1
|
Young I, Boydell N. 'Don't lose it on the bus!': Casting the normative biosexual citizen in early Scottish pre-exposure prophylaxis provision. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:1046-1062. [PMID: 36920962 PMCID: PMC7616225 DOI: 10.1111/1467-9566.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
The introduction of HIV pre-exposure prophylaxis (PrEP) raises important questions around how new biotechnologies are negotiated within contemporary settings and how they can shape the moral governance of biocitizens, or as we explore, biosexual citizens. This article draws on qualitative interviews and focus groups to consider how the normative biosexual citizen was cast at the start of provision in Scotland by clinical and community practitioners. Our findings show how practitioners navigated ideas around who was deserving of support and access to PrEP in the context of limited resources, interpreted what legitimate risk narratives might look like for different groups and translated particular gendered, sexualised and racialised risk profiles in the context of PrEP provision. This draws attention to how normative biosexual citizenship was not determined through meeting a set of clinical criteria and adhering to a prophylaxis regime but cast through ongoing negotiations with clinical and community practitioners in relation to normative ideas of essential care, constrained resources, risk narratives and gendered and racialised bodies. Our research indicates how access to PrEP will continue to demand particular enactments of normative biosexual citizenship that may well be at odds with the experiences and needs of communities affected by HIV.
Collapse
Affiliation(s)
- Ingrid Young
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nicola Boydell
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
2
|
Valentine K, Smith AKJ, Persson A, Gray R, Bryant J, Hamilton M, Wallace J, Drysdale K, Newman CE. The freighted social histories of HIV and hepatitis C: exploring service providers' perspectives on stigma in the current epidemics. MEDICAL HUMANITIES 2023; 49:48-54. [PMID: 35710625 DOI: 10.1136/medhum-2022-012382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
A virus has a social history. In the case of the hepatitis C virus (HCV) and HIV, this history is one involving stigma and discrimination, advocacy and activism, and recent dramatic improvements in treatment. These social histories influence the experience of people who live with the viruses, and those who work with them. One aspect of this is the impact of social changes on the biographical disruption and integration brought about by illness. Healthcare practitioners who see significant improvements in the effectiveness of treatment for a condition over the course of their professional life will incorporate those changes into their own history and their relationship to that condition.This article is based on a study of the experiences of serodiscordance, or mixed infection status, in families living with HIV and two types of viral hepatitis, hepatitis B and hepatitis C. The article explores the perspectives of healthcare workers who work with people affected by these viruses, who were asked about their experiences in working with serodiscordance in families. Interviews revealed that changing social meanings given to bloodborne viruses, and changes to treatment over time, held a significant place in the accounts that service providers gave of their work. In asking them to describe their work with HIV and HCV, we were also asking about work that has been shaped by changing patterns and sources of stigma, and recently reshaped by changes in treatment and outcomes. While typically the experiences of patients and their families are used to investigate the social histories of diagnosis and stigma, the professional perspectives and life stories of the service providers who work with them are also revealing. We heard accounts in which histories as well as current regimes were prominent, illuminated further by insights from the sociology of health on narrative and biographical disruption.
Collapse
Affiliation(s)
- Kylie Valentine
- Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Asha Persson
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Gray
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Myra Hamilton
- Work and Organisational Studies, University of Sydney Business School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne, Victoria, Australia
| | - Kerryn Drysdale
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Christy E Newman
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Philpot SP, Aung E, Templeton DJ, Stackpool G, Varma R, Power C, Robinson S, Stratigos A, Mao L, Grulich AE, Bavinton BR. Experiences of recently HIV-diagnosed gay and bisexual migrants in Australia: Implications for sexual health programmes and health promotion. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5801-e5810. [PMID: 36107017 PMCID: PMC10087732 DOI: 10.1111/hsc.14011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/22/2022] [Accepted: 08/20/2022] [Indexed: 05/24/2023]
Abstract
Gay and bisexual migrants from low- and middle-income countries living in high-income countries are disproportionately diagnosed with HIV. Most research focuses on preventing HIV acquisition among HIV-negative migrant gay and bisexual men (GBM). This study is uniquely positioned to report on migrant GBM's experiences and needs at and after an HIV diagnosis. Semi-structured interviews were conducted with 24 migrant GBM diagnosed at sexual health clinics in Australia from 2017 onwards. Interviews were analysed using a codebook thematic analysis. Due to the stigma of HIV and homosexuality in their countries of origin, about half of participants had poor HIV knowledge prior to diagnosis. Absorbing diagnosis information was consequently difficult, and feelings of shame, hopelessness, lost sexual opportunities and infectiousness were common. However, many were thankful for the comprehensive clinical support they received and believed that over time life would 'normalise' with sustained undetectable viral load. None reported that their clinician stigmatised them, but the anticipation of stigma nonetheless infused their experiences after diagnosis. Many were selective about HIV disclosure, and some mentioned that clinic systems posed a risk to confidentiality. Non-permanent residents were concerned about the impacts of HIV status on future visa applications. We recommend that newly HIV-diagnosed migrant GBM receive referral to legal and culturally appropriate migration services to help absorb what a diagnosis might mean for their health and visa status. We also recommend sexual health clinics continue to assess confidentiality in their systems. Health promotion initiatives should highlight to migrant GBM that high-HIV caseload sexual health clinicians provide confidential and comprehensive care.
