Live and Let Die: Rethinking Secondary Marginalization in the 21st Century

Over thirty years ago HIV/AIDS was one of the top ten leading causes of death for Americans as a whole and for blacks specifically. Indeed, blacks were 3.4 times more likely to die than whites. But this epidemic went largely ignored in black communities, a phenomenon Cathy Cohen called secondary marginalization.1 In detailing this dynamic Cohen retells a conversation she had with a retired teacher who’d begun a second career running an AIDS service organization. This woman deeply cared about people, deeply cared about people living with HIV/AIDS (PLWHA). But there was a gap.

Noticeably lacking from our conversation was a discussion of the impact of AIDS on black gay men … I looked around the room, where there seemed to be a poster on every space of wall, and I could not find one poster that focused on gay men … . There were posters telling you to wear a condom. There were posters telling you to talk to your sexual partners about AIDS. There were even posters telling you how to bleach your ‘works’ (needle and syringe), a radical stance in almost any environment, especially in a church. But I could see nothing that was aimed at, or spoke directly to, gay men.2

For Cohen this conversation served as a stand-in for the ways that black men living with HIV/AIDS were even ignored in promotional materials telling people how to stay safe.

Fast forward approximately ten years after Cohen’s work was published.

In 2011, I was driving through Park Heights, a predominantly black Baltimore neighborhood in Baltimore with one of the highest rates of concentrated poverty in the state of Maryland. On its most prominent thoroughfare hangs a huge billboard of two men standing together, shoulder to shoulder. One of the men (Andre) looks directly at the camera, while the other one, smiling, has his arm around him. The billboard headline reads “Deciding Moment: We Talk About Everything, Including HIV.” The “o” in “Moment” contains a > (“greater than”). The billboard is part of the Greater Than AIDS campaign, created by the Black AIDS Media Partnership. The 2011 nation-wide campaign features a number of prominent black church leaders, civil rights leaders, politicians, actors, musicians, singers, and MCs (the campaign included a number of radio ads and many of them used the hook from Ice Cube’s record “Check Yo Self”).

Juxtaposing this anecdote against Cohen’s, one could argue that a signal shift has occurred. HIV/AIDS and the black populations it afflicts has gone from being invisible to being highly visible. But yet and still we know that blacks still constitute a disproportionate number of its victims, particularly in southern and rural areas.3 What explains this?

During the eighties and the nineties, HIV/AIDS was a cross-cutting issue rather than a consensus issue. Over the course of the first decade of the 21st century HIV/AIDS became a (weak) consensus issue in black communities. I suggest that this occurred through a process of neoliberal translation that has the consequence of placing primary responsibility for combatting the disease on the populations least likely to have the capacity to do so.

The paper proceeds as follows. I first examine Cohen’s conception of secondary marginalization. I then examine the neoliberal turn and its effect on public health. Finally I examine the 2011 Greater Than AIDS media campaign. I argue that with the neoliberal turn, significant resources have been spent on trying to get black gay men to take responsibility for their sexual activity, making them personally responsible for the spread of the disease.

Secondary Marginalization

A few short years after the CDC recognized AIDS as a disease and HIV as the cause, it was clear that two subpopulations of African Americans were dying from the disease at startlingly high rates—intravenous drug users, and homosexual/ bisexual men. However, with exceptions black leaders and political representatives did not perceive or articulate HIV/AIDS as a “black” issue. It was either a “gay” (white) issue or it was a behavioral issue of individual blacks who’d succumbed to drug use or engaged in illicit sexual behavior. Because black populations were most at risk to become HIV positive, were the most likely to become full-blown AIDS cases and were most likely to die, blacks should have theoretically been expected to mobilize against the disease out of a sense of “linked fate.”4 Why?

