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Introduction

In this chapter we use images from community-based HIV prevention as a means of focusing attention on the ways that serodifference has been represented in gay communities in Australia. The images or representations ground our argument. We read these images and representations as cultural artefacts that embody and conceptualise serodifference. In turn, these representations have amplified social understandings of serodifference and shaped the relational possibilities for such partnerships.

Throughout the history of the HIV epidemic in Australia, textual and photographic representations have influenced government policy and social attitudes (Sendziuk 2003:5). Representations of serodifference have often sought to address negative stereotypes of those living with HIV, with the aim of removing the fear of sexual partnering with a person with HIV and encouraging the possibility of mixed HIV-status coupledom. We suggest the images also operate to code already extant and acceptable social and sexual practices with the intention of amplifying those practices.

The images examined in this chapter promote an understanding that sexual partnering of HIV-positive and HIV-negative men is acceptable and generally “OK”. Some image-making has suggested that partnering with a person of a different serostatus is perhaps also a place and space for the possibility of “true love and romance”. Other images display desirable outcomes from the attraction of “opposites”. Schatzki (2010) describes the ways in which “general understandings” are developed through social processes; general understandings that might be gleaned from the images we examine here are supportive of partnering and sexual negotiation between HIV-positive and HIV-negative men within the gay community. However, in examining these images more closely, we also identify some inconsistencies within the image-making.

One major problem is that in the image-making and amplification process, a binary has been maintained. The language of serodiscordance, generally used as the terminology to describe serodifference, suggests that seropositive and seronegative are incompatible. We also note that this binary, which was established in the literature and community discourse and came to be represented in various Australian images, left out the possibility of other alternatives, such as not knowing one’s HIV status. In each of the images we go on to examine, there is a coded assumption that the persons represented know their HIV status, whereas in reality a significant proportion of people have an uncertain HIV status at any given time (Pedrana et al. 2012; Holt et al. 2015).

Our observations are made not just as researchers and writers, but also as practitioners in the field of HIV health promotion and as people who have lived the realities of negotiating different relationships within a world that talks of serodiscordance. Our observations suggest that, as the language of serostatus has changed over time, so perhaps will it change further in the future – hence we emphasise the potentiality of language such as serodiversity and seroharmony. If language is not only a way of communicating or representing how we see things, but also, as Schatzki (2010) and other critical theorists argue, capable of shaping realities, then we see a shift to a language of serodiversity and seroharmony as assisting in the generation of new relational possibilities.

In this chapter we investigate the reasons why cultural constructions of a serodiscordant binary remain, and ask: what is the possibility of talking and practicing “serodiversity” and “seroharmony”? The notion of an “undetectable” HIV identity has now emerged; an identity that has potentially existed since the introduction of antiretroviral Therapy (ART) in the mid-1990s, but that has now gained increasing currency in community discussions with the recent Treatment as Prevention (TasP) strategy (Grace et al. 2015; Race 2015). Later we examine a visual representation of this identity. We note that the category of “undetectable” is very different to that of an uncertain HIV status, as the use of “undetectable” now also implies that an individual is on ART. We also note that people whose immune systems naturally suppress HIV to low or even undetectable levels may not be included in this new description of being undetectable and on ART. This supports the argument we are making for serodiversity; as it is now possible that people living with HIV are “undetectable” on treatments, but may also be “undetectable” without ART. We conclude by arguing that the binary of HIV-positive and HIV-negative still exists, but it exists within a mix of new HIV-identities in what Grace and colleagues (2015) have described as an “altered sexual landscape”, and what Persson (2015) has noted as a time when serodiscordant sexuality can potentially be reframed “away from risk and stigma”.

How Has Serodiscordance Been Understood in Australia?

The early responses to AIDS in Australia required gay men to alter their sexual behaviours in the context of a frightening and rapidly spreading disease (Altman 1986; Carr 2013; Duffin 2014). The problem recognised very early in the epidemic, in terms of intervening and creating and supporting safer sex behaviours, was one of “making sense of what gay men actually did” in their sex lives, as opposed to how they may have talked about it (Altman 1986:169). In this context, safe or safer sex for all was the message promoted.