Collapse
Affiliation(s)
| | - Eithandee Aung
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - David J. Templeton
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- Department of Sexual Health Medicine and Sexual Assault Medical ServicesSydney Local Health DistrictSydneyAustralia
- Discipline of Medicine, Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyAustralia
| | - Gai Stackpool
- Multicultural HIV and Hepatitis ServiceDiversity Programs and Strategy Hub, Population Health, Sydney Local Health DistrictSydneyAustralia
| | - Rick Varma
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- Sydney Sexual Health Centre, Population and Community HealthSouth Eastern Sydney Local Health DistrictSydneyAustralia
| | | | - Sharon Robinson
- Department of Infectious Diseases, Immunology and Sexual HealthSt George HospitalSydneyAustralia
- St George and Sutherland Clinical SchoolUNSW SydneySydneyNew South WalesAustralia
| | | | - Limin Mao
- Centre for Social Research in HealthUNSW SydneyNew South WalesSydneyAustralia
| | | | | |
Collapse
|
4
|
Philpot SP, Murphy D, Prestage G, Wells N. Using social media as a platform to publicly disclose HIV status among people living with HIV: Control, identity, informing public dialogue. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:881-898. [PMID: 35412691 PMCID: PMC9545241 DOI: 10.1111/1467-9566.13469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
Disclosure of HIV status is usually considered a private encounter involving only a limited number of people at a time. Many people living with HIV are strategic about deciding in what contexts, using which approach, to whom, and to what extent they disclose HIV status. However, social media platforms provide opportunities for people to publicly disclose information about themselves to their networks. Utilising semi-structured interviews with people recently diagnosed with HIV in Australia, we explore how, why, and using what strategies people living with HIV use social media as a means of publicly disclosing positive HIV status. Participants placed importance on having control of how they framed their life with HIV and adopted strategies to control the audience to whom they disclosed. Public disclosure on social media helped participants come out of the 'sero-closet', empowered identity affirmation, and enabled them to be voices for other people living with HIV to shift public dialogue. We conclude that public disclosure of a positive HIV status can strip HIV disclosure of being associated with delivering private and unpleasant information, and instead reframe living with HIV from a responsibility to disclose to a right to share.
Collapse
Affiliation(s)
| | - Dean Murphy
- Kirby Institute, UNSW SydneyKensingtonNew South WalesAustralia
| | | | - Nathanael Wells
- Kirby Institute, UNSW SydneyKensingtonNew South WalesAustralia
| |
Collapse
|
5
|
Genre N, Panese F. Merging care and prevention: preventive properties of antiretroviral drugs and HIV chronification in the case of Switzerland. Anthropol Med 2021; 29:14-28. [PMID: 34544292 DOI: 10.1080/13648470.2021.1949891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Medication is closely involved in the subjective experience of chronic diseases, but also in the chronification process of illnesses which is described in this paper in the specific case of HIV. The development of antiretroviral drugs (ARVs) and the progressive recognition of their potential dual use as treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP) reshape the experience of HIV and its transmission. Acknowledging the importance of a socioanthropological approach to drugs, this paper highlights how therapeutic strategies of treatment and prevention currently shape the process of HIV chronification and its experience for people concerned with ARVs in Switzerland, whether they are seropositive patients on lifelong treatment or seronegative people affected by the preventive properties of drugs.
Collapse
Affiliation(s)
- Noëllie Genre
- Institut des Sciences Sociales, Université de Lausanne, Lausanne, Suisse
| | - Francesco Panese
- Institut des Sciences Sociales, Université de Lausanne, Lausanne, Suisse
| |
Collapse
|
6
|
Herron LM, Mutch A, Lui CW, Kruizinga L, Howard C, Fitzgerald L. Enduring stigma and precarity: A review of qualitative research examining the experiences of women living with HIV in high income countries over two decades. Health Care Women Int 2021; 43:313-344. [PMID: 34534051 DOI: 10.1080/07399332.2021.1959589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The lived experience of HIV for women remains poorly understood. In particular, there has been little attention to the consequences for women living with HIV (WLHIV) of changing social, epidemiological, biomedical and policy contexts, or to the implications of long-term treatment and aging for the current generation of HIV-positive women. We reviewed qualitative research with WLHIV in selected high-income countries (Australia, Canada, New Zealand, the UK and the USA) to identify the most prevalent experiences of HIV for women and trends over time. Our synthesis highlights the relative consistency of experiences of a diverse sample of WLHIV, particularly the enduring prevalence of gendered HIV-related stigma, sociostructural barriers to healthcare and support, and negative encounters with health professionals. We also identified gaps in knowledge. Understanding women's experiences, particularly their changing needs and strategies for coping as they live long-term with HIV, is key to effective support and services for WLHIV.
