Embodied, clinical and pharmaceutical uncertainty: people with HIV anticipate the feasibility of HIV treatment as prevention (TasP)

Abstract

Evidence of the efficacy of HIV treatment as prevention (TasP) precipitated a highly optimistic global response and a radical re-design of HIV policy. Sociologists and others have framed TasP within promissory or enterprising discourses which require HIV prevention planners and people with HIV to engage in anticipatory assessments of risk and uncertainty. In 2013, I conducted focus groups with people with HIV in London, UK to explore their understandings and anticipations of TasP.An environment of economic constraint obliged participants to triage clinical need and presentation and they expressed scepticism about the sustainability of pharmaceutical investment in treatment innovation. These perceptions were informed by an embodied knowledge of HIV which implies a construction of health as a form of capital that is finite and must be conserved. This is contrasted with a bio-medical construction of health as a form of capital that can be exponentially generated through investment. The imperative of conservation entailed by people with HIV's anticipations contrasts with the speculative economy of biomedical production entailed in planners' anticipations of TasP.Rather than researching 'TasP acceptability' and considering whether people with HIV's behaviours constitute an obstacle to TasP's effectiveness, we should recognise that people with HIV are already involved in shaping what TasP is, what it will be and ultimately how it 'works'.

‘There’s this glorious pill’: gay and bisexual men in the English midlands navigate risk responsibility and pre-exposure prophylaxis

“…It may be tempting for public health policymakers to adopt an unproblematic neoliberal approach to understanding GMSM and the lives they believe they wish to live. However, those developing interventions need to be cognisant of how public health policies emanate from heteronormative definitions of risk, responsibility and health behaviour (Auerbach & Hoppe, 2015;Keogh, 2017;Race, 2016). An irony of the significant social and civil changes experienced by LGBTQ people in Western countries in recent years, especially around marriage and parenting rights, is the presumption that gay men want to become 'good gay citizens' and adopt 'homonormative' versions of lifestyles most heterosexuals are seen to aspire to (Brisson & Nguyen, 2017;Brown, 2012).…”

“…This superficial monothematic (im)moralisation of PrEP, alongside the association with notions of individual and collective irresponsibility (Keogh, 2017), ignores ideas of intimacy, assertions of erotic liberation, whilst subsequently also excluding GMSM that are not considered 'high risk' by public health bodies (Race, 2016). Such dichotomies stifle dialogue between those developing public health initiatives for GMSM and the intended 'recipients'.…”

A qualitative study on the intersectional social determinants for indigenous people who become infected with HIV in their youth

“…Several Indigenous scholars agree that the trans-generational trauma that is created by the breaking apart of families will need to be addressed through various forms of action within the health, child welfare and other institutions if Indigenous peoples in Canada (and other places with similar colonial histories) are to have improved health outcomes [ 52 – 56 ]. Many also argue that institutional transformation cannot only come through simple changes in policy [ 57 ], but will require pathways within institutions to make way for Indigenous resurgence through nation-building, reconnection to homelands, integration of culture and spirituality, leadership, and decolonized forms of decision-making [ 56 , 58 – 60 ]. Similarly, a qualitative study by Larkin et al found that young Indigenous people (from Ontario) were more aware of structural inequities that contribute to HIV risk than those who were not Indigenous [ 2 ].…”

Subordinated agency: Negotiating the biomedicalisation of masculinity among gay men living with HIV

“…Clarke et al (2010) theorise biomedicalisation as a trend in which biomedical knowledge and technologies play a central role in treating diseases to enhance health, manage risk, and transform bodies and identities. Emerging HIV/AIDS studies drawing on this theory have indicated the ways in which HIV ‘treatment as prevention’ and pre‐exposure prophylaxis contribute to the biomedicalisation of HIV prevention, and how processes of biomedicalisation are perceived and negotiated by individuals with different sero‐statuses and experiences (Keogh, 2017; Lloyd, 2018; Persson, 2013). Moreover, there have been efforts to engage with biomedicalisation theory from a gender perspective.…”