From subjects to relations: Bioethics and the articulation of postcolonial politics in the Cambodia Pre-Exposure Prophylaxis trial

Grant, Jenna

doi:10.1177/0306312716632617

Cited by 13 publications

(9 citation statements)

References 54 publications

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“…Reducing the number of tablets taken might lead to more cost-effective use of PrEP if this can be achieved without a loss of HIV prevention activity. Grant et al(51) have described that some MSM have variable periods of higher risk of HIV, and they are inclined to take PrEP more intensively during such periods. Such strategic use periodic use of PrEP may increase impact and lower the overall cost to the health system.…”

Section: Alternative Drug Regimensmentioning

confidence: 99%

Recent advances in pre-exposure prophylaxis for HIV

Desai

Field

Grant

et al. 2017

BMJ

109

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Although pre-exposure prophylaxis (PrEP)-the use of antiretroviral drugs by non-infected people to prevent the acquisition of HIV-is a promising preventive option, important public health questions remain. Daily oral emtricitabine (FTC)-tenofovir disoproxil fumarate (TDF) is highly efficacious in preventing the acquisition of HIV in people at risk as a result of a range of different types of sexual exposure. There is good evidence of efficacy in women and men, and when men who have sex with men use event based dosing. Studies have been conducted in several countries and epidemics. Because adherence to this treatment varies greatly there are questions about its public health benefit. Oral FTC-TDF is extremely safe, with minimal impact on kidney, bone, or pregnancy outcomes, and there is no evidence that its effectiveness has been reduced by risk compensation during open label and programmatic follow-up. It is too early to assess the impact of this treatment on the incidence of sexually transmitted infections (STIs) at a population level. Many challenges remain. Access to pre-exposure prophylaxis is limited and disparities exist, including those governed by race and sex. Different pricing and access models need to be explored to avoid further widening inequalities. The optimal combination prevention program needs to be defined, and this will depend on local epidemiology, service provision, and cost effectiveness. This review updates the evidence base for pre-exposure prophylaxis regarding its effectiveness, safety, and risk compensation.

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Section: Alternative Drug Regimensmentioning

confidence: 99%

Recent advances in pre-exposure prophylaxis for HIV

Desai

Field

Grant

et al. 2017

BMJ

109

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“…These may include bodies, but they may take us to places -e.g. microbial modelling (Paxson and Helmreich 2013), global circulatory systems (Nading 2016), crosscritter viruses (Lowe and M€ unster 2016;Grant 2016;Kelly 2012), or the commensality of walking and feeding (Ibañez Martin 2015) -where bodies constrain our analytic capacities. Indeed, when it comes to fashioning a medical anthropology that is not centred upon bodies, we could easily draw inspiration from the corpus of Schepher Hughes, who has devoted recent decades to tracing the uneven circulation of organs across vast geospatial terrain, or Lock, who has studied the sciences of dementia and epigenetics in a way that interrupts bodily boundaries by distributing bodies across personhood and time.…”

Section: Postscript: Planetary Healthmentioning

confidence: 99%

Counting bodies? On future engagements with science studies in medical anthropology

Yates‐Doerr

2017

Anthropology & Medicine

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Thirty years ago, Nancy Scheper-Hughes and Margaret Lock outlined a strategy for 'future work in medical anthropology' that focused on three bodies. Their article -a zeitgeist for the fieldsought to intervene into the Cartesian dualisms characterizing ethnomedical anthropology at the time. Taking a descriptive and diagnostic approach, they defined 'the mindful body' as a domain of future anthropological inquiry and mapped three analytic concepts that could be used to study it: the individual/ phenomenological body, the social body, and the body politic. Three decades later, this paper returns to the 'three bodies'. It analyses ethnographic fieldwork on chronic illness, using a rescriptive, practice-oriented approach to bodies developed by science studies scholars that was not part of the initial three bodies framework. It illustrates how embodiment was a technical achievement in some practices, while in others bodies did not figure as relevant. This leads to the suggestion that an anthropology of health need not be organized around numerable bodies. The paper concludes by suggesting that future work in medical anthropology might embrace translational competency, which does not have the goal of better definitions (better health, better bodies, etc.) but the goal of better engaging with exchanges between medical and non-medical practices. That health professionals are themselves moving away from bodies to embrace 'planetary health' makes a practice-focused orientation especially crucial for medical anthropology today.

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“…My goal is to delineate how decisions at certain points in the design, implementation and interpretation of clinical research create new categories of participants, parameters of compliance, and risk logics. These epistemic projects indeed rely on a fraught relationship between researchers and subjects that has increasingly come into question (Grant, 2016), but my methodology does not lend itself to making moral claims about the research process or about Homo adhaerens .…”

Section: Homo Adhaerens In Biomedical Hiv Prevention Researchmentioning

confidence: 99%

Homo adhaerens: Risk and adherence in biomedical HIV prevention research

Davis

2020

Soc Stud Sci

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After the turn of the millennium, HIV clinical researchers pivoted from developing and testing new antiretrovirals (ARVs) for treatment, to reconfiguring the same molecules for pre-exposure prophylaxis (PrEP). In 2012, Truvada became the first HIV therapy to also be approved by the FDA for PrEP, regarded as a magic bullet that promised to end the epidemic. However, six years after its approval, it continues to be inaccessible to those who are most vulnerable. In this article, I critically analyze HIV PrEP clinical trials, dissecting the novel techniques researchers use to demonstrate efficacy. I argue that in making sense of the interplay between adherence to a prophylactic regimen and risk for HIV, biomedical HIV prevention research has revealed a new subject of biopolitics, Homo adhaerens. In the early 2000s, clinical researchers operating in the Global South identified Homo adhaerens as the ideal subject, one who embodies both high-risk behavior and diligent adherence to a daily oral regimen. I trace the construction of Homo adhaerens to the United States, where I listen closely to activists engaged with the ongoing DISCOVER trial of PrEP. Activists either aspire for Homo adhaerens as a standard, making the liberal argument that expanding access could make PrEP successful, or they rebuke the framework of clinical research that produces narrow understandings of adherence, efficacy, and universality. Ultimately, I argue that by failing to grapple with the social realities that underlie poor adherence, PrEP clinical trials produce knowledge that is not useful for those who are most vulnerable.

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From subjects to relations: Bioethics and the articulation of postcolonial politics in the Cambodia Pre-Exposure Prophylaxis trial

Cited by 13 publications

References 54 publications

Recent advances in pre-exposure prophylaxis for HIV

Recent advances in pre-exposure prophylaxis for HIV

Counting bodies? On future engagements with science studies in medical anthropology

Homo adhaerens: Risk and adherence in biomedical HIV prevention research

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