HIV, Viral Suppression and New Technologies of Surveillance and Control

Abstract

The global response to managing the spread of HIV has recently undergone a significant shift with the advent of 'treatment as prevention', a strategy which presumes that scaling-up testing and treatment for people living with HIV will produce a broader preventative benefit. Treatment as prevention includes an array of diagnostic, technological and policy developments that are creating new understandings of how HIV circulates in bodies and spaces. Drawing on the work of Michel Foucault, we contextualize these developments by linking them to systems of governance and discursive subjectivation. The goal of this article is to problematize the growing importance of viral suppression in the management of HIV and the use of related surveillance technologies. For people living with HIV, we demonstrate how treatment-as-prevention's emphasis on individual and collective viral load is transforming the performative dimensions of embodied risk, affect, subjectivity and sex.

Reassessing the Ethics of Molecular HIV Surveillance in the Era of Cluster Detection and Response: Toward HIV Data Justice

“…This is true even of very advanced re-uses of personally-identifiable HIV surveillance data for direct prevention, such as uses of HIV genetic sequence data in escalated CDR (CDC 2018). Guta et al (2016) have expressed concerns about the impacts of new forms of HIV surveillance in which traditional epidemiological data, combined with the integration of biomarkers such as viral load, are used to reach out to the most vulnerable people living with and affected by HIV. These concerns are shared by many activists, researchers, and policy advocates (Center for HIV Law and Policy 2019;Chung et al 2019;Kempner 2019;McClelland et al 2019).…”

The ‘normality’ of living as a gay serodiscordant couple in Sydney, Australia

“…Moreover, issues such as class, race, rurality, and even age can play an important part in achieving ‘normal’ in relation to HIV, and researchers have provided insight into these issues (Guta et al . 2016, Holt 2016, Persson et al . 2017, Philbin 2014).…”

Gay Men’s Understanding and Education of New HIV Prevention Technologies in Vancouver, Canada

“…Other scholars have emphasized that the implementation of TasP has come with increased medical surveillance and regulation, while also transforming the subjectivity of people living with HIV as the language of “undetectability” has been taken up on a community level. While this splitting of HIV subjectivity has entailed the reduction of stigma for “undetectable” individuals, it has only intensified stigma for those who are still “detectable” and has occurred against the backdrop of increased HIV criminalization (Guta, Murray, & Gagnon, 2016). …”