Collapse
Affiliation(s)
- Lisa-Maree Herron
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Allyson Mutch
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Chi-Wai Lui
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lara Kruizinga
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Chris Howard
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
7
|
Bärnighausen K, Geldsetzer P, Matse S, Hettema A, Hughey AB, Dlamini P, Mavuso M, Fakudze D, Kahn K, Bärnighausen T, McMahon SA. Qualitative accounts of PrEP discontinuation from the general population in Eswatini. CULTURE, HEALTH & SEXUALITY 2021; 23:1198-1214. [PMID: 32633617 DOI: 10.1080/13691058.2020.1770333] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
People in receipt of pre-exposure prophylaxis (PrEP) for the prevention of HIV in Sub-Saharan Africa often discontinue taking the medication. We conducted 27 semi-structured interviews with men and women who had started PrEP but did not return to the clinic for a refill after a 1, 2 or 3-month period. These 'discontinuation' clients were enrolled in a PrEP demonstration project for the general population in nurse-led, public-sector, primary-care clinics in Eswatini. Reasons for discontinuation included changes to self-perceived HIV risk such as the end of pregnancy and absent partners. Others described PrEP as inaccessible when working away from home and many described difficulties relating to a daily pill regimen and managing side effects. Female clients described being prohibited from using PrEP by their partners and co-wives. From these results, we recommend that client-centred counselling stresses the prevention-effective adherence paradigm, which promotes PrEP use in risk periods that are identifiable and PrEP discontinuation when the risk period has finished. A national scale up of PrEP may mitigate problems accessing PrEP. Extended counselling and support could assist with adherence and the management of side effects. Education and support for partners and families of PrEP clients may also contribute to better PrEP continuation.
Collapse
Affiliation(s)
- Kate Bärnighausen
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Pascal Geldsetzer
- Faculty of Medicine, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Stanford University School of Medicine, Stanford, CA, USA
| | - Sindy Matse
- Eswatini Ministry of Health, Mbabane, Eswatini
| | - Anita Hettema
- Clinton Health Access Initiative Eswatini, Mbabane, Eswatini
| | | | - Phiwa Dlamini
- Clinton Health Access Initiative Eswatini, Mbabane, Eswatini
| | - Mxolisi Mavuso
- Clinton Health Access Initiative Eswatini, Mbabane, Eswatini
| | - David Fakudze
- Clinton Health Access Initiative Eswatini, Mbabane, Eswatini
| | - Kathleen Kahn
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Till Bärnighausen
- Faculty of Medicine, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Shannon A McMahon
- Faculty of Medicine, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
8
|
da Silva LAV, Duarte FM, Magno L, Dourado I, Squire C. Moral barriers to HIV prevention and care for gay and bisexual men: Challenges in times of conservatism in Brazil. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:424-440. [PMID: 33432619 DOI: 10.1111/1467-9566.13230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/26/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
This article examines narratives about promiscuity that are emphasized by some gay and bisexual men who are themselves living with HIV. We used semi-structured interviews to assess the processes, outcomes, and meanings of HIV diagnosis among 10 young gay and bisexual men aged between 18 and 30 years old. Interviews were conducted in health service settings for the diagnosis and treatment of HIV and AIDS in Salvador, Brazil. Based on a socioculturally oriented approach, the narratives suggest that discourse about promiscuity seems to persist, or is even strengthened, in order to explain HIV infection among young gays/bisexual men and to emphasize a more restrained sexual life following HIV diagnosis. Despite the biotechnologies and biomedical advances, some difficulties and tensions also persist in the daily life of young people living with HIV. Difficulties in starting new relationships, dilemmas around responsibility for infection/transmission, fear and guilt are elements that stand out in these narratives, demonstrating that HIV discourses and practices may produce greater stigma and discrimination in current times, individualizing and blaming certain people for the infection/transmission of the virus, and marginalizing practices that do not conform to hegemonic heteronormativity.
Collapse
Affiliation(s)
- Luís Augusto Vasconcelos da Silva
- Institute of Humanities, Arts and Sciences Professor Milton Santos, Federal University of Bahia (Universidade Federal da Bahia: UFBA), Salvador, Brazil
- Institute of Collective Health, UFBA, Salvador, Brazil
| | | | - Laio Magno
- Institute of Collective Health, UFBA, Salvador, Brazil
- Department of Life Sciences, Bahia State University, Salvador, Brazil
| | - Inês Dourado
- Institute of Collective Health, UFBA, Salvador, Brazil
| | - Corinne Squire
- Centre for Narrative Research, School of Social Sciences, University of East London, London, UK
| |
Collapse
|
9
|
Viljoen L, Bond VA, Reynolds LJ, Mubekapi‐Musadaidzwa C, Baloyi D, Ndubani R, Stangl A, Seeley J, Pliakas T, Bock P, Fidler S, Hayes R, Ayles H, Hargreaves JR, Hoddinott G. Universal HIV testing and treatment and HIV stigma reduction: a comparative thematic analysis of qualitative data from the HPTN 071 (PopART) trial in South Africa and Zambia. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:167-185. [PMID: 33085116 PMCID: PMC7894283 DOI: 10.1111/1467-9566.13208] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/16/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
Despite continued development of effective HIV treatment, expanded access to care and advances in prevention modalities, HIV-related stigma persists. We examine how, in the context of a universal HIV-testing and treatment trial in South Africa and Zambia, increased availability of HIV services influenced conceptualisations of HIV. Using qualitative data, we explore people's stigma-related experiences of living in 'intervention' and 'control' study communities. We conducted exploratory data analysis from a qualitative cohort of 150 households in 13 study communities, collected between 2016 and 2018. We found that increased availability of HIV-testing services influenced conceptualisations of HIV as normative (non-exceptional) and the visibility of people living with HIV (PLHIV) in household and community spaces impacted opportunities for stigma. There was a shift in community narratives towards individual responsibility to take up (assumingly) widely available service - for PLHIV to take care of their own health and to prevent onward transmission. Based on empirical data, we show that, despite a growing acceptance of HIV-related testing services, anticipated stigma persists through the mechanism of shifting responsibilisation. To mitigate the responsibilisation of PLHIV, heath implementers need to adapt anti-stigma messaging and especially focus on anticipated stigma.