Before HIV was identified and a reliable test for its presence available, the identifier of infection was not the presence of HIV but the presence of AIDS in one or more of its many forms. Until AIDS manifested, any man having sex with men was simultaneously both potentially not infected and potentially infected. A binary of “discordance” in this context was not relevant. By 1985, the modes of HIV transmission were understood and a reliable test for the presence of HIV antibodies was developed. The knowledge that it was the presence of the antibodies which indicated the presence of HIV, and therefore the possibility of developing AIDS, shifted the health intervention focus from just care and palliative care, to include a focus on the prevention of transmission from HIV-infected persons to others.

However, once a test became available, there was some resistance to identifying those who were HIV-positive during the early years of the HIV epidemic in Australia. Some gay men took the position that they would not test, firstly because there was no value in knowing their status (as no effective treatments were available), but secondly, because they did not wish to have the gay community separated into those who were HIV-positive and those HIV-negative. For these men, an unknown or an uncertain serostatus was a potentially HIV-positive status; for many this was a deliberate act of solidarity with those who were HIV-positive. At that time, as the Australian HIV specialist Adam Carr (2013) described in a retrospective speech, the aim was to be a “united gay community” that resisted any form of “antibody apartheid”.

In the absence of mandatory HIV testing (which was never supported by the gay community in Australia), the universal prevention message became: safe sex for all. For those who knew their serostatus in the early years of the HIV epidemic, this message dampened conversations about how HIV-positive and HIV-negative men might have a sexual relationship that bridged the problems of different serostatus. We have found no evidence in the literature that serodiscordance existed as term or concept at that time, and personal accounts (Paterson 2014) also point to its absence from the lived experience of the epidemic in the mid-1980s. Clearly gay men were having sexual relationships with men of different serostatus – whether they knew this or not – but during the 1980s, at least in Australia, these relationships had not been named as “serodiscordant”.

By the mid-1990s, in writings from the US and soon in research literature in Australia, “seroseparating” and “seroseparation”Footnote 1 (Sadownick 1996:221) became part of the lexicon and terminology used in the discussion of maintaining safer sex practices and sexual negotiation between HIV-positive and HIV-negative men. In Australian AIDS education, the expression “negotiated safety” and “strategic positioning” in relation to safer sex practices started to be used (Van de Ven et al. 2002).Footnote 2 The argument was developed that “seroadaption”, “serosorting” and “seropositioning” – all descriptors of different ways gay men used known serostatus to make decisions about their sexual practices and condom use within relationships – were effective strategies to reduce the risk of seroconversion (Van de Ven et al. 2002; Philip et al. 2010). It is not necessary here to recount the whole of this debate but to emphasise that “sero-identities” had now clearly emerged and that “serodiscordance” was now named and was a subject for research and specific health promotion interventions and strategies within gay communities. As we will argue, although HIV status came to be spoken about as a binary identity, in reality it has never been a simple oppositional relationship between two identities, but rather a “cluster” of identities. Most notably, there is a third group: those whose infection status is not known, as well as other potential and emerging serostatus identities.

Reading the Images

Serodiscordance has generally been represented in HIV prevention messages as a binary opposition. Despite attempts to make that binary appear complementary, an implicit assumption of oppositionality remains. In order to represent this oppositionality, a number of proxy devices are used. HIV status cannot be seen, so visual representations are arrived at, worked into and worked up within the context of gay community focused health promotion activities.

Stuart Hall (1995) has argued that visual signs always include particular codings, but the existence of different knowledge frameworks means that visual signs are usually read (or decoded) differently, according the knowledge framework of the reader. This understanding sets us up to offer our readings of the following images as one of any number of possible readings. That is, if we understand images to be a communicative exchange in Hall’s (1997) terms, the readings we apply to these images are not the only possible readings. Meanings are never permanently fixed, messages are never transparent and the reader is never the passive recipient of an intended meaning. In effect, we continue to read into, over and beyond these images. We suggest that, through image-making and cultural messaging within the gay community, the imaging of HIV-positive and HIV-negative gay men has been a repeated practice constructing understandings of serodifference in ways that have maintained a positive/negative binary.

