In this article we investigate the way in which viral load assays are used to assess the viruses of Human Immunodeficiency Virus (HIV)-positive pregnant women who are cared for in an HIV-specialist antenatal clinic in London. One of the viral load assays has been made more sensitive to subtypes of the virus that are considered to be local, possibly reading the viruses of those who have ‘foreign’ subtypes as undetectable. Consequently, the patient might not be offered the kind of care needed to prevent transmission of HIV, as her body is not recognised as sufficiently debilitated. Thus, being identified as a debilitated body in this setting facilitates the prevention of vertical transmission of HIV and the management of the HIV-positive pregnant patient's virus. Further to this, we argue that in our example, having a debilitated body as constructed by the viral load assay is thus a ‘privilege’ that is accorded to HIV-positive persons depending on the geographic origin of their virus. Using Karen Barad's agential realism, we argue that the manner in which HIV is read through the viral load assay constructs a specific woman/foetus/HIV phenomenon. The specificity of this phenomenon directly impacts on the course of care, opening up or foreclosing the possibility of her child having a future free from HIV.
In this paper, I will explore the development of vaginal microbicides (female-initiated HIV prevention methods designed as gels, fi lms, sponges and rings women can insert vaginally before having sex to protect themselves against HIV infection) as a women's health intervention that entangles feminist ideals of empowerment with biomedical enterprise. The fi eld of vaginal microbicide development pays heed to both the specifi c biological vulnerabilities of 'the female body' that are understood to make women more susceptible to HIV infection as well as the social gendered power relations that leave women at a higher risk of HIV within the power dynamics of their sexual relationships. I am particularly interested in the ambiguity that emerges between the eff ects of a biomedical search for facticity through clinical trial testing and advocacy promises of empowerment, which I will explore through analysing the clinical trials of Nonoxynol-9 microbicide candidates in the early 1990s -a microbicide candidate that was continuously linked to vaginal ulceration and consequently a potential increase in receptivity to HIV. Through an interrogation of clinical trial reports, advocacy documents and a social science study in which the women trial participants articulated Nonoxynol-9 as their "protector", I argue that the story of Nonoxynol-9 shows an intrinsic ambiguity between the fi eld's feminist promise of empowerment and the eff ects of the biomedical search for an eff ective microbicide candidate. Drawing on the work of Karen Barad, I argue that agential realism is able to provide a robust analytical framework to interrogate the political and ethical eff ects of this ambiguity that the fi eld's own discourse of empowerment does not suffi ciently provide.
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