Collapse
Affiliation(s)
- Lario Viljoen
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
- Department of Sociology and Social AnthropologyStellenbosch UniversityStellenboschSouth Africa
| | - Virginia A. Bond
- ZambartSchool of Public HealthRidgeway CampusUniversity of ZambiaLusakaZambia
- Global Health and Development DepartmentFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Lindsey J. Reynolds
- Department of Sociology and Social AnthropologyStellenbosch UniversityStellenboschSouth Africa
| | - Constance Mubekapi‐Musadaidzwa
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Dzunisani Baloyi
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Rhoda Ndubani
- ZambartSchool of Public HealthRidgeway CampusUniversity of ZambiaLusakaZambia
| | - Anne Stangl
- International Center for Research on WomenWashingtonDCUSA
| | - Janet Seeley
- Global Health and Development DepartmentFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and SocietyFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Peter Bock
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Sarah Fidler
- Imperial College NIHR BRCImperial College LondonLondonUK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Helen Ayles
- ZambartSchool of Public HealthRidgeway CampusUniversity of ZambiaLusakaZambia
- Department of Public Health, Environments and SocietyFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - James R. Hargreaves
- Department of Public Health, Environments and SocietyFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Graeme Hoddinott
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | | |
Collapse
|
10
|
Philpot SP, Persson A, Prestage G, Bavinton BR, Ellard J. The 'normality' of living as a gay serodiscordant couple in Sydney, Australia. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1837-1857. [PMID: 32767697 DOI: 10.1111/1467-9566.13171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
Serodiscordant couples are often understood through a discourse of HIV-risk or researched in terms of the psychological stressors they face. However, due to antiretroviral treatments people living with HIV can achieve undetectable viral loads, which not only make them non-infectious to partners, but allow them to think of their lives and relationships as safe and viable. These realisations mean that serodiscordant couples often embrace an HIV 'normalisation' discourse. In this article, we argue that this discourse of HIV 'normalisation' can overlook the more nuanced complexity of issues still faced by couples today, which reveal how their experiences of 'normal' are sometimes challenged and are not necessarily 'normal'. Utilising semi-structured interviews with 21 gay men in serodiscordant relationships in Sydney, Australia, we draw on the concept of 'home' life to explore how men engage with discourses of normalisation to describe and enact their relationships. We argue that although HIV is managed well enough to be insignificant in the context of home life, experiences or anticipation of stigma in public often remind couples that they are yet to be considered 'normal' socially.
Collapse
Affiliation(s)
| | - Asha Persson
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | | | - Jeanne Ellard
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
11
|
Jones C, Young I, Boydell N. The People vs the NHS: Biosexual citizenship and hope in stories of PrEP activism. SOMATECHNICS 2020; 10:172-194. [PMID: 39076596 PMCID: PMC7616309 DOI: 10.3366/soma.2020.0312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Discourses of pre-exposure prophylaxis (PrEP) revel in its radical potential as a global HIV prevention technology, offering a promise of change for the broader landscape of HIV prevention. In 2018, the British Broadcasting Corporation (BBC) aired The People vs The NHS: Who Gets the Drugs?, a documentary focused on the 'battle' to make PrEP available in England. In this article we explore how the BBC documentary positions PrEP, PrEP biosexual citizen-activists, as well as the wider role of the NHS in HIV prevention and the wellbeing of communities affected by HIV in the UK. We consider how biosexual citizenship (Epstein 2018) is configured through future imaginaries of hope, and the spectral histories of AIDS activism. We describe how The People crafts a story of PrEP activism in the context of an imagined gay community whose past, present, and hopeful future is entangled within the complexities and contractions of a state-funded health system. Here, PrEP functions as a 'happiness pointer' (Ahmed 2011), to orient imagined gay communities towards a hopeful future by demanding and accessing essential medicines and ensuring the absence of needless HIV transmissions. This biomedical success emerges from a shared traumatic past and firmly establishes the salvatory trajectory of PrEP and an imagined gay community who have continued to be affected by HIV. However, campaigns about the individual's right to access PrEP construct the availability and consumption of PrEP as an end goal to their activism, where access to PrEP is understood as an individual's right as a pharmaceutical consumer.
