 August 2007

y noted, but few have considered what, exactly, morexis? Central to such an inquiry is the question of howistory of Sexuality to elaborate a perspective on the useetween therapeutic and social-pragmatic approaches tot it seeks to maintain a critical awareness of the relationg de-pathologizing modes of care. An appreciation ofand risk that might otherwise go unregistered in the

sures that are in touch with given concerns and bodilyc and responsive approach to the practice of bodies and

418 K. Race / International Journal of Drug Policy 19 (2008) 417423

imagination (Im happy to say that students generally rise tothe challenge). In this article I provide some thoughts on itsimport for the field, with a view to formulating a perspectiveon the use

Why sexua

Viewedonset of tha mix of ptowards a ndrug use. Rit aims to remeasures s

injecting roraves. Of ctains morapossibilityharm. Butmay not beof HIV infeevents (suction and mitself fromuse per se,able, less dobject (Kegreat refusadherence

What chits commithealth servpathologygroups fromtinguishes hwhich it ofthe 1980s,gram and peducation ascriptions ato drugs orthat patholopolice or neinstead tospective ofa moral deoperation.their potenconditionsvices and sumodificatiocally mediadynamics aoutgrowthusually en

practices around drugs in terms of their potential to give riseto barriers to care. Thus, advocates contest dogmatic prac-tices around drug prevention on the basis of the barriers they

e to acraspin

atic srelat

e of Foal conindiviugh aed ho

hologygrou

rse, tpoliticd up inault cnce,tcome defic; Younowingese prive, thl fieldare ining ouis pe

l stigmc heaue theh inclurm redalley,fic elert knoecessithat whe privure as), whiffirmad plea

sexua

basist his as throuwell

ssionrt discto talsense

nto diof indme yof the pleasure within harm reduction.

lity? Why Foucault?

in terms of its conditions of development at thee AIDS crisis, harm reduction can be defined asrogrammes, principles and policies that striveson-moralized approach to care in the context ofather than seeking to eliminate drug use per se,duce the harms associated with drug use throughuch as needle and syringe exchange, supervisedoms, drug education for users, and pill testing atourse, the categorization of harm inevitably con-l assessments, and some have rightly queried theof achieving a value-neutral approach to drugwhile technically speaking, pure value-neutrality

achievable, the prevention of harm in the orderction, Hepatitis C transmission and other adverseh as overdose), provides a point of differentia-

obilisation whereby harm reduction distinguishesmore moralized approaches to care. It is not drugbut the prevention of these more serious, avoid-isputable harms that harm reduction takes as its

ane, 2003). This can be expressed in terms of aal: the refusal to make public care conditional onto moralized norms around abstinence.aracterizes harm reduction, on this reading, is

ment to providing practical care, education andices irrespective of categories of deviance andthat might otherwise function to exclude certain

public care and responsibility. This is what dis-arm reduction from other approaches to drug use,

ten works alongsidesometimes uneasily. Sinceharm reduction has grown into a broad social pro-ublic health movement that provides life-savingnd care against or despite grander ideological pre-bout how a moral citizen should behave in relationsex. Broadly speaking, it resists those processesgize individuals on the basis of their behavior, orglect them on the basis of their deviance, seeking

provide resources for their care and safety, irre-their imputed moral status. It does not engage in

cipherment of individuals, this is not its mode ofRather, the practices associated with drug use tial to give rise to more or less harm and thein which these emerge or in which access to ser-pport occurs comprise the target of analysis andn. Practices are approached here as sociotechni-ted by particular environments, inter-relationalnd available equipment rather than merely theof personal resolve. In addition, harm reductiontails a critical perspective on certain regulatory

creatG

pragmof thecanc

centrmalThroshowpsycsome

pervesociobounFoucdeviaan ou

innat1968in shin thspectsociatheymark

Thsociapublicritiqwhicof haOMspeciexpethe nlarlyand tpleastionsand aies anhowand aabounismAs isrepreexpementmakesex itruthTellcess to services.g harm reduction in this sort of specificity, as aocial program that maintains a critical awareness

