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Short abstract:

The lifesaving potential of naloxone is contingent on a broad set of mutually reciprocated care practices between people who consume opioids. We examine how consumers 'tinker' with technologically-mediated care practices in ways that may broaden the horizon of overdose prevention care.

Long abstract:

Take-home naloxone provision is regularly constituted as a lifesaving strategy that addresses the risk of overdose for people who consume opioids. Importantly, the lifesaving potential of this technology is contingent on a broad set of mutually reciprocated care practices between people who consume opioids. Most specifically, naloxone needs to be administered by a witness to an overdose and, therefore, relies on a person’s capacity to consume drugs with, or around, other people who can identify an overdose. Given the arrangements required for naloxone, people who consume opioids are regularly advised to ‘never use alone’, with those unable to follow such advice deemed at higher risk of fatal overdose. Working with feminist STS scholarship on care, specifically Mol and Hardon’s (2021) fluid conception of care, we analyse 15 interviews undertaken with women concerning their perspectives on and experiences of take-home naloxone. We use Mol and Hardon’s (2021) conceptualisation of care to analyse naloxone as a technology of care produced through an iterative process of ‘tinkering’. For example, while the women in our study were aware of the risks of consuming drugs alone, many were unable to, or chose not to consume drugs with others. Instead, they tinkered with different ways of incorporating naloxone into care when consuming drugs alone, many of which were mediated by other technologies such as video or phone calls. We argue that by pragmatically exploring, adapting or tinkering with technologically-mediated care arrangements, these practices support safety in ways that may broaden the horizon of overdose prevention care.

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Long abstract:

Hepatitis C is a longstanding public health problem. Transmission largely occurs in the context of the heavily stigmatised activity of injecting drug use. In recent years, new drugs that cure hepatitis C have emerged. The Australian government has invested heavily in them, and aims to eliminate hepatitis C. Although treatment uptake was initially high, it has since plateaued. To address it, policymakers and researchers need to know why this is happening. Commonly, those not yet tested and/or treated are described as having gone ‘missing’ or been ‘lost’, and various ‘novel’ strategies for finding them are proposed. Some argue that these ‘novel’ approaches are enabled by law and human rights, including the state’s duty of care to its citizens. I define these ‘novel’ approaches as a form of ‘narcotechsolutionism’, where drug-related problems are theorised as solvable in narrow terms. Importantly, narcotech solutions may overlook alternative explanations for the testing and treatment plateau, including the possibility that people who use drugs didn’t go missing, but resist being found. This may be because they do not trust health care systems, fear stigma or worry about the legal ramifications of testing positive. Drawing on insights from Karen Barad (2019) and Daniela Gandorfer (2019), I explore what is at stake in narcotechsolutionism, including how theory sits within and shapes it. I argue that researchers must reflect on their own role in shaping logics of and possibilities for care, and how we are always in the act of shaping what we might come to care about.

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Trauma-informed care is an increasingly common approach in alcohol and other drug (AOD) treatment in Australia and internationally. It developed as a gender-specific approach for women designed to facilitate long-term recovery from both addiction and trauma. Given these feminist origins and popular formulations of care as synonymous with femininity and altruism, trauma-informed care has been embraced as a positive development in AOD treatment. Yet vital questions concerning how trauma-informed care cares, for whom and under what conditions warrant closer attention. In this paper we explore these issues through an analysis of interviews with Australian stakeholders working in trauma-informed AOD policy, research and treatment. Drawing on feminist scholarship on ‘critical care’ (Martin et al., 2015; Puig de la Bellacasa, 2011) and related work on biopolitics, we treat trauma-informed care as a biopolitical technology of the social that can set in motion stigmatising formations of despair and deficit. Stakeholder accounts suggest that while it can sensitise practitioners and consumers to connections between trauma and AOD-related issues, it also draws on gendered, racialised and carceral logics to pathologise already marginalised people as vulnerable and in need of medical and/or state intervention. Given that trauma-informed AOD treatment can materialise as coercive and complicit with biomedical forms of pathologisation and surveillance, we argue that attention or ‘critical care’ must be paid to the biopolitical conditions and subjectifying effects of trauma-informed care.

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With the arrival of SARS-CoV-2 and the global pandemic that quickly ensued, healthcare had to radically change to reduce transmission risk. Although these were terrifying times, with instability also brought possibility. For the harm reduction community, the pandemic created an opportunity for doing care differently. Scholars, activists, and practitioners alike heralded it as a time of ‘emergent adaptation and experimentation’ (Grebely et al 2020). For Judy Chang and others at the International Network of People who Use Drugs (2020), the pandemic potentialized a ‘new normal’ – ‘an occasion to rethink the function of punishment, to reform the system and to work towards ending the war on drugs’.

