BackgroundKnowledge translation (KT) is a buzzword in modern medical science. However, there has been little theoretical reflection on translation as a process of meaning production in KT. In this paper, we argue that KT will benefit from the incorporation of a more theoretical notion of translation as an entangled material, textual and cultural process.DiscussionWe discuss and challenge fundamental assumptions in KT, drawing on theories of translation from the human sciences. We show that the current construal of KT as separate from and secondary to the original scientific message is close to the now deeply compromised literary view of translation as the simple act of copying the original. Inspired by recent theories of translation, we claim that KT can be more adequately understood in terms of a ‘double supplement’ – on the one hand, KT offers new approaches to the communication of scientific knowledge to different groups in the healthcare system with the aim of supplementing a lack of knowledge among clinicians (and patients). On the other, it demonstrates that a textual and cultural supplement, namely a concern with target audiences (clinicians and patients), is inevitable in the creation of an ‘autonomous’ science. Hence, the division between science and its translation is unproductive and impossible to maintain. We discuss some possible implications of our suggested shift in concept by drawing on pharmaceutical interventions for the prevention of HIV as a case. We argue that such interventions are based on a supplementary and paradoxical relation to the target audiences, both presupposing and denying their existence.SummaryMore sophisticated theories of translation can lay the foundation for an expanded model of KT that incorporates a more adequate and reflective description of the interdependency of scientific, cultural, textual and material practices.

Achille Mbembe states that 'the ultimate expression of sovereignty resides, to a large degree, in the power and the capacity to dictate who may live and who must die […]. To exercise sovereignty is to exercise control over mortality and to define life as the deployment and manifestation of power' (

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In both HIV science and public health policy, efforts to end the HIV epidemic are increasingly focusing on molecular HIV surveillance as a helpful tool for identifying, intervening in and controlling the disease. HIV surveillance is meant to identify clusters of genetically similar viral strains in near real-time in communities and areas where transmissions occur, and then to intervene by means of enhanced public health approaches. This article critically engages with how molecular HIV surveillance-a practice and technology portrayed as a benign public health intervention-empties and purifies many of the social and political contexts of HIV transmissions. McClelland et al. (Crit Public Health 1-7, 2019) see the rise of molecular HIV surveillance as a form of "repurposing" of clinical phylogenetic testing done in the context of HIV care. In this article, I argue that this so-called repurposing can be understood as a form of "translation". Looking at how phylogenetic HIV testing has been translated from clinical, patient-centered use to a form of molecular HIV surveillance, I seek to map some of the potential ethical and epistemological pitfalls of such a translational process. More specifically, I look at the unintended consequences of translating a particular evidence-based practicephylogenetic HIV testing-from one usage to another. To this end, I engage with Michel Foucault and his work on the biopower of medicine, exploring how such power disciplines subjects into undergoing a form of medical surveillance that influences norms and behaviors. Ultimately, I argue that the translation of phylogenetic testing from patient-centered care in the clinic to a form of epidemiological surveillance needs to be critically examined in order to avoid ethical and potentially detrimental consequences for HIV-affected communities.

Pre-exposure prophylaxis (PrEP) (Truvada) is a medication which if taken correctly is almost entirely effective in preventing HIV infection. In regions and countries where it has been widely taken up, HIV seroconversion rates have significantly decreased. Alongside testing and treatment, it offers the very real prospect of ending HIV infections. However, in England, commissioning it has (and still is) a controversial process, where NHS England has repeatedly raised supposed ‘uncertainties’, first legal and then scientific. The same has not happened in Scotland, where PrEP was commissioned to anyone who needed it in April 2017. This article presents a close reading of the IMPACT trial protocol, which we conclude cannot answer the questions it sets out to answer. We then suggest that the uncertainties the trial claims to address are in fact a tool of power which is deployed to strategically ration healthcare; introduce uncertainty about commissioning PrEP; and shift the boundary between individual responsibilities and state responsibilities for public health and HIV prevention. We conclude that all the above constitute an unethical use of clinical trial rhetoric, systematically discriminate against minority and vulnerable groups, and ration healthcare for those who most need it. As such, we call on all academics, clinicians and activists to resist further unethical misuses of clinical trial rhetoric.