ion between stigma and care, indicates the signifi-ucaults work for the field. For among Foucaultscerns are the historical construction of the abnor-dual and the material effects of this designation.series of historical and critical analyses, Foucaultw the sciences of the human subject (psychiatry,, sociology, etc.) are built upon the derogation ofps in relation to the social order the mad, thehe unproductive. Far from being removed fromal values, these ostensibly objective sciences arethe social attribution of deviance. In this respect,

an be read alongside the work of sociologists ofwho were concerned to show how deviance ise of processes of social labeling (rather than anyiency of individuals) (Becker, 1963; MacIntosh,g, 1971). But Foucaults work goes much further,how the medical and human sciences participateocesses of social categorization. From this per-e sociomedical sciences cannot stand outside theas the impartial corrective of cultural prejudice:

timately involved in the distribution of prejudicet normal and abnormal individuals.

rspective on medical practice and its relation toa prompts some reflexivity about the effects of

lth regimes. But while Foucault if often used toregulatory effects of public health an approachdes a number of valuable and important analysesuction (Fraser, 2004; Miller, 2001; Moore, 2004;

1999) the History of Sexuality takes aim at morements of the way pleasure and desire enter intowledge. This enables a reading that emphasizesty of ongoing critical work in this area (particu-hich attends to harm reductions regulatory effectsatization of responsibility, health, personhood andsociated with certain of its discourses and institu-le at the same time introducing a more dynamictive perspective on the social pragmatics of bod-sures. Foucault is concerned in this work to show

lity emerged as an object of scientific knowledgefor categorizing individuals. But what is originalrgument is his analysis of the specific mecha-gh which the individual is bound up with power.

known, Foucault rejects the idea of an historicalof sex by pointing to the massive proliferation ofourses about sex. These include a general incite-k about sex, and a specification of who gets toof it, and with what effects. It is the putting of

scourses that purport to be able to determine theividuals that is at the heart of Foucaults critique:our desire and I will tell you what you are. His

K. Race / International Journal of Drug Policy 19 (2008) 417423 419

focus, in other words, is the way sexuality and sexual desirebecome available to determine the truth of individuals. Whatconcerns Foucault is how individual disclosures around sexand desireclassify theof pleasureof therapeucentrally pr

In ordesketches twput to worars eroticaand easternfrom teacheinstructionsure and at(which Fouand desirethe hands ouses this inas normal ocault assocmakes sexuthe truth efthe individallocates thment, the pthat there aand subjectticular relaparticular s

What ispractices ocategory thit is not cleand subjectcategory ofsort of histrespect of swork of thiSedgwick,reasons fortive for, ifreduction.level for exaversion toprograms sthe primaryviduals deconcern. Rconditionsof intervenvidual as suindividual1999). In tbetween d

terms of how they entrench individualizing and typecastingtendencies.

But another reason for highlighting this work within theis the

riencesubjection assionxtent,ibutinon the

xamplt howrticle,as etespect

use of

the finFoucang poes anxaminn thisand hault hure, sineryea tha

es andand e

dies ae keyes aneen prt knowe, therlinkinoanal

s strucumanould n

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ive exormsh wer, withncum

not mare used to categorize and rank individuals tom as normal or pathological. Thus, the insertionand desire into normalizing regimes at the handstic discourses such as psychoanalysis is seen asoblematic.

r to specify the focus of his critique, Foucaulto different models whereby sex and pleasure arek for the purposes of learning. In the first, the(which Foucault associates with certain ancientcultures), the ways of pleasure are passed downr to novice, for no other reason than initiation andin certain techniques aimed at maximizing plea-taining bliss. In the second, the scientia sexualiscault associates with the modern West) pleasure

become subject to disclosure and decipherment atf a confessoror, in later times, an expert, whoformation to absolve or diagnose the individualr pathological. It is this latter model which Fou-

iates with the modern regime of power, and whichality such an effective vehicle for power. For it is