In the following sections we offer some detailed readings of these images to see how oppositionality is visually embedded in HIV prevention messages. We seek to challenge that framing, by talking about multiple HIV identities. We then turn to some concluding remarks where we explore the idea that a significantly different conceptualisation of HIV serostatus – serodiversity and seroharmony – would start by saying that we are all alike and yet possibly HIV-different. Through the lens of serodiversity and seroharmony, HIV serostatus (particularly serodiscordance) is not seen as an opposition or cleavage, but simply a cluster of possible HIV-related identities; managing sexual negotiations and relationships between people within this cluster is a matter of managing a difference much like any other. Importantly, this includes recognition of a desire for sexual relationships across or despite those HIV serostatus differences.

Image 1 from 1994

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Yes, David McDiarmid, 1994. Large acrylic on canvas. Heide Museum of Modern Art, Melbourne (Reproduced with the permission of the David McDiarmid estate)

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The artist David McDiarmid first produced an image for use by the AIDS Council of New South Wales (ACON), a community-based HIV prevention and service organisation, in 1988; the screen printed poster image, in black and white, advertised a “Safe Sex Ball”. The image included details of the event, naked male torsos and buttocks, as well as condom packets. In 1988, there was no representation of HIV-positive or HIV-negative. David McDiarmid’s subsequent artistic work for a series of health promotion posters in 1992 was the first time that images of HIV-positive and HIV-negative, represented by plus and minus signs, started to be made in the context of HIV education. Done in gouache on paper, the series of posters, which were also turned into postcards, looked at HIV and serodiscordance in a “pro-gay” and “pro-sex” way. The surrounding text in some of the ACON images included:

“Some of us have HIV, some of us don’t. All of us fuck with condoms – every time!”

“HIV, discrimination and grief threaten our community. Build our strength, stay together and support each other”.

The “Yes” image, shown here below, was produced 2 years later in 1994, and was part of McDiarmid’s art dedicated to the cultural politics of HIV and AIDS, a process he worked on between 1987 and 1995. McDiarmid’s graphic design practice was used to promote tolerance, fight intolerance and to stop prejudice against gay people and people with HIV and AIDS. The “Yes” image has many of the same motifs used in the 1992 ACON poster campaign, including muscled bodies, boxed heads and inscriptions of HIV-positive and HIV-negative symbols. We have chosen to focus on the 1994 image in this chapter as it speaks to some specific issues we want to address.

The “Yes” image would have been read in a particular way by the Australian gay community when it first appeared, because of the different historical and cultural context in which it was produced. But how might it be read from today’s perspective? The image seems to be saying that the world in which HIV and AIDS exist is a world in which two men can embrace closely and nakedly. Perhaps they could be considered buddies or friends supporting each other. However, the sexually explicit nature of McDiarmid’s earlier images in the 1992 ACON campaign, of men fucking and placing a condom on an erect penis, suggests that the context here is also sexual – an encounter and a coupling between men, one of whom is HIV-positive and the other HIV-negative.

At first glance, the image appears to diminish difference by casting serostatus as merely the difference of a stroke between a minus (−) and a plus (+); a seemingly minor and unproblematic difference. The image suggests that HIV-negative and HIV-positive can and do fit together. The image promotes, perhaps even celebrates the possibility of closeness between men of different serostatus. The “muscle-ness” of the image may be an immediate appeal to the gay men the message is targeting, but is also an interpolation of a normativity around body types. The image generally suggests that serodiscordance is acceptable and even that such couplings may be attractive and desirable. And yet, the image also suggests that gay men are either HIV-negative or HIV-positive and that these states are in tension and need to be actively reconciled.