For Cohen the concept of “secondary marginalization” (which refers to the ways elites within already marginalized groups marginalize sub-groups) looms large. Black elites construct the borders of what it means to be black through “respectability.” They then police this border by withholding care from groups who aren’t “respectable.” They then use this process to distinguish “consensus” issues defined as important to all members of the group from “cross-cutting” issues defined as important to only some (less powerful) members of the group.5 During the post-civil rights era, secondary marginalization becomes particularly important as a way to withhold valuable resources from subpopulations of already marginalized groups, as cross-cutting issues are becoming more and more visible. The concept of secondary marginalization is particularly effective in explaining how and why black communities largely ignored both HIV/AIDS and populations most likely to be afflicted with it. Rather than being viewed as a consensus issue that blacks in general should contest, HIV/ AIDS was viewed as a cross-cutting issue, one deemed not as important as other more pressing issues. “Respectable” people don’t engage in drug use. “Respectable” men don’t have sex with other men. AIDS, rather than a disease managed through politics, is a disease that primarily targets black people who deserve to die.

Scholars have extended this line of work by examining the way that some marginalized groups have contested intra-racial marginalization,6 by examining how this process plays out in advocacy organizations,7 how secondary marginalization is reinforced through silence,8 and how women living with HIV/AIDS navigate the disease.9 In implicitly thinking through the ways that HIV/AIDS came to be deemed a cross-cutting issue further marginalizing black gay men and intravenous drug users, scholars have also examined the role stigma plays in shaping attitudes about populations deemed to be at risk of contracting HIV,10 the role hypersegregation and the growth of the carceral state have played in the spread of HIV/AIDS in black communities,11 and the role the media plays in shaping black policy preferences.12

However, less emphasis has been placed on how issues transition from being cross-cutting to consensus issues. Doing so would accomplish a few specific goals. Specifically, it would help us understand this contemporary moment when HIV/ AIDS is no longer invisible. More broadly it would help us understand the conditions under which cross-cutting issues are no longer cross-cutting. Further, I think it helps us better understand the neoliberalization of black politics. The post-civil rights era has seen the gradual ascendancy of neoliberalism, a dynamic that exacerbates inter- and intra-racial inequality by creating institutional and ideological apparatuses that place more and more responsibility on the backs of populations most in need of state resources. HIV/AIDS represents, to me, an example of how a cross-cutting issue becomes a consensus issue through a process of neoliberal translation.

The Neoliberal Turn

I define neoliberalism as a set of policies and ideas that focus on the notion that individuals, populations, institutions, and governments should work and be shaped to work according to market principles, so as to better produce “free market” conditions in the world.13 Neoliberal policies are designed to significantly reduce the ability of governments to collect taxes, eradicate labor rights, and drastically roll back welfare provisions among other things. The end result significantly exacerbates inequality—levels of inequality in the United States are higher than they were during the Great Depression.14 And while this dynamic, which occurs through racial politics15 is nation-wide it takes a particular form in cities—cities are the central hubs of the Keynesian rollback and the neoliberal rollout, as the ability of cities to collect taxes, to provide a broad range of public goods, and to bolster the power of labor (among other things) is significantly weakened.16 With their ability to collect revenue weakened cities increasingly turn to public-private collaborations. These private institutions often offer services in lieu of tax revenue, but these services often work to entrepreneuralize subjects.17 The structural dynamics shaping the transmission and spread of HIV/AIDS are indelibly shaped by the turn.

As is the way the issue is dealt with. HIV/AIDS is a simultaneously a health issue and a political one. “Health insurance” is at base about reducing the risk of health-related harms by spreading that risk wide enough so it is not borne by any one person. With the neoliberal turn risk reduction increasingly occurs not through “socialized actuarialism” but through inculcating prudentialism at the individual level.18 The individual is increasingly tasked to recognize various health risks. The process of making the individual responsible for managing his/her own health is supposed to both prepare and liberate him/her from the fetters of the state.