fect of sex its enrollment in expert discourses onual that creates a hold over sexual subjects andem in moral terms. In relation to the broader argu-urpose of this distinction is to illustrate the pointre different ways of linking pleasure, knowledgeivity. The scientia sexualis represents a very par-tion between desire, knowledge and power, withubordinating effects.the relevance of this analysis for contemporary

f harm reduction? After all sexuality is only onerough which social subjects are marginalized, andar that this category can account for the stigmaion experienced by other drug users. Certainly, theaddiction can usefully be subjected to the same

orical and critical analysis that Foucault offers inexuality, and indeed much useful and suggestives sort has been done (Keane, 2004; Levine, 1978;1993; Valverde, 1998). Moreover, there are goodthinking that this critical orientation is instruc-

not already implicit in, much work around harmAs a sociomedical pragmatics at a populationample harm reduction is arguably guided by anpathologization. Excluding substitution therapy

uch as methadone, for example, addiction is nottarget of harm reduction. The nature of an indi-

sire in relation to drugs is not a matter of primaryather, the practices surrounding drug use, and thein which they take place, are the driving targettion: There is little or no concern with the indi-ch, in the disciplinary sense of the biographical

in need of correctional intervention (OMalley,his respect, Foucaults work helps to distinguishifferent practices of health service provision in

fieldexpehowsificadiscuthe econtrusers

for eabouthis asuchthis r

The

Inality,rallyiboditent ewithiopedFoucpleasmachthe iddesirlationof bo

Thbodibetwexpedesirence

psyching itthe hand clessvaluegiesindivdesirmore

creatthe fwhicnitiesless eIt isdetailed account it provides of how subjectiveis enfolded into normalizing regimes. It trackstive experience enters into the machinery of clas-nd segregation. This makes it germane to anyof the use of pleasure within harm reduction. Tomoreover, that harm reduction wishes to avoid

g to processes that individualize and marginalizebasis of their subjective experiences (of pleasure,

e), Foucaults analysis supplies a cautionary notebest, or how not, to proceed. In the next section ofI consider how concepts from the later volumes,

hics of pleasure and care of the self, might incontribute to the discussion.

pleasure

al pages of the first volume of the History of Sexu-ult proposes bodies and pleasures as a potentialint against the regime of sexuality. He contrastsd pleasures with sex and desire, whose insis-ation, he believes, will only bind us more tightlyregime. The remarks are cryptic and underdevel-ave been the source of much confusion. After all,as shown over the course of the first volume howexual experience and desire are caught up in theof power and confession. Since Foucault rejectst power works by a simple repression of personalsexual pleasure, but rather demands their articu-xamination, it is initially unclear how an assertionnd pleasures could resist the regime he describes.

to understanding Foucaults proposal aroundd pleasures relates to the distinction he makesleasure and desire in terms of their relation to

ledge (Davidson, 2001; Halperin, 1995). Unlikee was no established theory of pleasure, no sci-g it to the nature of the human subject. Whereysis purported to offer a theory of desire, depict-tures and proposing it as a universal law that drivessubject, pleasure was comparatively untheorised,ot be used to diagnose individuals. Pleasure wasup in the whole apparatus that extracts a trutherotic experienceall those therapeutic strate-diagnoses presuppose special insight into the

on the basis of supposedly universal norms ofthis sense, pleasure could be regarded as muchto historical construction, practical variation andperimentation. It provided a way of approachingof creative experimentation and world-buildinge going on around Foucault in queer commu-

the added advantage of being comparativelybered by therapeutic or scientific prescription.eant to invoke some pre-discursive domain of

420 K. Race / International Journal of Drug Policy 19 (2008) 417423

experience, as some have worriedpleasure is social and his-torical material, through and through. Foucaults commentsabout bodies and pleasures only indicate a preference forexperimentcultures thpossibilitiecultures of

This bathe second(Foucault,and Romanthe politicathe onset othis work wmedical an(Foucault,find modelspleasure, kpensed bycan be readars eroticafind modelpsycho-scidegree of fproject, Foknow thysWhile histoovershadowwants to finthat is lesswhat it wouciple of cato categoricpleasure ccerned witare less deftion of noFoucault wneed not reself, but ara basis fordifferent hknowledgechance of rof official d

