The discipline of geography is largely absent in discussions and debates about drug use practices and their relationships to sexual health. Given the important relationships among the use of drugs, performances of sexualized identities, and the practices of sex, it behooves medical and health geographers particularly, and social and cultural geographers more generally, to engage in the wider interdisciplinary debates about these relationships.

Through a discussion of one drug, Viagra, this brief intervention offers an agenda for studying the geographies of sex, sexuality, and drug use. It is argued that drug use is an inherently geographic practice that reshapes how places are resituated in relation to the fluid and dynamic meanings of sex, sexuality, and sexual health, areas of research and practice that medical and health geographers ought to consider more seriously.

A geography of Viagra™, that incredibly popular sexuopharmaceutical designed to make the penis erect in older men, might trace the global dynamics of its distribution and diffusion, focusing, in particular, on the diversity of places where this medical ‘revolution’ has been employed. A quick survey would demonstrate that Viagra, and other sexuopharmaceuticals, are finding markets throughout Asia and Latin America,1 although this drug’s largest markets are among men in the North America and Europe.

In tracing these global distributions, geographers might interrogate the enormous monies invested by ‘big Pharma’ in fighting patent infringements on drugs such as Viagra in countries like China (Global Insight, 2006) as well as the possible use of these drugs as substitutes for herbal medications related to male sexual practice (e.g., Von Hippel et al., 2005). Medical geographers could also investigate the comparative global investment in this ‘lifestyle’ drug in relation to other drugs designed to curb infectious diseases, such as malaria, tuberculosis, or HIV/AIDS (Silverstein, 1999). In fact, a historical medical geography might trace the inequitable investment in research and development, which marginalizes studies of drugs to fight infectious diseases that impact people extensively in tropical world regions in the post-colonial period (Flory and Kitcher, 2004). This is evident in the minimal investment in the development and distribution of drugs to curb the debilitating effects of HIV, malaria, and tuberculosis in sub-Saharan Africa versus the massive investment in research and development and advertising of drugs, such as Viagra, in North America, Europe, and parts of Asia (Flory and Kitcher, 2004).

Taking a slightly different approach, health geographers could examine these drugs as part of a shifting and dynamic set of therapeutic landscapes, albeit in a way that we have yet to discuss: investigating the intersections between sexuopharmaceuticals and the reification of certain masculine identities and performances of/in certain places, such as bars, brothels, or bedrooms. Such studies might offer insight into the medicalization of masculinity and male sexual practices in both global and local context. In working through the therapeutic nature of sexuopharmaceuticals and the medicalization of erectile (dys)function as a disability, therefore, we might continue the important critique of the ‘therapeutic landscape literature’ (Wilton and DeVerteuil, 2006, for a summary of this critique) and ask how power operates in and through these spaces to legitimate this highly symbolic corporeality of male sexual desire as an apparently essential condition of human existence. This would further complicate the nature of ‘therapeutic spaces’, which might be seen as rehabilitating to some (e.g., men using Viagra) and debilitating to others (e.g., women who are partners of men using Viagra) (see discussion by Potts et al., 2003, for example). What this suggests is that any study of how drugs and their use re-organize certain spaces and places needs to consider, more generally, the complex intersections between drug use and the gendering of sex, sexuality, and sexual health.

In examining the intersections between the development of sexuopharmaceuticals and the geographies of sex and sexual health, the remainder of this viewpoint is organized around three sections. First, I trace the ‘absence’ of studies on sexuality and drug use in geography, particularly medical and health geography. Second, I take up the question of how we might theorize the relationship between sexuopharmaceuticals, sex, and healthy/ill sexual identities through a weak or flaccid, dare I say ‘soft’, theoretical orientation. I argue that medical and health geographers can further their own criticality by working against the operative discursive practices of our global (medicalized) obsession with all things ‘hard’. Finally, I trace how an interrogation of these sexualized geographies might further open up the questions that medical and health geographers ask about the intersections among drug use (both legal and illegal), sex, sexuality, and sexual health and their concomitant and constituent spatialities.

Tracing the absence
Despite the increasing importance of sexually transmitted infections (STIs) globally, medical and health geographers have remained fairly marginal in discussions that cross the boundaries between sex, drug use, sexuality, and sexual health; they remain almost completely absent in the larger social scientific debate regarding the intersections between sex and drug use practices. It is important to note this absence given the attention that ‘geographers of health’ have paid to critical social theory over the last 15 years or so. The ‘critical’ turn in medical and health geography toward a ‘posting’ or ‘reform’ of the subdiscipline has opened up new research agendas and debates, many of which are evinced in the pages of this journal. At the same time, medical and health geographers have moved more slowly toward theories of the body and the suggestion by some in the subfield to engage in corporeal and embodied geographies. Until fairly recently (Parr, 2002), the call by Dorn and Laws (1994) for a more embodied medical geography was marginalized by a more dominant therapeutic landscapes literature and a reasserted disease ecology in the debates about the direction and future of medical and health geography ([Kearns, 1993], [Kearns, 1994a] and [Kearns, 1994b]; Mayer and Meade, 1994). This is, in part, not surprising given the inherently geographic nature of the landscape and ecology tropes, which focus our attention on one of geography’s core concepts, place. Therefore, while some geographers of health have engaged questions of embodiment (Hall, 2000; Longhurst, 2001), questions of sexual practice and desire have remained on the sidelines of the reform movement in the subdiscipline, despite its emergent ‘criticality’ (Brown and Duncan, 2002; Kearns and Moon, 2002; Parr, 2004).

