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BioSocieties

, Volume 13, Issue 2, pp 470–493 | Cite as

Centring ‘being undetectable’ as the new face of HIV: Transforming subjectivities via the discursive practices of HIV treatment as prevention

Original Article

Abstract

HIV treatment as prevention is an emerging biomedical prevention approach utilising routine HIV testing, immediate engagement in HIV care, and the consumption of antiretrovirals to suppress individuals’ viral loads, greatly reducing or eliminating the risk of onward transmission of HIV. Drawing on interviews with HIV scientists, policymakers, clinicians, and advocates, ethnographic field work at three global HIV scientific meetings, and analysis of textual and visual discourse data, I argue that several meso-level discursive practices are transforming the conditions of possibility for living with HIV. I explore three empirical sites—The Elite Society of the Undetectables, Housing Works’ The Undetectables Project, and AIDS Vancouver’s ‘reimagining’ of the Red Ribbon—where ‘being undetectable’, that is, having an HIV viral load that is so low as to be non-infectious, is coming to be centred as the best, perhaps only, way to live as a person with HIV. The centring of ‘being undetectable’ as a technoscientific identity has critical implications for transformations in subjectivity, for the configuring of the moral borders between those who achieve viral suppression and those who do not, and also for the future it becomes possible to anticipate, including the achievement of the so-called ‘End of AIDS’.

Keywords

HIV/AIDS HIV prevention subjectivity biomedicalisation biosociality anticipation 

Notes

Acknowledgements

This manuscript is composed of original material, derived from my doctoral dissertation, that is not under review elsewhere. My doctoral dissertation is titled, “Vital Politics and Anticipatory Practice of HIV Treatment as Prevention: The Discursive Work of the Biomedicalization of HIV Prevention”, which is available via ProQuest. The study described in this manuscript was approved by the University of California, San Francisco Committee on Human Subjects Research. The author has no competing intellectual or financial interests in the research described in this manuscript. I would like to extend my warmest thanks and gratitude to all the participants who spoke so openly and honestly with me for this project. I am also forever indebted to my research mentors, Shari Dworkin, Janet Shim, Janet Myers, and Adele Clarke, without whose guidance and moral support this project would not have been possible. 