Foucaulwho wish twithout conit suggestsmodes of cFoucault flcare and attqualified frto prescribpractices anthat these c

of normative categorizations of morality. This does not meanhis aesthetics of existence disregards all moral principles.Rather, it expands the scope of relations to such principles,

ioninge comal valuocioloe issuoral

es outacticeve shat be ention rsigni

it conne ansard Be (Bec

s thame re

at henationis effeusatio

any otser gragh prinfluenof deify then expers es

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n humd empart &hen throticas on ce

s, in wriencend mohievectualum ofprocedto repalous

nt onularizinto t

o percal practice over theory: he was interested in theat marginalized groups were creating and theirsincluding the possibility of creating innovativecare.

ckground helps to explain what is going on inand third volumes of the History of Sexuality

1986, 1990). Here Foucault turns to ancient Greekpractices to provide the outline of a response to

l problematic he sketches in Volume 1. Writing atf the AIDS crisis, one of Foucaults concerns inas how to adapt and direct the power exercised byd moral experts in the time of the AIDS epidemic1993). Central to his project was an attempt toof self-practice that conceived a relation between

nowledge and subjectivity different to that dis-the scientia sexualis. In this sense, these volumes

as an attempt to furnish his earlier outline of thewith some historical detail. Foucault wanted to

s for existence that might be less enthralled byentific knowledge, affording the subject a greaterreedom in shaping their existence. In framing hisucault discusses the ancient Greek imperatives toelf and take care of the self (Foucault, 1990).rically the principle of care of the self has beened by the imperative to know thyself, Foucaultd a basis for ethical decisions (about how to live)caught up in the sciences of identity. He wondersld be like to give greater prominence to the prin-re of the self (and, by implication, less priorityal self-knowledge). His proposal of an ethics of

an be understood in these terms: it is crucially con-h finding frames for shaping ones existence thaterential to the human sciences and their designa-rmal and abnormal (Foucault, 1997a, 1997b).anted to conceive forms of care and relation thatly for their validity on expert evaluations of thee nevertheless able to bring pleasure and formenhancing lives. To this end, Foucault explores

istorical relations between the self, pleasure and, with the hope of providing models that have someesisting the prescriptive and demoralizing effectseterminations of deviance.ts work here is highly suggestive for practitionerso attend to the care needs of stigmatized groupstributing to their further pathologization. Indeed,the possibility of conceiving de-pathologizing

are, education and service provision. In this work,ags the possibility of bringing a certain amount ofention to self-practice that is not automatically dis-om intelligibility on the basis of its non-adherenceed norms. He draws attention to the techniques,d aspirations that make up self-hood, and suggestan have a rationale that is relatively independent

positdocilcriticrary soff thsal mcarriits prto gimighreducis thedoes

OHowUseranismIn soin thexplaTo thof calikethe uthrouwas

tionidentranea

Beckat anusedtechna fragwithiwoul(Gom

Wars e

drawmentexpeing ato acinstinmediandtionscandtingeof regdowning tthem as a matter of active deliberation, rather thanpliance. The model has a specific sociological ande, though this tends to be lost in many contempo-gical applications. In particular, it takes attentione of whether an individual subscribes to univer-codes, and opens up the question of how a bodycertain moral aims, and which values or concernss aim towards. It prioritizes the subjects capacitype to their existence and asks how this capacityacted. This optic has great significance for harm

esearch, as I discuss in the next section. But whatficance of pleasure within this frame? And hownect to harm reduction practice?wer to this question can be drawn from the work ofcker in his classic essay Becoming a Marijuanaker, 1963). Here Becker details the social mech-t give rise to the use of marijuana for pleasure.spects, Beckers project complements Foucaults,seeks to dislodge the primacy of psychologicals that attribute some innate deficiency to users.ct, he reverses the normal psychological etiologyn, showing how the relevant motivations arise,her taste, as a socially acquired taste, in whichdually learns to enjoy certain aspects of the drug