Collapse
Affiliation(s)
| | - Ingrid Young
- Corresponding authors: Charlotte Jones and Ingrid Young
| | | |
Collapse
|
12
|
Abstract
This paper reflects on the meanings of 'post-AIDS' in the Global North and South. I bring together contemporary arguments to suggest that the notion of 'post-AIDS' is, at best, misplaced, not least because its starting point remains a biotechnical one. Drawing on aspects of the sub-Saharan African experience, this essay suggests that, despite significant shifts in access to antiretroviral therapy (ART), HIV continues to be fundamentally shaped by economic determinants and social and cultural practices. In this essay, I question the certainty of the discourse of (Western biomedical) 'positive progress' (Johnson et al. 2015), which underpins the 'post-AIDS' narrative, and suggest that living with HIV and AIDS in our contemporary global context is a life lived with ongoing complexity, stigma and chronicity. I suggest that HIV in the Global North shares many characteristics with HIV in the Global South yet differs in significant ways, not least in the fact that a resource-rich context generates an environment where health and social care support is possible, and, mostly, usual. In both contexts, however, the experience of living with a highly stigmatized illness with no cure in both the Global South and North suggests that this is a point of shared experience.
Collapse
Affiliation(s)
- Liz Walker
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX, United Kingdom.
| |
Collapse
|
13
|
Rudrum S. Promoting male circumcision as HIV prevention in sub-Saharan Africa: An evaluation of the ethical and pragmatic considerations of adopting a demand creation approach. Glob Public Health 2020; 15:1349-1363. [PMID: 32396036 DOI: 10.1080/17441692.2020.1761423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Male circumcision for HIV prevention is being promoted in 14 sub-Saharan African countries. Campaigns take a demand creation approach, a strategy based on generating awareness of and demand for an intervention. This article analyzes campaign materials, making the case that a focus on demand per se, at the expense of quality public health information, constitutes an ethical and pragmatic campaign flaw. Clinical trials have demonstrated that circumcision can reduce transmission of HIV from women to men by 53-60%. Since circumcision does not approach 100% prevention efficacy for men and does not directly protect women, behavioural and structural interventions remain necessary, leading international health bodies to position circumcision as an add-on to behavioural interventions. However, in practice, circumcision promotion often lacks information about behavioural prevention. At times, campaigns omit any HIV prevention message. Instead, campaigns variously favour representing circumcision as a route to normative masculinity, to sexual prowess, or to good citizenship, among others. Alongside their targeted outcomes, public health campaigns also contribute to public discourses around sexuality and non-HIV aspects of health, in this case potentially leading to confusion and mistrust. The current public health promotion strategy for circumcision threatens to undermine the social processes needed to support HIV prevention.
Collapse
|
14
|
Horter S, Bernays S, Thabede Z, Dlamini V, Kerschberger B, Pasipamire M, Rusch B, Wringe A. "I don't want them to know": how stigma creates dilemmas for engagement with Treat-all HIV care for people living with HIV in Eswatini. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:27-37. [PMID: 30782082 DOI: 10.2989/16085906.2018.1552163] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
"Treat-all" programmes aim to improve clinical outcomes and to reduce HIV transmission through regular HIV testing and immediate offer of antiretroviral therapy (ART) for those diagnosed HIV-positive, irrespective of immunological status and symptoms of disease. Global narratives on the benefits of Treat-all anticipate reduced HIV-related stigma and increased "normalisation" of HIV with Treat-all implementation, whereby HIV is remoulded as a manageable, chronic condition where stigmatising symptoms can be concealed. Drawing on Goffman's stigma work, we aimed to investigate how stigma may influence the engagement of clinically asymptomatic people living with HIV (PLHIV) with Treat-all HIV care in Shiselweni, Eswatini (formerly Swaziland). This longitudinal research comprised 106 interviews conducted from August 2016 to September 2017, including repeated interviews with 30 PLHIV, and one-off interviews with 20 healthcare workers. Data were analysed thematically using NVivo 11, drawing upon principles of grounded theory to generate findings inductively from participants' accounts. Stigma was pervasive within the narratives of PLHIV, framing their engagement with treatment and care. Many asymptomatic PLHIV were motivated to initiate ART in order to maintain a "discreditable" status, by preventing the development of visible and exposing symptoms. However, engagement with treatment and care services could itself be exposing. PLHIV described the ways in which these "invisibilising" benefits and exposing risks of ART were continually assessed and navigated over time. Where the risk of exposure was deemed too great, this could lead to intermittent treatment-taking, and disengagement from care. Addressing HIV related stigma is crucial to the success of Treat-all, and should thus be a core component of HIV responses.
