‘The world has changed’: pharmaceutical citizenship and the reimagining of serodiscordant sexuality among couples with mixed HIV status in Australia

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.

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

“…More recently, researchers have been investigating the various ways in which TasP as a biomedical technology and a technology of biomedicalisation is playing out in the intimate and social lives of people with HIV: that is, investigating the emerging social and intimate uses of TasP beyond reductions in HIV transmission on a population level (Davis, 2015;Grace, et al, 2015;Persson, 2016).…”

“…In a recent paper, Perrson describes the ways in which TasP impacts the intimate lives of serodiscordant couples (where one partner is HIV positive and the other is not); on how such couples perceive their relationship; and how they represent their sero-discordancy to others (Persson, 2016).…”

Supporting the Sexual Rights of Women Living With HIV: A Critical Analysis of Sexual Satisfaction and Pleasure Across Five Relationship Types

“…The emphasis on HIV prevention is evident in the large literature on: safer sex, which has primarily interrogated (male) condom use practices (Carvalho et al, 2011); safer conception (Matthews et al, 2017) and prevention of vertical transmission (Ambia & Mandala, 2016); and more recently, treatment-driven prevention strategies, for which the latest science shows that people who are adherent to combination antiretroviral therapy (cART) and achieve and maintain an undetectable viral load (VL) have effectively no risk of sexually transmitting the virus to HIV-negative partners (Rodger et al, 2016). While important inequities in treatment access and adherence exist owing to a myriad of social factors (e.g., substance use, violence, poverty) (Carter, Roth, et al, 2017), researchers are beginning to theorize that this biomedical science may have the unintended good consequence of freeing people living with HIV from repressive discourses of sexual risk and opening up new possibilities for sexual pleasure (Persson, 2016).…”

Social Support Networks of People Recently Diagnosed with HIV in Queensland: A Qualitative Exploration

“…Poor ART adherence can lead to the onset of AIDS-defining illnesses and increase the likelihood of drug resistance, which can limit future treatment options (ASHM, 2014a; Starr & Bradley-Springer, 2014). With the advent of TasP, a new moral discourse is emerging with an increased focus on the role of ART in HIV prevention (Persson, 2015).…”

“…They include the feeling of being too well to need ART, prioritising other health needs, misconceptions about the efficacy of ART, distrust of medicines and pharmaceutical companies, preference for complementary or alternative therapies and fear of side effects (Beer et al, 2012;Christopoulos et al, 2015;Newman, Mao, et al, 2015;Sevelius et al, 2014). Some PLHIV also express concerns about the lack of data on the long-term effects of ART use, their ability to adhere long-term and the consequences of non-adherence, including viral resistance (Down et al, 2014;Grace, Chown, et al, 2015;Newman, de Wit, Crooks, et al, 2015;Persson, 2015).…”