ocesses of social interaction. Beckers approachtial for subcultural studies, where the investiga-

viance in its socially situated context helped tocustoms and systems of value that shape subter-

erience. But what is particularly innovative aboutsay is how it frames the subject: In order to arrive

rstanding of marijuana as something that can beeasure, the user must become proficient in certainand ways of framing their experience. Pleasure iscomplishment. While Beckers project is locatedanist sociology, a more contemporary reading

hasize how these techniques make up the subjectHennion, 1999).inking about the work of pleasure here, Foucaultseasily comes to mind. Pleasure is an event thatrtain pedagogical practices and technical arrange-hich what is learnt is not only how to identify andcertain effects, but also the frames for appreciat-derating these effects: how to conduct the practicecertain desirable states. Here, pleasure is not anurge, waiting for expression and release, but thea process of learning in which new techniques

ures are acquired. It does not stand in opposi-ressive social power a hidden knowledge witheffects but is a quality of experience that is con-

certain procedures and skills and the combinationed patterns of activity. Becker breaks the processhree distinct stages: learning the technique, learn-eive the effects and learning to enjoy the effects.

K. Race / International Journal of Drug Policy 19 (2008) 417423 421

Each technique depends on social interaction, the exchangeof meaning and some evaluation of the experience. One of thememorable insights of this essay is that drugs have multiple,contradictoable. Not oenjoyable,depicts an acare than tthe antithethrough wh

I will disreduction mtextualizingHIV prevenmate of thehomosexuaabstinence,and againsresisted poSafe sex wapleasures asafe sex mastrategies, pities and ex(Cohen, 19Sendziuk, 2an interventested morafor safetymany of thizing prevewhich peopencountersdo so. Buttioned, notin its pedagpossibilitie

Activating

Thus fadistinguishlated intoso to countof pleasuretively disalabsence ofand moreValverde, 2attention tofor harm recentral imppleasure isreading ofnot be app

light will give us special access to the truth (of drugs orindividuals), but rather as a dynamic social material whichis elaborated through embodied interactions. If normalizing

gies wls) frargueio-tecactor

ngagebe frevely leoucau

espectpract

rentlyf pleass andcompmore

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its socry effects, not all of which are obviously enjoy-nly does the user learn to identify certain effects asbut also to interpret and prevent other effects. Thisltogether different relation between pleasure and

hat which is commonly assumed. Pleasure is notsis of self-regulation and safety, but the mediumich certain shared protocols of safety take shape.cuss the implications of this observation for harmethodology in the next section. But by way of con-this point, an analogy from the field of gay menstion might be useful. In the highly moralized cli-early AIDS crisis, moral authorities condemned

ls, sex-workers and addicts, and dogmatic calls formonogamy and quarantining proliferated. Over

t these calls, these groups devised strategies thatpular desires for their identification and erasure.s one such strategy: building on the characteristicnd styles of embodiment found among gay men,de promiscuity redundant as a target of hygienicromoting instead condoms, alternate sexual activ-plicit community education as effective measures88; Crimp, 1988; Escoffier, 1999; Patton, 1990;003). In this respect, safe sex can be regarded as

tion in the same league as harm reduction. It con-lized strategies of control by devising measures

grounded in existing embodied practice. Today,e best educational strategies work by contextual-ntion techniques in terms of the situations withinle elaborate techniques of pleasure. This approachpolitical obstaclesand probably will continue toin this instance, it is clear that pleasure has func-as the antithesis of safety, but as a crucial elementogya sociohistorical resource providing criticals for survival.

pleasure in harm reduction praxis

r I have used Foucaults History of Sexuality totwo broad models whereby pleasure is articu-

relations of knowledge and power. I have doneer the presumption that a straightforward voicing, in a context where such voicing is presump-lowed, is a progressive achievement in itself. The

pleasure in harm reduction discourse is morefrequently noted (Mugford, 1993; OMalley &004), but few have considered what, exactly, morepleasure might dowhat is the value of pleasureduction praxis? How might it be put to work? Ofortance to such an inquiry is the question of howgrasped, conceptually and methodologically. A

