"Risk" as a conceptual approach for much of the research on health has come under attack from many sides. Risk is everywhere and nowhere, it seems. When it comes to gay men's health, gay men's sexual risk practices have particularly been scrutinized by researchers who wish to stop gay men from doing such naughty things as having sex without condoms. Many have suggested that rethinking "risk" (traditionally conceived of through the lens of an isolated rational actor making complex cost-benefit analyses aimed at maximizing returns and minimizing harm for him/herself) as a concept is a necessary step towards creating a more effective / ethical / social public health.

As I was reading for my class today on the Sociology of Law, I came across this very interesting distinction between "risk" and "uncertainty" that gets made in the literature on organizational behavior:

"On the whole, then, high-technology start-up financing poses challenges not only of risk but also of uncertainty. Although lay parlance often employs these terms interchangeably, the organizational decision-making literature uses them to describe two distinct conditions. Under conditions of "risk," decision-makers may not be able to predict the future deterministically, but at least they can describe it probabilistically: with a little effort, individuals can identify the full range of options and outcomes, and they can determine roughly how likely it is that any given option will produce any particular outcome. Consequently, despite the presence of risk, decision-makers can still make rational choices based on expected-value calculations, and markets can still produce efficient coordination based on contingent-claims contracts.

Uncertainty, on the other hand, arises when decision-makers cannot determine either (1) the full menu of alterative behavioral options or (2) the relative probability of alternative possible outcomes. Unlike risk, uncertainty is deeply incompatible with the neoclassical model of fully rational decision-making. Instead of producing a careful expected-utility analysis of all lines of action, conditions of uncertainty tend to produce "boundedly rational" decision strategies, involving "good enough" choices, gut feelings, and rules of thumb. At a more macroscopic level, uncertainty elevates transaction costs and exacerbates intra-organization strains and power struggles. Consequently, unresolved uncertainty poses a fundamental cognitive and organizational obstacle to the formation and maintenance of stable markets for high-technology start-up capital."

-- Suchman, M. & Cahill, M. (1996) "The Hired Gun as Facilitator: Lawyers and the Suppression of Business Disputes in Silicon Valley." Law & Social Inquiry, 21(3): 679-712.

So my questions of the day: What would it mean to reconceptualize men's safer sex practices as enacted in an environment of uncertainty -- rather than in an environment of risk? Is "risk" really the appropriate concept for understanding these complicated, negotiated practices?