These men are nameless and anonymous caricatures. The HIV-negative man has no name; the HIV-positive man on the other hand has several names inscribed on his body; it could be any of Paul, Mark, Jeff, John, Chris, Brian, Frank or Bill. Are we meant to read this as: any man can have HIV? The answer is probably yes. Is it also suggesting that the HIV-positive man is everywhere and at the same time promiscuous? This answer is less obvious. It is unlikely that this was the message intended by the artist, especially given his known intentions were to prevent discrimination and stereotyping. However, HIV was linked to stereotypes of sexual promiscuity from the beginning of the epidemic and shifting this association has proven difficult.

The HIV-negative man has no name, but is given a descriptor as the “yes, yes, yes” man. This suggests vitality and activity, whereas the HIV-positive man appears to be more passively positioned, enclosed by the arms of the HIV-negative man. Perhaps this is a position of “yes, I care”, or a defiant stance of “yes, I am comfortable with serodiscordant sex”, and “I say yes to HIV-positive men”. But it could also be read as a position of “yes, I have control of this situation”. In short, what is the significance of the “yes” and of it being confined to the HIV-negative man? It is possible to read themes of dominance and subordination in serodiscordant relationships in this image, as if HIV-negative men are positioned with more agency than HIV-positive men. To explore this particular reading of the image further, we observe that the two men are not looking at each other, but outward; is this an invitation to participate with the “yes” HIV-negative man in control of the HIV-positive anybody? Looking at the image in this way, perhaps desire can be read as one-sided. Is the HIV-negative man with the ability to say “yes” the gatekeeper of the sexual negotiation? The “yes” inscribed exclusively on the body of the HIV-negative person could be seen as emphasising this; a kind of dominance also suggested by the fact that he is placed as the potential insertive (behind) partner in a potential act of anal intercourse.

Extending Hall’s (1997) argument that decoding images depends on the knowledge framework of the reader of the image, we could say that there are other suggestions built into the McDiarmid image regarding anal sex and different sexual roles. For gay men who had some detailed information about modes of HIV transmission at that time (that is, gay men who had a particular knowledge framework), an HIV-negative man may have considered that insertive anal intercourse was a way to reduce the possibility of HIV transmission where a partner was known to be or was potentially HIV-positive. Using the image we can ask the question: were HIV-negatives established as the suitable “top”, while the invitation was for HIV-positives to be the “bottom”? Was this an attempt to “position” HIV-positive men as “bottoms” as part of a coded strategy aimed at preventing HIV transmission?

The image seems to be silent about whether knowing one’s sero-status is desirable or of any use. The image is also silent about whether there are any concerns about serodiscordance and yet, in summary, the binary is established and made clear. HIV-positive and HIV-negative are imaged, embodied and coded as “different”.

Image 2 from 2005

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Opposites Attract – A true love romance. June 2005. ACON and the Victorian AIDS Council Inc/Gay Men’s Health Centre Inc (reproduced with permission from the copyright-holder)

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Below is the front cover of a booklet, which was a collaborative project between ACON and the Victorian AIDS Council Inc/Gay Men’s Health Centre Inc. The intended purpose was to provide information for HIV-negative men in serodiscordant relationships. The booklet, entitled Opposites Attract, is about living in “a discordant world” and contains tips and suggestions for the HIV-negative partners of men who are HIV-positive.

In reading this image, one way to make sense of its message might include the following; this could be a heteronormative version of gay relationships. On the other hand, because the image was most likely produced by gay men working in HIV education programs, it might equally represent aspirations of happiness that are not particular to heterosexual, homosexual or any other differently gendered partnering arrangements. There is also a “camp” or ironic tone to the image. Inside the booklet, the images continue in the same campy vein to portray serodiscordant relationships between gay men as acceptable, uncomplicated, enjoyable and even fun. Notably, however, it is not made clear who is HIV-positive and who is HIV-negative, which potentially normalises serodiscordance and erases difference (though it could be argued that “difference” is encoded by the ethnic backgrounds of the men in the image). Flow, harmony, electro-chemistry and domestic bliss are implied with the appearance of things “fitting in” with two people oriented towards each other, but facing outwards with happiness and pride.