This creates a “new public health” comprised of a number of elements of which I focus on one—health promotions. Health promotion strategies are increasingly adopted in order to incentivize individuals to take responsibility for their own health. These strategies are designed to inform individuals about their health, about health-related risks, and the various steps they can take to prevent their health from deteriorating. These strategies include advertising campaigns that warn individuals of the morbidity risks posed by certain practices and behaviors, warn individuals of the problems associated with various diseases/ailments, give individuals data as to various morbidity rates, or some combination of the above. These campaigns can take the shape of billboard ads, magazine ads, public service announcements, television interviews and appearances, and in the Internet age, websites and YouTube style videos. And although these campaigns often implicitly target populations deemed to be at risk. These techniques are designed to get the individual to take responsibility for his/her health through being exposed to information and activities that will make him/her change their activities.

These strategies place the primary responsibility for health on the individual. It is the government’s responsibility along these lines to provide the individual—who is viewed as rational and interested in preserving his/her/their own health—with the information he/she/they needs in order to stay healthy. This technique inculcates the “moral duty to be well.”19 Individuals with the capacity to govern their own health are asked (from a distance) to be aware of the risks associated with various activities and to do the work (positive work such as working out, eating right, being vigilant, and engaging in safe activity; negative work such as staying away from bad practices, and the people/places associated with them) required to keep them healthy. Rather than an individual in need of care from a health specialist, the individual is transformed into a patient-consumer with the power to choose—again if given the proper information—between various choices, some of them healthy, some of them less so. The relationship between patient strength and consumer strength is direct—the better a consumer an individual is, the more information the individual has about the choices available to her, the better patient she is. And inevitably the healthier the individual is. The individual is given information as to the types of activities he can engage in to become healthier, the types of routines, the types of medicine.

Individuals deemed to be at risk of contracting HIV and being exposed to AIDS, individuals who already have HIV or AIDS, and populations in general are increasingly disciplined, incentivizing the individual to take responsibility for the individual level actions needed to be taken to become or stay healthy. Black elites (including black gay activists) help to translate HIV/AIDS into a consensus issue through making the populations most at risk of contracting the disease take responsibility for it. And they do so particularly in cities eviscerated by the neoliberal turn, through public-private partnerships between government entities and non-government ones. While there are a number of overlapping health promotion attempts going on at once in black communities, I focus on one, Greaterthan.org, at a specific moment in time (2011) and in a specific space–Baltimore. I choose Baltimore because it is both a majority black city and a city with one of the highest HIV/AIDS rates in the country. In transitioning HIV/AIDS from a cross-cutting issue believed only to affect a marginalized group of blacks to a consensus issue believed to be important to blacks in general black elites are using a new form of neoliberal respectability via health promotion campaigns like the one employed by Greaterthan.org.

Greaterthan.org

During the early 2010s the Black AIDS Media Partnership (BAMP), a coalition of black media companies concerned about the spread of HIV/AIDS collaborated with the Center for Disease Control, the Kaiser Family Foundation, state/local governments with black populations hard hit by the disease, mainstream media companies (including CBS, NBC, Fox, and MTV among others), the National Basketball Association, and Walgreens, on a campaign to reduce HIV/AIDS rates in black communities by means of a social marketing campaign entitled “Greaterthan.org.” The name itself is shorthand for a mathematical equation (I/ We are greater than AIDS). The campaign includes magazine, billboard, and sidewalk advertising, along with radio ads, commercials, promotional posters, a website, a twitter account, and a Facebook page.

In the early 2010s the Greaterthan.org campaign tour traveled to black events such as the Essence Festival, generated billboards in major cities with large black populations, created radio ads for black radio stations and commercials on black television networks. The virtual aspects of the campaign (multimedia banners, downloadable videos and radio ads) were advertised on black websites and sent to black bloggers. The campaign itself worked on people’s desires to be well, making wellness not only a desire but a moral prerogative—people concerned both about themselves and about black people should take the proper steps to be healthy. And it did this by connecting expert knowledge to certain types of desirable black bodies. A number of prominent actors and media personalities lent their efforts to the video and to the voice ads. All of the videos I examine below can be found on the organization’s YouTube page, while my analysis of the website itself is based on an archived version.