In the UK, like many countries, tightly controlled opioid agonists (used in the treatment of opioid dependency) were made available to take home, removing stigmatising supervised consumption practices. A new long-acting formulation of opioid agonist also arrived at this time. Drawing on a survey and interviews with people who use, provide and commission drug services in the UK, this paper reflects on the freedoms, flexibilities, and new subjectivities these technologies enabled. But what happened? Participants also overwhelming remark that ‘everything is back to normal!’. Therefore, while exploring this air of potential, and, namely, as realised in new opioid agonist formulations and forms of prescribing, I also attempt to unpick what made some of these changes so easily reversible and its care unrealisable, and the politics this reveals for who is worthy of care.

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Long abstract:

Alcohol and other drug residential rehabilitation in Australia, and elsewhere, increasingly operates at the intersection of “carceral” and “therapeutic” organisational logics, with a growing incorporation of “therapeutic jurisprudence” into community-based treatment settings. With a focus on the tensions that follow from these carceral logics, this paper draws on ethnographic data and conceptual tools from science and technology studies (Mol 2008;Law 2010) to analyse collective care relations and practices at Open Roads, a residential alcohol and other drug therapeutic community in Eastern Australia. Caring for and with collectives (of subjects, animals, knowledges, atmospheres, spaces etc.) when it worked well at Open Roads, enacted rules, knowledges and categories in fluid and open ways, enabling people to participate in changing living conditions in accordance with their needs and preferences. Yet choreographing care in response to imperatives of therapeutic jurisprudence often resulted in compromises and limitations in the practice of care as-well-as-possible. While offering respite from prison incarceration for some, enacting quasi-carceral regimes of care placed pressure on care participants to choreograph disparate and dissonant care imperatives in ways that hinged on tighter disciplinary regimes, therapeutic responsibilisation and enacting greater vulnerability and institutional dependency. Staying with the trouble of residential rehabilitation today we argue, requires adequate flexibility and resourcing to attend to, and ongoing assessment of, the needs of various collectives bound up in care relations. For policy makers, this requires a more direct accounting of alignments and incongruities between the needs of people entering care from criminal legal settings and other community members.

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Long abstract:

Digital ‘transformation’ constitutes a significant policy priority in health and care, with oft-cited promises of efficiency gains, democratisation, and increased ‘patient choice’. While such promissory narratives of digitalisation generate major interest and resources (Borup et al., 2006), scholars in STS and related fields (e.g. Pols & Willems, 2010; Nicolini, 2006) have highlighted the need to move beyond reductionist ideas of technological interventions as linear ‘solutions’ with stable and predictable outcomes across settings and over time.

This study focuses on the case of remote group clinics where patients receive care in groups, rather than one-to-one, via online platforms (e.g. video-based, hybrid). We draw on ongoing ethnographic and multimodal research (2022-24) at four general practices in England to trace how these new sociotechnical arrangements – or sites of care - come to produce different forms of caring and being cared for across settings. While staff attempt to ‘tame’ (Pols & Willems, 2010) remote technologies in ways to make them fit with organisationally driven objectives (e.g. prescription efficiency, promoting compliance), patients and carers work creatively with the possibilities of these technologies (e.g. selective use of webcam, chat) to negotiate their new responsibilities projected through group-based care (e.g. being a ‘good’ example to others, sharing intimate illness experiences). We conclude by discussing how such practices function to make remote group-based care align with local routines and goals of different users, but can also coalesce in ways that create unexpected forms of exclusion.

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Long abstract:

This ethnographic study investigates the impact of technology integration in healthcare provision, with a focus on a Netherlands-based healthcare company's utilization of remote care assistance and AI tracking tools. Over three months, one of the researchers immersed themselves in the company's operations to explore how technology affects relational and empathic care dimensions. The study uncovers a complex interplay between technological advancements and caregiving principles, highlighting the gradual substitution of relational and empathic practices with efficiency-driven approaches. Central to these technological innovations is the replacement of face-to-face empathy provision from nurses with 15-minute online weekly coaching sessions, labelled as the “empathy of the week” that homecaring clients are supposed to receive. The company's overarching goal is to optimize care delivery by reducing nurses' in-person interaction time, prioritizing efficiency over empathic engagement. This paradigm shift prompts critical reflections on the nature of empathic connection in a digital context and raises ethical concerns about the mechanization of emotional practices in healthcare. Drawing from ethnographic data and in-depth interviews with the company employees, the presenters will discuss how this efficiency-centric approach manifests in organizational ethos, interpersonal dynamics, and recipient experiences. The study underscores the ethical implications of rethinking efficiency in relational care, emphasizing the potential dehumanization and mechanization of technopolitical transition within healthcare settings.

