Marsha Rosengarten

DIAGNOSIS AND STIGMA AND IDENTITY AMONGST HIV POSITIVE BLACK AFRICANS LIVING IN THE UK

Individual in-depth, semi-structured interviews with 30 HIV positive Black Africans were conducted in London, UK. The interviews focused upon experiential accounts of living with HIV. The interviews were transcribed and analysed for recurrent themes using interpretative phenomenological analysis. The social context of being a Black African living in the UK emerged as an important framework within which the experience of being HIV positive was positioned. In terms of peoples accounts of their own experiences of living with HIV, diagnosis figured as an important moment in peoples lives. The majority of participants were surprised and upset upon receiving their positive antibody test results. Many reported a period of depression and social isolation. Stigma and prejudice associated with HIV also emerged as a major force shaping the daily lives of the participants. We discuss the role of identity and social context in disrupting the medical meaning of diagnostic tests.

Willingness to use HIV pre-exposure prophylaxis and the likelihood of decreased condom use are both associated with unprotected anal intercourse and the perceived likelihood of becoming HIV positive among Australian gay and bisexual men

Objectives To investigate willingness to use HIV pre-exposure prophylaxis (PrEP) and the likelihood of decreased condom use among Australian gay and bisexual men. Methods A national, online cross-sectional survey was conducted in April to May 2011. Bivariate relationships were assessed with χ2 or Fishers exact test. Multivariate logistic regression analysis was performed to assess independent relationships with primary outcome variables. Results Responses from 1161 HIV-negative and untested men were analysed. Prior use of antiretroviral drugs as PrEP was rare (n=6). Just over a quarter of the sample (n=327; 28.2%) was classified as willing to use PrEP. Willingness to use PrEP was independently associated with younger age, having anal intercourse with casual partners (protected or unprotected), having fewer concerns about PrEP and perceiving oneself to be at risk of HIV. Among men who were willing to use PrEP (n=327), only 26 men (8.0%) indicated that they would be less likely to use condoms if using PrEP. The likelihood of decreased condom use was independently associated with older age, unprotected anal intercourse with casual partners (UAIC) and perceiving oneself to be at increased risk of HIV. Conclusions The Australian gay and bisexual men the authors surveyed were cautiously optimistic about PrEP. The minority of men who expressed willingness to use PrEP appear to be appropriate candidates, given that they are likely to report UAIC and to perceive themselves to be at risk of HIV.

Medicine: Experimentation, Politics, Emergent Bodies

In this introduction, we address some of the complexities associated with the emergence of medicine’s bodies, not least as a means to ‘working with the body’ rather than simply producing a critique of medicine. We provide a brief review of some of the recent discussions on how to conceive of medicine and its bodies, noting the increasing attention now given to medicine as a technology or series of technologies active in constituting a multiplicity of entities – bodies, diseases, experimental objects, the individualization of responsibility for health and even the precarity of life. We contrast what feminist theorists in the tradition of Judith Butler have referred to as the question of matter, and Science and Technology Studies with its focus on practice and the nature of emergence. As such we address tensions that exist in analyses of the ontological status of ‘the body’ – human and non-human – as it is enacted in the work of the laboratory, the randomized controlled trial, public health policy and, indeed, the market that is so frequently entangled with these spaces. In keeping with the recent turns toward ontology and affect, we suggest that we can regard medicine as concerned with the contraction and reconfiguration of the body’s capacities to affect and be affected, in order to allow for the subsequent proliferation of affects that, according to Bruno Latour, marks corporeal life. Treating both contraction and proliferation circumspectly, we focus on the patterns of affects wrought in particular by the abstractions of medicine that are described in the contributions to this special issue. Drawing on the work of A.N. Whitehead, we note how abstractions such as ‘medical evidence’, the ‘healthy human body’ or the ‘animal model’ are at once realized and undercut, mediated and resisted through the situated practices that eventuate medicine’s bodies. Along the way, we touch on the implications of this sort of perspective for addressing the distribution of agency and formulations of the ethical and the political in the medical eventuations of bodies.

Rethinking the Bioethical Enactment of Medically Drugged Bodies: Paradoxes of Using Anti-HIV Drug Therapy as a Technology for Prevention

In this paper we examine the work of bioethics in the enactment of medically drugged bodies by focusing on the development of an oral pre-exposure chemo (drug) prophylaxis for preventing HIV, called PrEP. Our aim is to show how the operationalisation of bioethics to mediate drug development obscures a more complex and relational dynamic out of which emerges the qualities and, indeed, problematics of bodies incorporated into PrEP. Our analysis is drawn from a small body of literature from trial affected communities, advocacy groups, researchers and trial sponsors. In particular, we focus on bioethical questions about how best to protect the interests of participants in ‘offshore’ randomised clinical trials. We argue that the predominant bioethical frame insufficiently addresses the challenges posed by PrEP. By rendering PrEP a singular thing that differs across contexts, more fruitful alternative conceptions are obscured. Specifically, we argue that PrEP trials should be conceived as ‘ontologically multiple’—emerging out of divergent assemblages of heterogeneous entities, including material and cultural differences in and across context-specific bodies. On the basis of this alternative account of PrEP, we propose that the bioethical work of pharmaceutical development can become more inclusive.