Foucault gives us one perspective: Pleasure needroached as a repressed thing whose bringing to

strateviduahavea soc

manyare e

ever

relatithat Fthis rmous

appaBut iedgemaybeinggivena focciatenorm

indivcrafta fraexchconv

methTh

mustgo unAs mcertacerns

by esusefutify ttake epract2000on Egenewoodaroun

1999formogypractgencmen,

codeDowKippical aandork by extracting individuals (or types of indi-om pleasure as part of a therapeutic strategy, Id that pleasure might alternatively be grasped ashnical medium and process of exchange in whichs and concerns, including concerns about safety,d. This is not to suggest that such a framing coulde from relations of power; only that it may bess susceptible to the processes of pathologizationlt identifies as predominating within biopower. (In, I find myself oddly in alignment with one anony-itioner who, when asked to contribute to this issue,objected, pleasure has no therapeutic value.)ure is entwined with specific techniques, knowl-

practices as part of a pedagogical apparatus thatlement the project of harm reduction, it is worth

specific about how it may be approached withinratuses of knowledge and intervention: What doespleasure allow that might otherwise not be appre-at alternative does it provide to the processes of

ion and individualization that mark out deviant? How might pleasure be put to work so as toharm reduction praxis? In particular, how does

of pleasure as an affect that is contingent on thef certain techniques and concerns serve to reworkal perspectives on using practice? What are thegical implications?

ary value of this frame, as I see it, is the focus itpractices of safety and care that might otherwiseered in the current punitive political environment.ed, it opens up the question of how a body effectssformations, or realizes certain principles or con-ace of the usual focus on whether a body abideshed norms. This approach has been particularlycent drugs research. Maria Pini has used it to iden-ctices of self-care adopted by young women who, including the specific concerns that inform thesehich extend from health to sexual safety (Pini,

). She argues that the social panic around girlsures these practices and has the likely effect ofeven riskier ones. Erica Southgate and Max Hop-ment the forms of subjugated knowledge that existg use in gay community (Southgate & Hopwood,ailing the contribution they make to controlledse through the circulation of a folk pharmacol-gate & Hopwood, 2001). In the context of sexualsimilar frame has helped to identify the emer-

iverse strategies to reduce HIV risk among gaying strategies that do not conform to the condom

ey, 2002; Kippax, Crawford, Davis, Rodden, &993; Kippax & Race, 2003; Rosengarten, Race, &00). With the successive introduction of new med-mmunication technologies, a focus on pleasureial pragmatics has been very helpful in keep-

422 K. Race / International Journal of Drug Policy 19 (2008) 417423

ing track of what I have called shifting prevention ethics(Race, 2003). From this vantage point, subjects of risk maybe seen to subscribe to the general moral principle of pre-venting HInovel waysWhere a mapproach suof ethicsbine pleasunew envirobroad apprconceivingconcerns a

of being taaround risk2000; Raceto admit othe co-concare.

These inrelied on qcan be broapproach,ally and minterested ithan the phto these stuological. Qas makinga Foucauldin that theybehaviourain public hpractices ounderstandhas been acbetween ququantitativebasis of vaedge aboutrole of insMeasham &prevention

While etary meathe comptous but iday to dais a deeshould b279)

Daviesotherwise htion outside

of recidivism among gay men. Davies signals the needfor methods that are capable of bringing embedded prac-tices of risk reduction into perspective. Qualitative insights

ack thes thrccordpliant

beddea pard harmof freeativeberal smotivsed w

that arhat prelatioossibiat fiee fostne, 20al fraure asassistegard.