Collapse
Affiliation(s)
- Shona Horter
- a London School of Hygiene and Tropical Medicine , London , UK.,b Médecins sans Frontières/Doctors Without Borders , Nhlangano , Eswatini
| | - Sarah Bernays
- c Sydney School of Public Health , University of Sydney , Sydney , Australia
| | - Zanele Thabede
- b Médecins sans Frontières/Doctors Without Borders , Nhlangano , Eswatini
| | - Velibanti Dlamini
- b Médecins sans Frontières/Doctors Without Borders , Nhlangano , Eswatini
| | | | - Munyaradzi Pasipamire
- d Swaziland National AIDS Programme , Swaziland Ministry of Health , Mbabane , Eswatini
| | - Barbara Rusch
- e Médecins sans Frontières/Doctors without Borders , Geneva , Switzerland
| | - Alison Wringe
- a London School of Hygiene and Tropical Medicine , London , UK
| |
Collapse
|
15
|
Rai T, Bruton J, Day S, Ward H. From activism to secrecy: Contemporary experiences of living with HIV in London in people diagnosed from 1986 to 2014. Health Expect 2018; 21:1134-1141. [PMID: 30168239 PMCID: PMC6250870 DOI: 10.1111/hex.12816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Successes in biomedicine have transformed HIV from a debilitating and frequently fatal infection to a chronic, manageable condition. Objective To explore how the contemporary metanarrative of HIV as a chronic condition is understood by patients and how it varies depending on when they were diagnosed. Design Qualitative interviews with 52 people living with HIV who were diagnosed during different phases in the history of the epidemic. Setting and participants Participants were recruited from two HIV clinics in London to include four “HIV generations”: generation 1 were those who had been diagnosed pre‐1997 (pre‐ART), generation 2 from 1997 to 2005 (complex ART), generation 3 from 2006 to 2012 (simpler ART) and generation 4 diagnosed in the year before the study (2013‐2014). Results Participants in all HIV generations took their medication as prescribed, attended clinic appointments and were well informed about their immunological biomarkers. While the pre‐treatment generation had been engaged in community endeavours such as activism, public education and use of support groups, those more recently diagnosed had little experience of collective activities and their HIV was essentially a private matter, separate from their social identity. These strategies worked for some; however, those experiencing clinical or social problems related to HIV or wider issues often relied exclusively on their HIV clinic for wider support. Conclusion The loss of public conversation around HIV, the imperative for patients to take on greater individual responsibility for HIV management and the streamlining of HIV services alongside reductions in ancillary support services may expose some people to suboptimal health outcomes.
Collapse
Affiliation(s)
- Tanvi Rai
- School of Public Health, Imperial College London, London, UK
| | - Jane Bruton
- School of Public Health, Imperial College London, London, UK
| | - Sophie Day
- School of Public Health, Imperial College London, London, UK
| | - Helen Ward
- School of Public Health, Imperial College London, London, UK
| |
Collapse
|
16
|
Walker L. 'There's no pill to help you deal with the guilt and shame': Contemporary experiences of HIV in the United Kingdom. Health (London) 2017; 23:97-113. [PMID: 29090636 DOI: 10.1177/1363459317739436] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The experience of living with HIV, in the global north, has changed significantly over the past 20 years. This is largely the result of effective biomedical methods of treatment and prevention. HIV is now widely considered to be a long-term condition like many others - it has been argued that HIV has been 'normalised'. Drawing on online qualitative survey data, with respondents aged 18-35 years, diagnosed with HIV in the past 5 years, this research explores contemporary subjective experiences of being diagnosed, and living, with HIV in the United Kingdom. The data reveal ambiguous experiences and expectations, as the 'normative' status of HIV exists alongside ongoing experiences of fear, shame and stigma - maintaining its status as the most 'social' of diseases. In rendering HIV 'everyday', the space to articulate (and experience) the 'difference' which attaches to the virus has contracted, making it difficult to express ambivalence and fear in the face of a positive, largely biomedical, discourse. In this article, the concepts of normalisation and chronicity provide an analytical framework through which to explore the complexity of the 'sick role' and 'illness work' in HIV.
Collapse
|
17
|
Cormier McSwiggin C. Moral Adherence: HIV Treatment, Undetectability, and Stigmatized Viral Loads among Haitians in South Florida. Med Anthropol 2017; 36:714-728. [PMID: 28777660 DOI: 10.1080/01459740.2017.1361946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In the United States, HIV is rendered a chronic condition, and viral transmission is minimized through strict adherence to pharmaceutical treatment. Treatment reduces viral loads to untraceable levels in the blood, a status known as "undetectable," as determined by laboratory testing. For Haitians living with HIV in South Florida, "undetectable" has become more than a viral status; it is a means to know and govern themselves as moral actors and to survey and stigmatize others who remain "detectable." The ethnographic evidence I present here suggests that Haitians adopt novel forms of subjectivity based on undetectability, producing identities entangled in biotechnical categorizations and dominant narratives of responsibility, morality, and health. Haitians' experiences with these processes reveal the persistence of HIV stigmatization and the centrality of biomedical morality in mediating perceptions of inclusion, value, and worth of people living with HIV.