Willingness to use HIV pre-exposure prophylaxis has declined among Australian gay and bisexual men: Results from repeated national surveys, 2011-2013

Abstract:We surveyed willingness to use pre-exposure prophylaxis (PrEP) and the likelihood of decreased condom use among Australian gay and bisexual men in 2011 and 2013 (n = 2384). Willingness to use PrEP declined from 28.2% to 23.3% [adjusted odds ratio = 0.83, 95% confidence interval (CI): 0.68 to 1.00, P = 0.050]. Willingness to use PrEP was the greatest among men with HIV-positive partners and among those who had taken HIV postexposure prophylaxis. Among men willing to use PrEP, the likelihood of decreased condom use remained stable between 2011 and 2013 (8.0% vs. 11.9%; adjusted odds ratio = 1.40, 95% CI: 0.80 to 2.45, P = 0.23). A minority of men remain willing to use PrEP and appear to be appropriate candidates for it.

Consumer Activism in the Pharmacology of HIV

This article explores problems posed by HIV anti-retroviral combination therapies by focusing on the UK media promotion of Trizivir (a GlaxoSmithKline three-drugs-in-one tablet). Using the substance of the figural in the style of feminist critiques of science and borrowing from actor network theory, a synergistic relationship comprising HIV, anti-HIV drugs, drug manufacturers and their media, medical publications, consumer representative treatment information and mass media is shown to construct a worrisome set of choices. The coming together of otherwise divergent interests and media raises questions about a certain adherence to drug manufacturer ‘facts’. But more provocative is the Trizivir campaign itself. For it suggests a stridency that goes well beyond the limits of its choices and, in doing so, offers the possibility for renewed consumer activism.

HIV, Globalization and Topology: Of Prepositions and Propositions

In this article we explore how two enactments of HIV – the UN’s AIDS Clock and clinical trials for an HIV biomedical prevention technology or pre-exposure prophylaxis (PrEP) – entail particular globalizing and localizing dynamics. Drawing on Latour’s and Whitehead’s concept of proposition, and Serres’ call for a philosophy of prepositions, we use the composite notion of pre/pro-positions to trace the shifting topological status of HIV. For example, we show how PrEP emerges through topological entwinements of globalizing biomedical standardization, localizing protests against PrEP trials and globalizing ethical principles. We go on to examine how our own analysis manifests a parallel topological pattern in which we deploy a globalizing argument about the localizing of the globalizing found in the AIDS Clock and the PrEP trails. Finally, we consider how the movement of ‘topology’ into the social sciences might itself benefit from a topological treatment.

What is nature capable of? Evidence, ontology and speculative medical humanities

Expanding on the recent call for a ‘critical medical humanities’ to intervene in questions of the ontology of health, this article develops a what we call a ‘speculative’ orientation to such interventions in relation to some of the ontological commitments on which contemporary biomedical cultures rest. We argue that crucial to this task is an approach to ontology that treats it not as a question of first principles, but as a matter of the consequences of the images of nature that contemporary biomedical research practices espouse when they make claims to evidence, as well as the possible consequences of imagining different worlds in which health and disease processes partake. By attending to the implicit ontological assumptions involved in the method par excellence of biomedical research, namely the randomised controlled trial (RCT), we argue that the mechanistic ontology that tacitly informs evidence-based biomedical research simultaneously authorises a series of problematic consequences for understanding and intervening practically in the concrete realities of health. As a response, we develop an alternative ontological proposition that regards processes of health and disease as always situated achievements. We show that, without disqualifying RCT-based evidence, such a situated ontology enables one to resist the reduction of the realities of health and disease to biomedicines current forms of explanation. In so doing, we call for medical humanities scholars to actively engage in the speculative question of what nature may be capable of.

Australian gay and bisexual men's attitudes to HIV treatment as prevention in repeated, national surveys, 2011-2013.

Objective Assess the acceptability of HIV treatment as prevention and early antiretroviral treatment among gay and bisexual men in Australia and any changes in attitudes over time. Methods National, online, cross-sectional surveys of gay and bisexual men were repeated in 2011 and 2013. Changes in attitudes to HIV treatment over time were assessed with multivariate analysis of variance. The characteristics of men who agreed that HIV treatment prevented transmission and thought that early treatment was necessary were identified with multivariate logistic regression. Results In total, 2599 HIV-negative, untested and HIV-positive men participated (n = 1283 in 2011 and n = 1316 in 2013). Attitudes changed little between 2011 and 2013; most participants remained sceptical about the preventative benefits of HIV treatment. In 2013, only 2.6% of men agreed that HIV treatment prevented transmission; agreement was associated with being HIV-positive, having an HIV-positive regular partner, and having received HIV post-exposure prophylaxis. In contrast, 71.8% agreed that early antiretroviral treatment is necessary; younger men were more likely and HIV-positive men and participants with HIV-positive partners were much less likely to agree with this. Conclusions Promoting the individual health benefits of HIV treatment rather than its preventative benefits remains more acceptable to Australian gay and bisexual men.

The Challenge of HIV for Feminist Theory

In this article I consider the field of HIV treatment and prevention in light of poststructural feminist critiques of the self-evidence of matter. Both HIV and poststructural feminist theory are viewed in relation to the current state of HIV scientific research of which it has been said: ‘much remains left to the imagination’ (McCune, 2001, emphasis added). Importantly, it is in the absence of ‘real’ knowledge of bodily matter and virus, that imagination is presumed by science as a fall back. Paradoxically, recent debate within feminist theory provides an almost perverse counter to this way of characterizing the struggle against HIV. Rather than considering imagination as something outside or external to the ‘real’, there is now substantial argument suggesting that imagination is always already present and inherent to the ‘real’. In the course of this paper, these differing positions of science and feminist theory are used to challenge and extend each other. The empirical matter of HIV medical science is shown as evidence of matter beyond the normative insistence of (human) language. On this basis, a theory of performativity - devised by Judith Butler and extended by Karen Barad - is argued as grounds for a methodologically expanded science.