Mackenzie, S.Structural Intimacies: Sexual Stories in the Black AIDS Epidemic. New Brunswick: Rutgers University Press. 2013. £25.95. xi + 204 pp. ISBN 978‐0‐8135‐6098‐4.

In this well-written and interesting book, Sonja Mackenzie explores local understandings of the HIV epidemic in a black US community. She does so through a discursive lens which theorises the epidemic as ‘a convergence of structural factors, cultural conditions, and individual agency productive of sexual selves’ (p. 2-3). She draws on Csordas's notion of embodiment to explore the interplay between the social and the felt presence of power, on Bourdieu's concept of habitus to highlight how societal forces and structural inequalities are internalized by individuals, and on queer theory's emphasis on reflexivity and agency. The analysis is based on a set of interviews conducted in 2005/6 with 43 black people in the San Francisco Bay Area. It focuses on what Mackenzie describes as three ‘structural intimacies’, i.e. sexual stories that ‘coarticulate the production of sexual bodies and practices and the structural conditions in which they are embedded’ (p.15). More specifically, in three separate chapters she explores: the relationship between cheap alcohol outlets and risky sexual behavior; men ‘on the down low’ (having sex with other men in secret); and AIDS conspiracy theories. The theme of AIDS conspiracy theory continues into the final chapter which discusses the challenges faced by Barack Obama during the 2008 election when Jeremiah Wright (his preacher) argued that HIV was a US bioweapon. Mackenzie's central claim is that the narratives she uncovers should be understood as structural intimacies because they ‘insist on the decentering of sex and sexuality from essential states of being to the often gritty realities of structural and cultural conditions’ (p.7). But while some stories can convincingly be framed in this way – for example that rot-gut alcohol made available by profiteers and city planners on ‘every street corner’ facilitates drunkenness and unsafe sex – it seemed too much of a stretch to me to apply this to AIDS conspiracy theory. Indeed, in her chapter on AIDS conspiracy narratives she usefully highlights the historical trauma of slavery and medical experimentation and the ‘archives of feeling’ these create within which AIDS conspiracy beliefs are sustained, rather than sexual stories per se. Her concept of structural intimacy would, in my view, have been stronger if it had not sought to saturate the entire social world in sexual terms (a critique that can, of course, be applied more generally to queer theory). A more substantive question for me was how far one can push this kind of discourse analysis of a convenience sample into the policy arena. Mackenzie accepts that her study must ‘not be deemed ‘representative’ of the general population of Blacks … and may not be reflective of other Blacks in the Bay area’ (p.127) yet she goes on to make policy findings as if her study is representative, and as if her interpretation of the interviews (which privileges those narratives that locate stories of individual responsibility within a structural context) can be read as reality itself. For example, she writes that the narratives ‘speak to the convergence of two epidemics – that of the HIV virus and that of social inequalities’ and that they ‘tell us that addressing one without the other will continue to render ineffective our efforts to curb HIV/AIDS among Blacks’ (p.95). But is this the case? There are important methodological and epistemological issues at stake here. Mackenzie argues that her ‘stories of structural intimacy show shifting forms of narrative representations of sex and the body towards the structural’ yet ‘exist in a complex interplay with ongoing narratives of individual responsibility’ (p. 136-7). But what this ‘complex interplay’ amounts to or what it implies for actual policy intervention remains obscure. Does it mean that HIV prevention will not be effective unless accompanied by the removal of social inequality? Not necessarily. Other scholars who have investigated the relationship between AIDS conspiracy beliefs and HIV risk behaviors in the US propose a different set of interventions, such as greater use of black peer educators in HIV prevention interventions and for government and public health entities ‘to acknowledge the origin of conspiracy beliefs openly in the context of historical discrimination as well as to collaboratively work to address current discrimination within the health care system’ (Bogart and Thorburn 2005). Mackenzie does not engage with these ideas, perhaps because they exist at a meso level, somewhere between the individual and the structural. Most of Mackenzie's respondents held AIDS conspiracy beliefs. This sets her sample apart from the available survey data showing that AIDS conspiracy beliefs are typically minority views and that most black people in the same social context do not hold them (Bogart and Thorburn 2005, Nattrass 2012). This raises questions about the extent to which the narratives she highlights are constitutive of broader publics, or whether they are marginal social theories and hence unreliable markers of the way that socio-economic and structural constraints are generally mediated and internalised. A related difficulty with Mackenzie's dualistic focus on individual narratives and structural context is that it silences the role of individual cultural agents who propagate AIDS conspiracy beliefs. In my own work, I have argued that black community leaders such as Louis Farrakhan in the US, and President Thabo Mbeki and his health Minister in South Africa played a key role in promoting AIDS conspiracy theories and undermining HIV science (Nattrass 2012). I would like to have seen some discussion of the role of opinion leaders and organisations in San Francisco in promoting or legitimating the conspiracy narratives that may have been appropriated and re-shaped by the individuals participating in Mackenzie's study. That said, I would like to emphasize that I enjoyed Mackenzie's thoughtful and engaging book, and that our differences in opinion are in large part a product of our location in different epistemic communities. Those committed to discourse analytic approaches and queer theory in particular will find the book innovative and important. Those on the social science end of sociology will probably share some of my reservations, but nevertheless find the book interesting and an accessible window into this kind of theory-driven analysis.

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