In similar ways, medical and health geographers have yet to fully engage with the broader discipline’s interest in queer theories or sexuality studies (Brown, 2000; Elder, 2002; Nast, 2002; Knopp, 2004; Oswin, 2004; Sothern, 2004), the latter of which intersects with various social theoretical and cultural studies perspectives in addition to queer theories (Brown and Knopp, 2003). The importance of queer theory to medical/health geography is incredibly relevant, however, because it forces us to interrogate the sexualized, gendered, and raced assumptions embedded in societies—and power/knowledge systems sutured to meanings of health and illness, wellness and health care—that privilege heterosexuality, masculinity, and whiteness. This is particularly true if we consider the incredibly dynamic and important interrelationship between health (broadly conceived across the array of mental and physical health concerns) and sexualities (as they are complexly performed in a multitude of ways). Moreover, the global distribution of HIV and AIDS as well as the diffusion of other STIs, such as syphilis, gonorrhea, and hepatitis B and C, all have varying and unique place-based patterns and processes of transmission (Brown, 2006) tied to the practice/performances of various sexualized identities. Yet, because queer theory and ‘sexuality and space studies’ remains fairly marginal to the programmatic discussions in medical/health geography (as well as geography more generally) when medical and health geographers do take on these issues they tend to focus on the dynamics of health–place interactions more so than on the sexual practices and performances—operating through various hetero- (Hubbard, 2000) and homo-normativities (Oswin, 2004; Puar, 2006)2—that might put people at risk for an infectious disease (Philo (2005) makes a similar argument about discussion of ‘sex’ in population geography, a related subdiscipline). Medical and health geographers thus tend to marginalize ‘the sociobiological…[and] the ways in which bodies are both socially constructed and materially experienced’ (Parr, 2002, p. 243, citing Hall 2001, emphasis in original). But, sex is a sociobiological and geographic practice: sex acts vary in relation to the spaces and people that are part of the process of sex itself. The intersections between sex acts and risks to one’s health vary relationally as well: the same sex act—penetrative vaginal sex, for example—in different places might lead to new performances attached to unique risks, from sexual violence to transmission of a STI (cf. Singer et al. (2000), who provides a similar argument on social geographies of drug use). Moreover, drug use and sex are often practiced simultaneously, as individuals use drugs to engage in sex and use sex to engage in drug use (Kochems and Del Casino, 2004).

At the same time, while medical and health geographers have investigated the use of drugs such as tobacco and alcohol ([Poland, 1998] and [Poland, 2000]; Twigg et al., 2000; Twigg and Moon, 2002), there have been fewer studies that examine illicit drug use (there are several exceptions, see Punch, 2005; Saldanha, 2005; Wilton and DeVerteuil, 2006).3 When we couple the marginality of sexuality studies in the discipline with the limited study of drug use more generally, it is quickly apparent that geographers could do more to investigate the intersections between drug use, sex, sexuality, and sexual health. Given the context of a ‘reformed’ or ‘post’ medical geography, it is important that geographers take up these intersections, particularly when health geographers have growingly engaged questions related to identity and difference (e.g., Craddock, 2000; Moss and Dyck, 2002). As critical health geographers could surmise, drug use is always situated somewhere tied to the complex performance of various identities—recreational user, the barfly, addict, tweaker, etc.—and the processes of subjectification that are part and parcel of the duality of drug use (legal and illegal) as both medically and socially appropriate and/or stigmatizing (Dovey et al., 2001). As Poland (1998, p. 209) effectively argues in the context of smoking, ‘the social construction of smoking as a moral social problem is partly predicated on (although also facilitative of) the legal control of space’ (see also Poland et al., 2000). At the same time, drug use also alters the spaces in which that drug is taken, shifting the very meanings we might ascribe to certain spaces and the practices in which we might engage when we are in them.

The diffusion of sexuopharmaceuticals provides a unique opportunity for medical and health geographers to participate in discussions of the intersections between sex, drug use, sexuality, and sexual health. These drugs are unique because, on the one hand, they identify a clear challenge to male hegemony by articulating a socially stigmatizing flaccidity. On the other hand, they reinforce that same hegemony by reaffirming that penal penetration is a necessity of sex, giving unlimited sexual mobility to men to control their bodies, particularly their penises, and ‘get hard’ where, when, and how they want. The use of sexuopharmaceuticals clearly intersects with sex acts themselves in interesting and provocative ways that raise important questions for medical and health geographers regarding the meanings we ascribe to certain bodies, the performances of these bodies in and through various places, and the dynamic socio-spatial interrelationships between drug use, sexual practices, sexualities, and sexual health. In addressing these issues, I want to offer an alternative (flaccid) framework that destabilizes the normative assumptions that are part and parcel of the social geographies of the circulation and use of sexuopharmaceuticals in relation to various sex acts and performances of sexuality.

References

Aldridge and Measham, 1999 J. Aldridge and F. Measham, Sildenafil (Viagra) is used as a recreational drug in England, British Medical Journal 318 (1999), p. 669. View Record in Scopus | Cited By in Scopus (31)

Berg, 1994 L. Berg, Masculinity, place and a binary discourse of ‘theory’ and ‘empirical investigation’ in the human geography of Aotearoa/New Zealand, Gender, Place and Culture 1 (1994), pp. 245–260. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (29)

Bishop and Robinson, 2002 Bishop, R., Robinson, L.S., 2002. How my dick spent its summer vacation: labor, leisure, and masculinity on the web. Genders 35. left angle bracket www. genders.org/g35/g35_robinson.htmlright-pointing angle bracket.

Boynton, 2004 P. Boynton, Better dicks through drugs? The penis as pharmaceutical target, SCAN: Journal of Media Arts Culture 1 (2004), pp. 1–6.

Brown, 2000 M. Brown, Closet Space, Routledge, London and New York (2000).

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Source: Health & Place
Volume 13, Issue 4, December 2007, Pages 904-911