lusion

arm ref thei

ster thes aroa aboworkeasurethe unure asexten

atholot it enaould

ical ening shimpuativeibutioich agders,in freeon. Thrationcapac

or degogy.V infection, but realize this aim in historically, by means of changing techniques and strategies.ore conventional epidemiological frame wouldch practices in terms of noncompliance, the frameprompts a focus on how subjects actively com-re, safety and other concerns as they negotiatenments and conditions. The significance of thisoach is threefold: first, it provides a basis forpractical measures that are in touch with given

nd bodily practices, and thus have more chanceken up. Second, it helps stave off moral panicand withstand its counterproductive effects (Pini,, 2007). Third and most importantly it is ablef the active participation of affected subjects instruction of meaningful practices of safety and

sights around pleasure and safety have generallyualitative and ethnographic techniques, or whatadly characterized as a symbolic interactionist

which is able to grasp how practice is contextu-eaningfully negotiated. Since Foucault was moren the epistemological construction of reality ratherenomenological experience of it, his contributiondies is conceptual rather than directly method-ualitative methods can nevertheless be regardedan important epistemological intervention (whichian orientation helps us grasp the significance of),provide a basis for querying the self-evidence of

l measures that tend to dominate the policy fieldealth, and which are typically used to assess thef risk groups. In my experience, a more adequateing of the practices and strategies of those at riskhievable only by means of a robust conversationalitative and quantitative researchers, in whichmeasures are actively queried and revised on the

rious forms of insider and qualitative knowl-social pragmatics. (On the often-unacknowledgedider knowledge in harm reduction research see

Moore, 2006.) To import comments from HIVmade by Peter Davies:

pidemiological monitoring requires simple, uni-sures of unsafe sex, these cannot be used to clarifylex responses of ordinary men who make momen-ncreasingly routine decisions about safer sex fromy . . . Working on heuristic rules about the world

ply embedded feature of human interaction ande encouraged, not condemned. (Davies, 1993, p.

comments refer to the emergence of what wouldave been unrecognized strategies of risk reduc-the condom code, which were prompting claims

(or legoriand acom

Eman idindeesure

norm

neolias a

confucare

self tand rthe pto thcan b(Keaceptupleasmaythis r

Conc

Hpart oto fochoicdramlaterof plwithpleasto theand pin thathat wpolitto beas an

alterncontrin whprovicertarelatias a

is apatedpedaereof) directly impact the formation of the cat-ough which risk and safety become intelligible,ing to which groups and individuals are deemed or noncompliant.ed work on heuristic rules about the world isticularly compatible with Foucaults ethics and

reduction praxis in that it instantiates a mea-dom in self-fashioning that is absent from more

applications. But this is not the freedom of theubject, the presumption of which generally serves

e for disregard. Nor should care of the self beith the moralistic demands around health and self-e so familiar today, which presume an atomizede-exists, and is neatly separable from, techniquesns of power (Sybylla, 2001). Rather, it refers tolity of adopting an active and reflexive relationld of action we call the selfa possibility thatered or foreclosed by social programs and policy03; Stengers & Ralet, 1997) as well as the con-mes we bring to the field. Some appreciation ofa social process and interactively crafted mediumin the materialization of freedom and self-care in

duction practitioners are aware that a substantialr work involves efforts to de-dramatize risk so ase conditions in which people can make practicalund care and safety, free from an overblown moralut good and evil, wholesomeness and guilt. Theof Foucault helps to navigate the complex terrainand care in such a way that care is not conflatedthinking imposition of norms. A conception ofa social pragmatics is useful for harm reduction,t that it provides an alternative to the normalizinggizing tendencies implicit in therapeutic morality,bles the recognition of practices of safety and careotherwise go unregistered in the current punitivevironment. Such practices are fragile, and proneamed out of existence. An appreciation of care

lse that may be immanent in pleasure could makeversions of safety intelligible. Among its otherns, such an approach would intervene in the waysency is usually distributed among users, service-researchers, drugs and the state by according adom to drug-using subjects in their ethical self-is freedom cannot be taken for granted, nor usedale for disregarding those in danger. Rather, itity that can be fostered or foreclosed antici-nied by practices of government, inquiry and

K. Race / International Journal of Drug Policy 19 (2008) 417423 423

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The use of pleasure in harm reduction: Perspectives from the history of sexualityIntroductionWhy sexuality? Why Foucault?The use of pleasureActivating pleasure in harm reduction praxisConclusionReferences