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Long abstract:

Background

Long-acting injectable depot buprenorphine has become an important treatment option for the management of opioid dependence. However, little is known about patients’ experiences of depot buprenorphine and its embodied effects. Viewing care as a 'more-than-human' endeavour, and drawing on new materialism, we explore patients’ embodied experiences of depot buprenorphine, and how human and non-human actors shape, open-up, and foreclose care.

Methods

Participants were recruited from sites in Sydney, regional New South Wales, and Melbourne, Victoria, Australia. Thirty participants (16 men, 14 women; mean age 47.3 years) participated in semi-structured interviews. Participants had histories of both heroin and prescription opioid use, and previous opioid agonist therapy including daily dosing of buprenorphine/methadone.

Analysis

Our analysis illuminates: (1) how patients’ expectations/concerns about treatment are linked to past embodied experiences of withdrawal and uncertainty about the effectiveness of depot buprenorphine; (2) the diverse meanings patients attribute to the depot buprenorphine substrate ‘under the skin’; and, (3) how depot buprenorphine is embedded within a wider ecology of care in treatment settings, such as counselling and social supports.

Conclusion

Our work destabilises commonplace assumptions about a linear, causal relationship between the pharmacological action of depot buprenorphine and patients’ experiences of care. Instead, it highlights patients’ variable experiences of depot buprenorphine, tracing how treatment experiences materialise in diverse ways, depending on patient context/environment. We conclude with reflections on the implications of our analysis for alcohol and other drug clinical practice, and reflect on the 'new materialist' turn and what future research may like to consider.

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Short abstract:

This interview study with decision-makers focuses on how ‘welfare technologies’ are mobilized in imagining the future of elder care in Sweden. It analyzes how welfare technologies intersect with political structures, shaping both the conditions for digitalization and the meaning of care and welfare.

Long abstract:

This study focuses on how ‘welfare technologies’ are mobilized in imagining the future of elder care in Sweden. It builds on interviews with decision-makers in Swedish municipalities and focuses on the work practices surrounding the implementation of welfare technologies. I explore how decision makers make sense of and work with the concept of welfare technologies and its role in their imaginaries of future elder care provision. The concept welfare technology is used in Swedish policy documents and politics to describe technology aiming to improve welfare through increased safety, activity, participation, and independence for those with (or who risk developing) disabilities.

I combine theoretical perspectives on sociotechnical imaginaries (Jasanoff and Kim 2009) with thinking around care crises (Fraser 2017, Hansen et al 2023) to make sense of how the interviewees connected welfare technology to broader challenges facing elder care in Sweden. In my analysis, I discuss how welfare technology was conceptualized as a solution to an imaginary of a universal care crisis: the ‘aging population’. I illustrate how the crises that the municipalities (the government entity responsible for elder care provision) faced were in fact not universal but rather highly dependent on the location and size of the municipalities. I argue that these differences in conditions point to how welfare technology must be understood in relation to the political structures governing welfare in Sweden, shaping not only the conditions for digitalization, but also the meaning of care and welfare.

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Long abstract:

This paper aims to explore the technologies and infrastructures that care for cleft lip and/ palate (CLP). My work is situated in a clinic in Asunción, Paraguay run by a global NGO that offers cleft lip and palate surgeries and treatments. Yet despite the promise from the NGO that CLP is an easy problem to fix, CLP research begs otherwise (e.g. Taylor-Alexander, 2016). Numerous methods are available and few unanimous studies. How does the NGO navigate these inconsistencies as they offer care? CLP is further an interesting case to explore care and its relationship to technology since the treatment of CLP focus on four areas: closure of the cleft, hearing, speech, and growth of the face, which in turn also impacts the psychosocial wellbeing of the person and their appearance. This implies that CLP treatment is by default a multidisciplinary endeavour that evokes conflicting values and hierarchies in care. Building off M’chareks and Shramm’s work on the face as multiple (2020), I want to think about the different sites of care that are mobilized through the treatment of CLP which in turn may raise questions about the boundaries between reconstructive and cosmetic and how this boundary is institutionalized within global care regimes. By focusing on CLP, I argue that more insights can be offered to contemporary research on the face within STS, reveal insights on how “we” design (Sabrina, 2016), and offer new ways to unpack the face and what it does.