The images imply that everything is going “to be roses” or full of “daffodils, angels and matching yellow shag-pile carpets”, but perhaps this obscures how difficult serodiscordance might be to negotiate. The booklet itself expounds themes of communication and trust within a serodiscordant relationship, but genuine questions about rejection, sexual challenges, or HIV transmission fears are not represented through the cover image or any other image in the booklet. Uncertainty, misunderstandings and the potentially difficult parts of negotiating “opposites attracting” are relegated to the text of the booklet. Much of the text, addressed to the HIV-negative partner, recommends positive ways in which serodiscordant relationships may be managed.

The images in the booklet promote the idea that happiness, or domestic bliss, can easily be achieved by gay men in serodiscordant relationships and that the presence of HIV in such relationships can be managed – the whole tone seems to suggest that there can be a “happy-ever-after” experience. Whilst the “Yes” image is represented as a static moment with explicitly sexual connotations, the images in Opposites Attract position negotiations in serodiscordant relationships as something that includes love, loss, home-life, and perhaps home-work-life. Whilst negotiations around sex do feature within the booklet under a heading “Bedtime stories”, the muscly, naked and sexually charged imagery of “Yes” is not seen in Opposites Attract. In a sense, in its attempt to normalise serodiscordant relationships, the booklet’s imagery ends up inadvertently “domesticating” gay men and their sexual desires.

Image 3 from 2011

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FearLessLiveMore. 2011. Australian Federation of AIDS Organisations (reproduced with permission from the copyright-holder)

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This image was one of a series of images from an online social marketing campaign conducted by the Australian Federation of AIDS Organisations and the National Association of People with HIV/AIDS Australia in 2011. The FearLessLiveMore campaign aimed to reduce HIV stigma by challenging assumptions and beliefs that many HIV-negative men hold about HIV and people with HIV. According to de Wit and colleagues (2013), there was evidence that a serostatus divide existed among gay men in Australia and this campaign addressed itself to that issue.

If images are to be read as an “encoding” (Hall 1995, 1997) of accepted norms and as a representation of “general understandings” (Schatzki 2010), then this image does represent a significant attempt at normalising gay male serodifferent relationships. The normalisation is not being done through the image alone—that of two men walking along hand-in-hand—but also by the surrounding text spelling out that serodifference is “as normal as dealing with arguments over toothpaste or snoring”, or that the negotiation of serodifference is like any other relationship challenge or difference.

Both Opposites Attract and FearLess emphasise the ordinariness of HIV-positive and HIV-negative men in relationships and this is done with nuance and subtlety. This might also reflect a more general and growing acceptance of same-sex relationships, including those of gay men, in contemporary Australia. The assumed different HIV statuses of the couple in the FearLess campaign is encoded and perhaps decoded as unremarkable and manageable. Nevertheless, “difference” remains the key representational device, through the use of the proxy difference of a tall and short person, or differently shaped bodies, or a mixed race couple; a binary is still implied.

Image 4 from 2012

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SERO DISCO 2 – Let’s talk. 2012. Positive Life New South Wales (reproduced with permission from the copyright-holder)

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In 2008, the community organisation Positive Life NSW, representing people living with HIV in New South Wales, commenced a campaign to “start a conversation” about gay men living in serodifferent relationships. The title of the campaign was “Why let HIV get in the way of a good relationship?” The first phase of the campaign included community meetings and on-line discussions. Drawing on personal stories, the campaign aimed to cover a range of potential problems that might occur in these relationships, including disclosure and possible rejection, intimacy, vulnerabilities, relationship agreements and attitudes towards sex. For the first time in community-level discussions, this campaign invoked the word “undetectable”, meaning that a person’s viral load is fully suppressed through effective antiretroviral therapy (ART). It also explored the idea that being “undetectable” meant that an HIV-positive person was “un-infectious”.