References

  1. Adams, V., Murphy, M. and Clarke, A.E. (2009) Anticipation: technoscience, life, affect, temporality. Subjectivity 28: 246–265.CrossRefGoogle Scholar
  2. AIDS Vancouver. (2017) Undetectable: the new face of HIV. http://www.aidsvancouver.org/ undetectable, accessed on 25 March 2015.
  3. Asboe, D., Aitken, C., Boffito, M., Booth, C., Cane, P., Fakoya, A., Geretti, A.M., Kelleher, P., Mackie, N., Muir, D., Murphy, G., Orkin, C., Post, F., Rooney, G., Sabin, C., Sherr, L., Smit, E., Tong, W., Ustianowski, A., Valappil, M., Walsh, J., Williams, M. and Yir rell, D. on behalf of the BHIVA Guidelines Subcommittee. (2012) British HIV Asso ciation guidelines for the routine investigation and monitoring of adult HIV-1-infected individuals 2011. HIV Medicine 13: 1–44.CrossRefGoogle Scholar
  4. Beer, L., Bradley, H., Mattson, C.L., Johnson, C.H., Hoots, B., Shouse, R.L. for the Medical Monitoring Project. (2016). Trends in racial and ethnic disparities in antiretroviral therapy prescription and viral suppression in the United States, 2009–2013. Journal of Acquired Immune Deficiency Syndromes 73(4): 446–453.Google Scholar
  5. Bernard, E. and Cameron, S. (2016) Global trends in HIV criminalisation. Poster presented at 21st International AIDS Conference, 21 July 2016, Durban, South Africa.Google Scholar
  6. Biehl, J. (2007) Pharmaceuticalization: AIDS treatment and global health politics. Anthropological Quarterly 80(4): 1083–1126.CrossRefGoogle Scholar
  7. Branscum, P. and Sharma, M. (2009) Comic books an untapped medium for health promo tion. American Journal of Health Studies 24(4): 430–439.Google Scholar
  8. British Columbia Centre for Excellence in HIV/AIDS. (2013) Momentum builds globally as France and Brazil adopt treatment as prevention. http://www.cfenet.ubc.ca/news/forecast/momentum-builds-globally-france-and-brazil-adopt-treatment-prevention, accessed on 20 October 2016.
  9. Charmaz, K. (2006) Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Thousand Oaks, CA: Sage Publications.Google Scholar
  10. Clarke, A.E. (2005) Situational Analysis: Grounded Theory After the Postmodern Turn. Thousand Oaks, CA: Sage Publications.CrossRefGoogle Scholar
  11. Clarke, A.E., Mamo, L., Fosket, J.R., Fishman, J.R. and Shim, J. (eds.) (2010) Biomedicalization: Technoscience, Health and Illness in the U.S. Durham, NC: Duke University Press.Google Scholar
  12. Cohen, J. (2011) HIV treatment as prevention. Science 334(6063): 1628.CrossRefGoogle Scholar
  13. Cohen, M.S., Chen, Y.Q., McCauley, M., Gamble, T., Hosseinipour, M.C., Kumarasamy, N. et al. (2011) Prevention of HIV-1 infection with early antiretroviral therapy. New Eng land Journal of Medicine 365(6): 493–505.CrossRefGoogle Scholar
  14. Collins, S. (2016) Treatment as prevention (TasP) in the UK supports access to ART at any CD4 count. HIV Treatment Bulletin. http://i-base.info/htb/29594, accessed on 19 October 2016.
  15. Colvin, C.J., Robins, S. and Leavens, J. (2011) Grounding ‘responsibilisation talk’: masculiity, citizenship and HIV in Cape Town, South Africa. Journal of Development Studies 46(7): 1179–1195.CrossRefGoogle Scholar
  16. Crawford, R. (1994) The boundaries of the self and the unhealthy other: reflections on health, culture, and AIDS. Social Science and Medicine 38(10): 1347–1365.CrossRefGoogle Scholar
  17. Douglas, M. (1966/1969) Purity and Danger: An Analysis of Concepts of Pollution and Taboo. London: Routledge & Kegan Paul.Google Scholar
  18. Douglas, M. (1985) Risk Acceptability According to the Social Sciences. New York: Russell Sage Foundation.Google Scholar
  19. Foucault, M. (1988) Technologies of the self. In: L.H. Martin, H. Gutman and P.H. Hutton (eds.) Technologies of the Self: A Seminar with Michel Foucault. Amherst, MA: Uni versity of Massachusetts Press, pp. 16–49.Google Scholar
  20. Foucault, M. (1984) Biopower. In: P. Rabinow (ed.) The Foucault Reader. New York: Pan theon Books, pp. 258–289.Google Scholar
  21. Foucault, M. (2008) The Birth of Biopolitics: Lectures at the Collège de France, 1978–1979. Basingstoke: Palgrave Macmillan.Google Scholar
  22. Gibbon, S. and Novas, C. (2008) Introduction. In: S. Gibbon and C. Novas (eds.). Biosocialities, Genetics and the Social Sciences: Making Biologies and Identities. New York: Routledge, pp. 1–18.Google Scholar
  23. Housing Works. (2014). The Undetectables, Issue 1, Spring 2014. https://liveundetectable.org, accessed on 24 March 2017.