The 2011 website was divided into five major sections (Know, Protect, Real Talk, Get Tested, Take Action—”the five ways to be greater than AIDS”) plus a Home and an About page, which contains a description of the site, its core message, the need for action, and information about partners. The About page contained four short sections, the first stating what Greaterthan.org is, the second stating the campaign message, the third stating why the campaign began, and the final one listing some of the campaign’s partners. The message section worked to connect the need to think of HIV/AIDS as a core component of “the black agenda.” This message functions to make black men and women perceive HIV/ AIDS work the same way they perceived anti-racist/black empowerment work.

Four of the six sections (Know, Protect, Get Tested, Take Action) had similar page structures, prominently featuring a video on the top of the page (with Facebook, Twitter, MySpace, and email download links), and authoritative information links below the video. Each video used experts (Dr. Drew Altman, President of the Kaiser Family Foundation; Dr. Kevin Fenton, Director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, civil rights leaders (Julian Bond, former NAACP Chairman of the Board), gay activists (Phil Wilson, Founder and Executive Director of the Black AIDS Institute; Jesse Milan, former Board Chairman of the Black AIDS Institute), and black culture workers (actors Essence Atkins, Sam L Jackson, Nia Long, Christopher and Kyle Massey, Tia Mowry, Naturi Naughton, Gina Rivera, Journee Smollet, and Jesse Williams, MTV VJ Sway Calloway, and comedian Steve Harvey). These elites all used a combination of statistical data and “common sense” to connect disciplinary actions (what individuals were incentivized to do) to population health.

In the “Know” video (“It Begins with Knowledge, because Knowledge is greater than ignorance”) for example, the elites emphasize how HIV/AIDS has “fallen off the radar screen” domestically even as the disease disproportionately affects African Americans.20

The actors’ combined message depicts HIV/AIDS as an enduring black crisis that can only be combated by knowledge. The “Protect” video (“Safe is Greater Than Sorry”) emphasizes protecting one’s self through condom usage.21 The “Get Tested” (“Knowing is Greater than Doubt”) video which contains more actors and media personalities (Nia Long, Sam L Jackson, Tia Mowry, Journee Smollet, Essence Atkins, Jesse Williams, and Sway Calloway). It began with Long and Jackson repeating the question “What if I told you …” with Williams concluding by noting a statistic—1 in 5 Americans with HIV do not know they have it. A voice then intones “HIV is hurting sisters left and right. Brothers too. If we don’t talk about getting tested for HIV with our partners, then we all in a hot mess. It starts with us” . As the narrator speaks here, we see a series of equations (Knowing > Doubt; Talking > Silence; Hope > Fear; Knowledge > Ignorance; Action > Apathy; We > Me; Inspired > Complacent; United > Divided; Forgive > Forsake) with some highlighted for effect. Smollet then talks about the reason she knows about HIV tests (“because last year, I got two”), followed by Calloway emphasizing testing as something individuals really need to do, followed by a young black HIV positive woman talk about how she had the disease for a long time without knowing about it.22

The information below the 2011 archived page emphasized the various testing types, how HIV tests work, who should get tested for HIV, whether HIV tests are part of routine physicals, whether blood donors are tested for HIV, how much HIV tests cost, what to do if the tests are negative/positive, what treatment is available, and finally who has access to test results. Although the testing argument is made to black people in general, the implicit message here—bolstered both by the voiceover and by the individual speakers—is that testing is particularly a black woman’s issue and that testing is the individual act that can end the threat of HIV.

I noted earlier that I first became aware of the Greaterthan campaign driving through Baltimore. More specifically I became aware of the Greaterthan campaign driving through Southern Park Heights. Over 95% of its population is black (compared to the city’s 64%), its median household income is approximately $27 K ($10 K less than the city), its unemployment rate is 50% higher than the city’s, and its poverty rate is 73% higher than the city’s average . The billboard I saw featured Aziz, one of approximately thirty black men and women featured in the billboard campaign. The real stories (“deciding moments”) of the black men and women featured on these billboards represent the moments people decided to get tested, to deal directly with the concept of stigma, to support loved ones who contracted the disease, to protect people they loved from getting the disease. In talking about the disease, the subjects all emphasized three broad themes: responsibility, ignorance, and a third I explain below.