The second phase of the campaign included a 59 page magazine-style publication, entitled SERO DISCO 2, which was released in 2012 and was an attempt to capture and represent the diversity and complexity of what was by then referred to colloquially as “pos-neg” relationships. It was also an attempt to address cultural barriers in the Australian gay community, which many contributors to the development of the campaign had identified. Indeed, in the above image, which was the cover image for the booklet, we see a further normalisation not only of serodiscordance but also inter-racial relations. The pose in the SERO DISCO 2 image is strikingly reminiscent of the earlier McDiarmid image of arms wrapped around a lover. But unlike McDiarmid’s “Yes” image, there are now faces to the image and there is no attempt to code a distinction between who is HIV-positive and who is HIV-negative. Similar to McDiarmid’s image, the gaze is outward, but not necessarily an outwardly sexual invitation. The text surrounding the image (“Let’s talk”) is an integral feature, without the implication that “talk” is simply about sex.

The images examined so far in this chapter can all be seen as gay community responses to the “social silence” (Persson et al. 2015) that has surrounded serodiscordant relationships. Looking back over these images, we can see an increasing realism, from figurative and cartoonish representations to the appearance of models whose faces were known within the community and who were willing to be identified. The SERO DISCO 2 cover image, along with the other images in the campaign, is presented in a rather “no-nonsense” manner; “this is what two gay men in a serodifferent relationship may look like”. Perhaps it is possible, from seeing this kind of imaging develop, to speak of seroharmony rather than serodiscordance. Unlike the earlier Opposites Attract campaign, the harmony is not constructed in the SERO DISCO image as camp artifice, but appears genuine and frank, as these two gay men in a “pos-neg” relationship pose comfortably with each other and are prepared to look out to the world (and also apparently comfortable to be looked at by the world).

Image 5 from 2015

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Cover image of the Positive Living magazine. 2015. National Association of People with HIV Australia (reproduced with permission from the copyright-holder)

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The possibility that people who are treated with ART are sexually non-infectious has been part of community discussions for many years, particularly since the release of a statement to this effect from the Swiss Federal AIDS Commission in 2008 (Vernazza et al. 2008). The idea that an undetectable viral load can be a method of HIV prevention for serodiscordant sexual partners has come to be known as “treatment as prevention” (TasP) and is now well supported by clinical trial evidence (Cohen et al. 2011). In a recent article, Race (2015) talks about “discourses of undetectability”, noting that gay men with HIV have begun to adopt the term “undetectable” as a self-descriptor in online hook-up environments.

The above image, taken from the cover of the national magazine for people with HIV Positive Living, imagines the gay man with an undetectable viral load as an emergent superhero (Menadue 2015). The image is striking for a number of reasons. It is both hypermasculine and individualistic; the figure is alone, baring his chest to the viewer. It is possible to read several messages into this image of masculine power and its superman referenced character: “I can do anything and I’m doing everything I can (to stop the virus), which makes me responsible and therefore a hero”, but also “I can do anything sexually, with anybody, because I’m non-infectious and therefore of no risk to anyone”.

It is quite conceivable that this emergent undetectable identity would be a relief to many HIV-positive men as it presents an empowered image. As David Menadue (2015) writes about the so called “undetectables”: “If [they] sound like a bunch of superheroes, working silently to change the world for the better, then maybe – when put in the context of a desire to reduce HIV transmissions – that’s kind of what they are.”

But the image can also be read as a caricature of the sexually empowered and autonomous post-modern gay man. The highly individuated figure is nonetheless not an individual but merely a faceless cipher. Paradoxically, “undetectable” is imagined as an identity that is no identity, and the sexually empowered individual is one that exists outside of sexual relations. Such an image leaves much outside the frame, including the relational elements of all human sexuality, as well as those people with HIV who cannot achieve an undetectable viral load despite good treatment. At the same time, however, the emergence of the undetectable identity does destabilise the HIV-positive and HIV-negative binary. There are now more identities in the mix.