  24. INSIGHT START Study Group. (2015) Initiation of antiretroviral therapy in early asymp tomatic HIV infection. New England Journal of Medicine 373(9): 795–807.CrossRefGoogle Scholar
  25. Joint United Nations Programme on HIV/AIDS (UNAIDS). (2014) 90-90-90: An Ambitious Treatment Target to Help End the AIDS Epidemic (JC2684, English original, October 2014). Geneva: UNAIDS.Google Scholar
  26. Keller, R. (2013) Doing Discourse Research. London: SAGE Publications.CrossRefGoogle Scholar
  27. Lloyd, K.C. (2016) Vital politics and anticipatory practice of HIV treatment as prevention: the discursive work of the biomedicalization of HIV prevention. PhD dissertation, University of California, San Francisco, CA.Google Scholar
  28. Martin, E. (1994) Flexible Bodies: The Role of Immunity in American Culture from the Days of Polio to the Age of AIDS. Boston, MA: Beacon.Google Scholar
  29. McCloud, S. (1993) Understanding Comics: The Invisible Art (6th ed.). New York: Harper Perennial.Google Scholar
  30. Montaner, J.S.G., Hogg, R., Wood, E., Kerr, T., Tyndall, M., Levy, A.R. and Harrigan, P.R. (2006) The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet 368: 531–536.CrossRefGoogle Scholar
  31. Muthulingam, D., Chin, J., Hsu, L., Scheer, S. and Schwarcz, S. (2013) Disparities in en gagement in care and viral suppression among persons with HIV. Journal of Acquired Immune Deficiency Syndromes 63(1): 112–119.CrossRefGoogle Scholar
  32. Petersen, A. and Lupton, D. (1996) The New Public Health: Health and Self in the Age of Risk. London: Sage Publications.Google Scholar
  33. Rabinow, P. (1992). Artificiality and enlightenment: from sociobiology to biosociality. In: J. Crary and S. Kwinter (eds.) Zone 6: Incorporations. New York: Zone Books, pp. 234–252.Google Scholar
  34. Rabinow, P. (2005). Artificiality and enlightenment: from sociobiology to biosociality. In: J.X. Inda (ed.) Anthropologies of Modernity: Foucault, Governmentality, and Life Politics. Malden, MA: Blackwell Publishing, pp. 181–193.Google Scholar
  35. Rabinow, P. and Rose, N. (2006) Biopower today. BioSocieties 1, pp. 195–217.CrossRefGoogle Scholar
  36. Race, K. (2001) The undetectable crisis: changing technologies of risk. Sexualities 4(2): 167–189.CrossRefGoogle Scholar
  37. Rose, N. (2007) The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twen ty-First Century. Princeton, NJ: Princeton University Press.CrossRefGoogle Scholar
  38. Rosengarten, M. (2009) HIV Interventions: Biomedicine and the Traffic Between Information and Flesh. Seattle, WA: University of Washington Press.Google Scholar
  39. Santos, G., Wilson, E.C., Rapues, J., Macias, O., Packer, T., Raymond, F.H. (2014) HIV treatment cascade among transgender women in a San Francisco respondent driven sampling study. Sexually Transmitted Infections 90: 430–433.CrossRefGoogle Scholar
  40. Strauss, A.L. (1978) A social worlds perspective. Studies in Symbolic Interaction 1: 119–128.Google Scholar
  41. The Housing Works. (2015) The Undetectables Project. http://www.housingworks.org/heal/medical-and-dental-care/the-undetectables/, accessed on 15 March 2015.
  42. Thompson, M.A., Aberg, J.A., Cahn, P., Montaner, J.S., Rizzardini, G., Telenti, A. et al. (2010) Antiretroviral treatment of adult HIV infection: 2010, Recommendations of the International AIDS Society-USA panel. Journal of the American Medical Association 304: 321–333.CrossRefGoogle Scholar
  43. Vernazza, P., Hirschel, B., Bernasconi, E. and Flepp, M. (2008) Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitment antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bulletin des Médecins Suisses 89(5): 165–169. (English translation, including translator’s affidavit, available at: http://tinyurl.com/cpyt5n).
  44. Visual AIDS. (2017) The red ribbon project. https://www.visualaids.org/projects/detail/the-red-ribbon-project, accessed 24 March 2017.
  45. World Health Organization. (2016) Global Health Observatory (GHO) data: Number of deaths due to AIDS. http://www.who.int/gho/hiv/epidemic_status/deaths/en/, accessed 20 October 2016.
  46. World Health Organization. (2015) Guideline on When to Start Antiretroviral Therapy and on Pre-exposure Prophylaxis for HIV, September 2015. Geneva: World Health Organization.Google Scholar

Copyright information

© Macmillan Publishers Ltd., part of Springer Nature 2017

Authors and Affiliations

  1. 1.School of Pharmacy, University of ReadingReadingUK

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