They consistently connect personal responsibility (in this case the responsibility to practice safe sex, to disclose one’s status, and to get tested) to protection (from other individuals), partnership, choice, and through choice, empowerment. Aziz (male HIV positive) emphasizes that you are ultimately responsible for your own care independent of your relationship status:

If you don’t take care of yourself, if you’re not the one to look out for you, you can’t rely on another human being to do that for you.23

The individuals emphasize an eternal vigilance, connecting that eternal vigilance and responsibility to the act of regular testing. Being responsible, means being forever responsible and on guard against other individuals. Andre (male HIV-) emphasizes how proud he is of being gay and how proud he is of speaking about HIV and of being tested. Speaking directly to the viewer he also connects condom usage to love and monogamy:

If he won’t use a condom he’s not ‘the one’ for you. There’s another Prince Charming out there who will use a condom.24

Individuals communicated this idea in the “Protect videos,” implicitly articulating preferences for monogamous relationships. Even as support for same-sex marriage increases, a number of gay and lesbian activists argue marriage itself is a heteronormative institution that reproduces rather than contests neoliberalism. As such they argue that fighting for marriage represents a conservative struggle that ends up dividing people within gay and lesbian communities. While Andre, again, is proud of being gay and proud of his willingness to speak up about HIV and getting tested, he emphasizes conservative ideas about relationships. Although implicitly recognizing the hypocritical nature of the concept of “Prince Charming” (by saying there will be another Prince Charming he is implicitly assuming the first individual too irresponsible to use a condom was himself a Prince Charming) his use of the terms ‘The one’ and ‘Prince Charming’ reflect the assumption each individual can only have one true (i.e., responsible) partner. The only time we see gay men’s relationships dealt with is through this framework.

The concept of “Prince Charming” also appears in Marvelyn’s (female HIVþ) story. Marvelyn depicts herself as the all-American monogamous, active, country girl (she grew up around chickens and cows) who ended up being infected by her boyfriend, noting he was her “Prince Charming.” Refusing to be bitter, she argues that she contracted the virus because she was irresponsible and ignorant. Whether he knew his status or not (we aren’t told whether he did) it was her responsibility to use a condom. That night, she had a choice. She would’ve been safe had she used a condom.25

Chauncey (female HIV-) is a poet who uses her platform in order to deal with issues afflicting black communities, including HIV/AIDS. She does so in part in order to fill the silences around sex that as Jordan-Zachery (2017) notes shapes black women’s politics forcefully. She speaks of responsibility as a form of empowerment rather than pure protection.

You are the author of your life. By making wise decisions you can create any destiny you choose.26

We see the two different poles of responsibility here—at one end responsibility is an intensely individualistic mode of protection against outside forces, at the other end responsibility is a type of wisdom that properly used can significantly expand one’s life choices.

I noted Marvelyn’s ideas about ignorance above. Ignorance is the second major theme expressed by the subjects, reflecting the importance of the central equation “Knowledge > Ignorance.” Here knowing the facts about protection and about HIV and AIDS can literally save your life, while ignorance is deadly. More expansively societal ignorance (or in this case ignorance in and of black communities) can significantly reduce aggregate life chances. Individual knowledge is linked to individual power.

Chauncey emphasized black ignorance in general, in talking about developing a positive attitude toward sex. The only sex talk she heard from blacks growing up was “you better not come home with no babies.” Given how she became aware (enough to participate in the project), the viewer is led to presume not only that she developed her own positive sex talk but that this positive sex talk in turn implied responsible sex talk .