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Long abstract:

The rise of the #MeToo movement has prompted a public reckoning with sexual consent, definitions of which are contested even among legal experts. At stake in these debates are foundational conceptions of agency and volition, with free will often treated as synonymous with consent. While such accounts largely ignore the role of more-than-human actors in shaping consent, alcohol and other drugs are actors that are routinely over-emphasised. For example, studies suggest consumption is a risk factor for sexual and gender-based violence by increasing men’s sexual aggression and reducing women’s inhibition, thereby increasing their susceptibility to violence. In these accounts, alcohol and other drugs are mobilised as straightforwardly impairing capacity to give and negotiate consent. Drawing on feminist and posthumanist scholarship on intoxication and care, this paper analyses the complexities of sexual consent in the context of alcohol and other drug consumption. We explore how contemporary consent discourses that reify the human subject as the single source of agency limit our understanding of sexual encounters involving alcohol or other drugs. We propose a posthumanist rethinking of consent as distributed and encompassing human and more-than-human actors including drugs, and the dynamics of pleasure, risk and intoxication. Such a rethinking shifts the focus of consent and harm reduction opportunities toward the gendered relations of care and control enfolded in contemporary sexual cultures, inviting attention to the agency of alcohol and other drugs, not simply as impediments to consent, but as transforming sexual relations and reshaping consent in diverse ways.

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In this presentation, we consider how care is enacted across species and scales using the case of the human microbiome. Increasingly, the microbiome – consisting of trillions of microbes that exist within and upon us, and which influences almost every aspect of health and wellbeing – is recognised as a potential site of intervention and care. But how care manifests at the microbial scale and how caring for the microbiome features in individual and collective endeavours to optimize human health remains unclear. On the one hand, the multiplicity inherent in the microbiome heralds collectivist potential and a relational vision of care that is rarely as evidence in other health domains. But on the other hand, the microbiome is also deployed in more individualized ways as a site of self care – as a novel technology of the self – which can simultaneously perpetuate the long-standing disciplinary logics evident in more well-established biopolitical imperatives to secure and maintain one’s own optimal state of health and wellbeing. Drawing on data from a broader program of research on human-microbial relations in the context of everyday practices of informal care, this analysis focuses on the perspectives of: 1. parents and carers for young children, and; 2. University students who are currently studying microbiology to explore the paradoxes emerging around the microbiome as a site of (self) care.

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Recently there has been growing recognition of the productive and protective features of our microbial kin and the crucial role of 'commensal' microbes in supporting and sustaining health. Current microbiological and pharmacological literature is increasingly highlighting the role of maternal gut microbiomes in the long-term health of both mothers and children. According to this research, it quite literally takes a more-than-human village to raise healthy children. Our research has shown that this post-Pasteurian trend gives rise to new relations of care and understandings of parenthood that are, at once, newly collective and more-than-human - but also disciplinary in ways that position the maternal microbiome as a new site of scrutiny that disproportionately responsibilises and burdens mothers. Drawing on this work and our interviews with parents of young children in Australia, in this presentation I consider the ways in which parents navigate and make sense of their living together with microbes and the role this has on the management of health in the family. I reflect on the politics of this form of microbial care.

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This presentation explores the socio-technical reconfiguration of care in the context of Emotion AI designed for mental health support. Emotion AI is an emerging field in the development and research of artificial intelligence for the detection, interpretation and simulation of (human) emotions. Such a technology seeks to introduce a novel dimension of intimacy into the field of healthcare, where emotional sensations are increasingly reconfigured by and deeply intertwined with AI devices. Against this backdrop, gender biases are inscribed into AI technologies, suggesting an uncertain shift in the socio-technical reconfiguration of affective care practices in relation to gender. Drawing on feminist STS, this presentation thus places particular emphasis on the connections between inscribed gender roles and the embedded "feeling rules" (Hochschild 1983) of care as manifested in and through AI technologies.

By examining an AI-mediated chatbot applied to simulate romantic and therapeutic relationships, I provide empirical insights into how care and its affects are reconfigured by Emotion AI. Central to this exploration is the goal of uncovering the implicit societal 'feeling rules' guiding these mediations and the underlying gender biases that extend into the realm of ‘more-than-human care’. Based on auto-ethnographic fieldwork, I discuss how AI-mediated care inadvertently perpetuates and reinforces existing heteronormative gender stereotypes.