Discussion: Hints of Seroharmony

Our reading of these images is not intended as a critique or evaluation of health promotion campaign materials produced about serodiscordance. They all served an important purpose at their time. Rather, we have used the images to pay particular attention to the way that the binary of HIV-positive and HIV-negative emerged and how that binary has been hard to jettison. We traced how that binary was established and showed how the discourse of serodiscordance is one predicated on difference. However, as we suggest below, there have been other, parallel ideas about how serodiscordance or difference can be understood within the HIV epidemic and within gay men’s sexual relationships, ideas that can be seen as precursors to a conceptualisation of “seroharmony”.

In his preface to Practices of Freedom, Simon Watney (1994) reflected on what gay identity meant to him. He talked about ordinary activities of friendship and intimacy, the exchange of ideas, of lovers and friends coming and going in one’s life. Relevant to the idea of seroharmony, he talked about affirming the ethical and political dimensions of gay friendships and relationships, including the importance of avoiding any separation between HIV-positive or HIV-negative gay men. Watney (1994:137) argued that gay men, both those infected with HIV and those not infected, invented safer sex as one of the gay communities’ “cultural practices” in response to the HIV epidemic, demonstrating the ability of working together across serostatus differences.

Similar arguments can be found in Australia. In a monograph, which drew on empirical material from the Australian HIV Futures surveys, the monograph’s editor and social researcher Michael Hurley (2002) introduced the concept “cultures of care” to describe a range of apparent and emergent personal and gay community practices. In one of the monograph’s chapters, researchers extended “cultures of care” conceptually into the arena of sexual negotiation and the sexual lives of both HIV-positive and HIV-negative men – with “self-care” and “care-of-others” being the emphasis (Willis et al. 2002). This work was an early and genuine nod toward the possibility of “seroharmony”. We argue that the “cultures of care” approach has offered a counter-narrative to the so called “serostatus divide” (de Wit et al. 2013; Persson 2015) or what Carr (2013) referred to as “antibody apartheid”, by foregrounding gay men caring for each other regardless of their HIV status. This was an approach of inclusivity rather than separation, one that aimed to emphasise harmony rather than difference. Like Watney in the US, Hurley and others in Australia explicitly worked against a binary of HIV-positive and HIV-negative.

Conclusion

From the early AIDS epidemic until now, images of “serodiscordance” have framed sexual relationships between gay men of different HIV statuses. These representations often implied that different serostatuses were a significant problem to be overcome and this problem was binary in nature. By showing both the variety of these representations and their change over time, we wish to highlight their historical and cultural contingency despite their sometimes “common sense” appearance. We have, through examining this imagery, noted how the separation of the identities of those infected with HIV and those not infected has left out other groups, most significantly those whose HIV status is unknown. Their exclusion became cemented as health promotion strategies increasingly relied on imagery and language that was binary.

The biological fact of HIV infection is assumed to determine serodiscordance, but this fact has perhaps always been more unstable than it seems. In earlier years, this instability was underpinned by uncertain knowledge of HIV status, due to the lack of a reliable HIV test, or gay men not being interested in testing, or a political commitment to downplaying status differences and, throughout the epidemic, the possibility of HIV prevention measures failing. More recently, new scientific knowledge has emerged that has continued to change the meanings of HIV status and the potential for transmission. To live with HIV and have an undetectable viral load implies a different and new way of being HIV-positive, and this has profound implications for what it means to live in a serodifferent relationship. We imagine that the meanings of HIV serostatus will continue to evolve in light of scientific developments. For example, both HIV cure research and vaccine development suggest the possibility of people being HIV antibody positive but uninfected with active virus.

Despite the good intentions of earlier representations that sought to emphasise the desirability and normality of sexual relationships between those with different HIV statuses, it is only in recent years that representations of serodifference have shifted from difference as oppositionality to difference as multiplicity, with HIV serostatus difference being relativised as a kind of difference like any other between two people. This shift presages a movement beyond binary HIV identities towards something more diverse and hopefully inclusive; a world of seroharmony in which people may be, among other things, HIV-negative, HIV-positive, HIV-positive and undetectable, HIV unknown, or HIV-negative and on PrEP. It is perhaps only through the undoing and denaturalising of the serostatus binary that the persistent stigma of HIV will finally lose some of its power.