Marteniz (male HIVþ) articulates similar ideas—when he was growing up the only thing the people in his community harped on was how important it was to not get anyone pregnant. Protection in this case was protection from birth not protection from disease. Because he was gay he wasn’t concerned about the possibility of bringing children into the world. Because he was ignorant, he engaged in unsafe practices, which in turn caused him to get infected.27 Yvonne (female HIV-) argues that using safe sex is a form of protection against ignorance as “there are so many people walking around that don’t know they’re infected.”28 DJ’s (male HIV-) deciding moment came when his friend died of AIDS.29 However, ignorance shaped how he treated that friend—DJ didn’t know anything about the disease other than what he read.

Which brings us to the third major theme emphasized in the videos. Yvonne’s statement above implicitly divides black communities into people who know they’re infected and people who don’t. But even within these two populations there is a significant amount of confusion—people who are infected may or may not disclose their status, while people who don’t know their status may or may not have safe sex. Two of the individuals (Freda and Lolisa—both HIVþ) either make or at the very least acknowledge clear distinctions between HIV positive populations. Freda:

“It’s not only affecting men it’s affecting women as well. Professional women, not just someone that’s out there, you know, using drugs, it’s affecting mothers you know, women in the church. It don’t discriminate. It’s affecting married women. I get married women in my office that say I didn’t know my husband was positive. And [they’re] married.”30

Now when she (like the actor Jesse Williams in the Get Tested video) says it doesn’t discriminate, we can on the one hand understand them as saying the disease does not somehow “decide” who to infect or who not to infect based on surface characteristics. But putting aside the fact that the disease itself does not make decisions, there are two caveats. There are certain populations that are more likely to contract the disease than others. Further, even though the disease does not discriminate people do. Freda does this when she implicitly notes that even people “like her” (professional women, church women, and although Freda isn’t married, married women) are contracting the disease as opposed to people who engage in more problematic behaviors. The campaign does this itself in part by focusing on sex as the primary way HIV is transmitted. Only one ad emphasizes intravenous drug use and its connection to HIV. Lolisa notes a similar set of ideas—when she was younger she would watch PLWHA on old nineties television shows and she’d feel sorry for “them.” After having realized she was HIVþ (again she was likely born with the disease) she realized it wasn’t “them” it was “us.”31

The new public health works by seeking to make people healthy by making them do the preventative work required to keep from becoming ill, by making them knowledgeable about various health risks, by making them a patient-consumer. In this instance of black HIV/AIDS vigilance, black men and women are expected to deal with the growing HIV/AIDS crisis by becoming more knowledgeable, more responsible, and more vigilant. Those who are responsible, who are aware, who are vigilant, are viewed as respectable and worthy of care. Getting tested for HIV/AIDS and using protection when engaging in sex becomes the traits of a healthy responsible and ethical black person, one responsible not only to him/herself but to the race. The campaign gets people to work on this manner by a combination of images, expert knowledge, and “real talk” that translate expert knowledge about HIV/AIDS into language that motivates individuals. The campaign works on and through individuals, and in some ways works almost as the virus does, as the social marketing campaign itself works “virally.” And the campaign clearly attaches HIV/AIDS vigilance to what could be called “the black agenda.” HIV/AIDS is not an issue facing a small subsection of black communities, it is an issue facing the black community.

How does this specific campaign however, reproduce rather than contest contemporary inequality? I’d make three claims. First HIV/AIDS rates are particularly high in rural areas and in the south. Public health campaigns such as Greaterthan may actually work to exacerbate differences between rural and urban areas on the one hand and between the south and the rest of the country on the other as they require a level of institutional infrastructure and coordination that rural areas simply do not have and that other areas of the country likely possess more than the south. Secondly within cities like Baltimore campaigns such as these may exacerbate intra-urban inequality by articulating a message that suggests that individuals are primarily responsible for doing what needs to be done in order to contest the disease. Given the demographics of a neighborhood like Southern Park Heights, much less the demographics of a neighborhood like Sandtown Winchester (where Freddie Gray was killed in an encounter with Baltimore police), individual attempts to take responsibility will likely be dwarfed by the structural inequities that shape HIV/AIDS transmission. Third, this approach likely helps relatively well-off populations at risk of becoming HIVþ as well as well-off PLWHA, but also reproduces inequality within these populations as well.