Collapse
|
18
|
Moore D, Pienaar K, Dilkes-Frayne E, Fraser S. Challenging the addiction/health binary with assemblage thinking: An analysis of consumer accounts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 44:155-163. [DOI: 10.1016/j.drugpo.2017.01.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/06/2017] [Indexed: 11/25/2022]
|
19
|
Bernays S, Paparini S, Seeley J, Rhodes T. "Not Taking it Will Just be Like a Sin": Young People Living with HIV and the Stigmatization of Less-Than-Perfect Adherence to Antiretroviral Therapy. Med Anthropol 2017; 36:485-499. [PMID: 28379042 DOI: 10.1080/01459740.2017.1306856] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Global health priorities are being set to address questions on adherence to HIV antiretroviral therapy in adolescence. Few studies have explored young people's perspectives on the complex host of social and relational challenges they face in dealing with their treatment in secret and their condition in silence. In redressing this, we present findings from a longitudinal qualitative study with young people living with HIV in the UK, Ireland, US, and Uganda, embedded within the BREATHER international clinical trial. Drawing from Goffman's notion of stigma, we analyze relational dynamics in HIV clinics, as rare spaces where HIV is "known," and how young people's relationships may be threatened by non-adherence to treatment. Young people's reflections on and strategies for maintaining their reputation as patients raise questions about particular forms of medicalization of HIV and the moralization of treatment adherence that affect them, and how these may restrict opportunities for care across the epidemic.
Collapse
Affiliation(s)
- Sarah Bernays
- a School of Public Health , University of Sydney , Sydney , Australia.,b London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - Sara Paparini
- b London School of Hygiene and Tropical Medicine , London , United Kingdom.,c Graduate Institute of International and Development Studies , Geneva , Switzerland
| | - Janet Seeley
- d Medical Research Council , Uganda Virus Research Institute , Entebbe , Uganda
| | - Tim Rhodes
- b London School of Hygiene and Tropical Medicine , London , United Kingdom
| |
Collapse
|
20
|
Keogh P. Embodied, clinical and pharmaceutical uncertainty: people with HIV anticipate the feasibility of HIV treatment as prevention (TasP). CRITICAL PUBLIC HEALTH 2016. [DOI: 10.1080/09581596.2016.1187261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
21
|
Persson A. 'The world has changed': pharmaceutical citizenship and the reimagining of serodiscordant sexuality among couples with mixed HIV status in Australia. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:380-395. [PMID: 26360799 DOI: 10.1111/1467-9566.12347] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this article, I revisit the question of whether HIV can ever be reimagined and re-embodied as a potentially non-infectious condition, drawing on a current qualitative study of couples with mixed HIV status (serodiscordance) in Australia. Recent clinical trials have consolidated a shift in scientific understandings of HIV infectiousness by showing that antiretroviral treatment effectively prevents the sexual transmission of HIV. Contrary to common critiques, I explore how the increasing biomedicalisation of public health and the allied discourse of 'normalisation' can in fact de-marginalise stigmatised relationships and sexualities. Invoking Ecks's concept of 'pharmaceutical citizenship', I consider whether the emerging global strategy of HIV 'treatment-as-prevention' (TasP) can open up new trajectories that release serodiscordant sexuality from its historical moorings in discourses of risk and stigma, and whether these processes might re-inscribe serodiscordant sexuality as 'normal' and safe, potentially shifting the emphasis in HIV prevention discourses away from sexual practice toward treatment uptake and adherence.
Collapse
Affiliation(s)
- Asha Persson
- Centre for Social Research in Health, UNSW, Australia
| |
Collapse
|
22
|
Persson A, Newman CE, Mao L, de Wit J. On the Margins of Pharmaceutical Citizenship: Not Taking HIV Medication in the "Treatment Revolution" Era. Med Anthropol Q 2016; 30:359-77. [PMID: 26756317 DOI: 10.1111/maq.12274] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Abstract
With the expanding pharmaceuticalization of public health, anthropologists have begun to examine how biomedicine's promissory discourses of normalization and demarginalization give rise to new practices of and criteria for citizenship. Much of this work focuses on the biomedicine-citizenship nexus in less-developed, resource-poor contexts. But how do we understand this relationship in resource-rich settings where medicines are readily available, often affordable, and a highly commonplace response to illness? In particular, what does it mean to not use pharmaceuticals for a treatable infectious disease in this context? We are interested in these questions in relation to the recent push for early and universal treatment for HIV infection in Australia for the twin purposes of individual and community health. Drawing on Ecks's concept of pharmaceutical citizenship, we examine the implications for citizenship among people with HIV who refuse or delay recommended medication. We find that moral and normative expectations emerging in the new HIV "treatment revolution" have the capacity to both demarginalize and marginalize people with HIV.
Collapse
Affiliation(s)
- Asha Persson
- Centre for Social Research in Health, UNSW Australia.
| | | | - Limin Mao
- Centre for Social Research in Health, UNSW Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW Australia
| |
Collapse
|
23
|
Paparini S, Rhodes T. The biopolitics of engagement and the HIV cascade of care: a synthesis of the literature on patient citizenship and antiretroviral therapy. CRITICAL PUBLIC HEALTH 2016. [DOI: 10.1080/09581596.2016.1140127] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
24
|
Claiming rights, making citizens: HIV and the performativity of biological citizenship. SOCIAL THEORY & HEALTH 2015. [DOI: 10.1057/sth.2015.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
25
|
Mazanderani F, Paparini S. The stories we tell: qualitative research interviews, talking technologies and the 'normalisation' of life with HIV. Soc Sci Med 2015; 131:66-73. [PMID: 25753287 DOI: 10.1016/j.socscimed.2015.02.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Since the earliest days of the HIV/AIDS epidemic, talking about the virus has been a key way affected communities have challenged the fear and discrimination directed against them and pressed for urgent medical and political attention. Today, HIV/AIDS is one of the most prolifically and intimately documented of all health conditions, with entrenched infrastructures, practices and technologies--what Vinh-Kim Nguyen has dubbed 'confessional technologies'--aimed at encouraging those affected to share their experiences. Among these technologies, we argue, is the semi-structured interview: the principal methodology used in qualitative social science research focused on patient experiences. Taking the performative nature of the research interview as a talking technology seriously has epistemological implications not merely for how we interpret interview data, but also for how we understand the role of research interviews in the enactment of 'life with HIV'. This paper focuses on one crucial aspect of this enactment: the contemporary 'normalisation' of HIV as 'just another' chronic condition--a process taking place at the level of individual subjectivities, social identities, clinical practices and global health policy, and of which social science research is a vital part. Through an analysis of 76 interviews conducted in London (2009-10), we examine tensions in the experiential narratives of individuals living with HIV in which life with the virus is framed as 'normal', yet where this 'normality' is beset with contradictions and ambiguities. Rather than viewing these as a reflection of resistances to or failures of the enactment of HIV as 'normal', we argue that, insofar as these contradictions are generated by the research interview as a distinct 'talking technology', they emerge as crucial to the normative (re)production of what counts as 'living with HIV' (in the UK) and are an inherent part of the broader performative 'normalisation' of the virus.
Collapse
Affiliation(s)
- Fadhila Mazanderani
- University of Edinburgh, Science, Technology & Innovation Studies, Old Surgeon's Hall, High School Yard, EH1 1LZ, United Kingdom.
| | - Sara Paparini
- London School of Hygiene & Tropical Medicine, United Kingdom
| |
Collapse
|
26
|
Keogh P, Dodds C. Pharmaceutical HIV prevention technologies in the UK: six domains for social science research. AIDS Care 2015; 27:796-803. [PMID: 25559236 PMCID: PMC4732466 DOI: 10.1080/09540121.2014.989484] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 11/12/2014] [Indexed: 11/13/2022]
Abstract
The development of pharmaceutical HIV prevention technologies (PPTs) over the last five years has generated intense interest from a range of stakeholders. There are concerns that these clinical and pharmaceutical interventions are proceeding with insufficient input of the social sciences. Hence key questions around implementation and evaluation remain unexplored whilst biomedical HIV prevention remains insufficiently critiqued or theorised from sociological as well as other social science perspectives. This paper presents the results of an expert symposium held in the UK to explore and build consensus on the role of the social sciences in researching and evaluating PPTs in this context. The symposium brought together UK social scientists from a variety of backgrounds. A position paper was produced and distributed in advance of the symposium and revised in the light this consultation phase. These exchanges and the emerging structure of this paper formed the basis for symposium panel presentations and break-out sessions. Recordings of all sessions were used to further refine the document which was also redrafted in light of ongoing comments from symposium participants. Six domains of enquiry for the social sciences were identified and discussed: self, identity and personal narrative; intimacy, risk and sex; communities, resistance and activism; systems, structures and institutions; economic considerations and analyses; and evaluation and outcomes. These are discussed in depth alongside overarching consensus points for social science research in this area as it moves forward.
Collapse
Affiliation(s)
- Peter Keogh
- School of Health and Social Care, University of Greenwich, London, UK
| | - Catherine Dodds
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
27
|
Persson A. Non/infectious corporealities: tensions in the biomedical era of 'HIV normalisation'. SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:1065-1079. [PMID: 23278343 DOI: 10.1111/1467-9566.12023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In the contemporary HIV epidemic, antiretroviral treatments are increasingly considered so effective at viral suppression that they render people with HIV sexually non-infectious. With its radical implications for global HIV prevention, this emerging paradigm is invested with the potential to turn the epidemic around and to 'normalise' one of the most feared infectious diseases in history, thus echoing wider trends of 'biomedicalisation'. What remains unexamined is whether this paradigm shift will bring about a parallel shift in the embodied experiences of being HIV-positive. This article explores the nascent trajectory from infectious to non-infectious corporeality against the backdrop of the discursive history of HIV, with particular focus on the landmark Swiss Consensus Statement, and in the context of research with heterosexuals with HIV in Australia. In-depth interviews revealed that HIV corporeality was not a stable, homogenised experience across participants and time, nor did it simply follow medical discourses. Instead, HIV corporeality emerged as a contingent set of tensions between conflicting discourses of infectiousness that were negotiated and made sense of within situated and embodied life histories. These findings pose challenges to the imperative of HIV normalisation and the related tendency in HIV prevention to universalise the notion of 'infectiousness'.
Collapse
Affiliation(s)
- Asha Persson
- National Centre in HIV Social Research, The University of New South Wales, Sydney, Australia
| |
Collapse
|
28
|
Flowers P, Davis M. Obstinate essentialism: identity transformations amongst gay men living with HIV. PSYCHOLOGY & SEXUALITY 2013. [DOI: 10.1080/19419899.2012.679364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|