Conclusion

Twenty years ago, Cathy Cohen lamented the absence of promotional ads featuring black men in a clinic designed to treat HIV þ men and women. Those ads are now ubiquitous, which represents a victory of sorts. But I’d suggest this victory is pyrrhic.

The health promotions campaign is based on the traditional ad campaign model that seeks to get consumers to make purchases they might not make in other ways. In this way the HIV/AIDS issue is a not necessarily a structural issue, not for instance a matter of the lack of access to drug treatment, the lack of access to clean needles, the lack of universal health care, but rather an issue of people simply not making the proper choices about their own bodies. People become consumers, and consumption is tied to “healthy choices.”

The various HIV/AIDS social media campaigns target African Americans (and increasingly Latinos) because the HIV/AIDS rates among black men and women are so incredibly high compared to other populations. In fact, one could argue that the reason the programs are deployed is in part because they exhibit an earnest effort to deal with the exigencies of racism. And this racial knowledge is itself the product of statistical techniques of aggregation and measurement.

Expertise played a central role in the HIV/AIDS campaign—experts helped devise the media ads used, experts were used to helped generate the most productive testing regiment. Expertise works in these cases to render them apolitical and technical. Moreover, they used aggregate level statistical data to determine the proper spatial context in which to apply the techniques. The ads are not only tailored to specific populations deemed to be “high risk,” they are tailored to very specific neighborhoods—the billboards in Baltimore for instance appear in some of the poorest black neighborhoods as well as almost all of the bus stops black Baltimoreans frequent, and this knowledge comes from combining knowledge of HIV/AIDS rates with knowledge of the race and class demographics of Baltimore neighborhoods.

Relatedly, these techniques are incredibly mobile. The HIV/AIDS health promotions campaign was not only easily spread to a number of cities throughout the country, the technique itself can easily be modified to deal with other similar health issues.

Neoliberalism relies on two sets of technologies—technologies of subjection and technologies of subjectivity.32 Here I focus largely on technologies of subjectivity— technologies applied to populations that have expressed or can potentially express the ability to be self-governing according to neoliberal dictates. The techniques above are designed by experts but they are designed in such a way as to get individuals to govern themselves, to “take control” of their own lives. But in the process of doing so the techniques above make clear distinctions between populations. The healthy men and women are the ones able to maintain testing regimes, are the ones who always practice safe-sex, are the ones who always ask (and truthfully answer) questions about sexual habits. Whereas technologies of subjectivity are used on (and by) the winners, gradually technologies of subjection are used on (rarely by) the losers. And it becomes very difficult to contest the losers’ status, particularly in the HIV/AIDS example. Given how deadly the disease still is, how should we view those unable or unwilling to continually test themselves, to continually practice safe sex, and to be open about their sexual history (and to expect such open-ness from their partners)? While in this paper I did not fully examine the institutional structure behind the ad campaign, it is worth considering not just the messages contained in the various videos and campaign websites, but the coalition required to generate the videos and campaign itself.

The concept of secondary marginalization helps us understand why a range of issues affecting black communities are placed on the backburner. However, it is far less helpful in explaining how issues that are taken up by black communities are framed in ways that reproduce rather than contest marginalization. Placing issues like HIV/AIDS on “the black agenda” has happened by making the issue more visible but doing so in a way that places the bulk of the responsibility on those most in need of our care. Rather than making issues like HIV/AIDS more visible through health promotion projects, what the next generation of activists should focus on is the political economy that makes HIV/AIDS particularly problematic in neighborhoods and in populations without resources. Such an approach would not place the burden and the primary responsibility on the populations and neighborhoods most at risk, but rather would—perhaps through something like healthcare for all—distribute the risk far more broadly.