Antiretroviral Treatment and HIV Prevention: Perspectives from Qualitative Research with Gay Men with HIV in the UK

Abstract

This is an extract from an interview regarding the implications of antiretroviral treatment (ART) for the risk of transmission in sexual intercourse. It comes from research I will consider in later parts of the chapter. The quotation concerns the idea that undetectable viral load, one of the desired effects of ART, implies that the risk of HIV transmission is reduced. As such, it reflects a narrative that recognises the advent of ART as a biotechnological watershed in the epidemic with implications for knowledge concerning the action of HIV in bodies, its status as a biological entity and for social responses to the epidemic. Alasdair’s expression of confusion raises the themes I want to address. He makes a division between his own and medical expertise, suggesting the challenge of engaging with the knowledge and effects pertaining to ART and HIV prevention. However, the advice from the medical expert is represented as the source of confusion, so we are led to the view that technical considerations and expertise are not the only issues here. Further, ‘not knowing whether I can believe them or not’ expresses awareness of the potentially controversial implications of the medical expert’s perspective. Alasdair’s account acknowledges that reduced risk of HIV transmission has implications for sexual relations. But, it also underlines that the technical appraisal of the relative risk of HIV and hepatitis B transmission is not, in and of itself, an answer to the question of how to act. In this way, the technical aspects of the knowledge systems of ART and implications for the risk of HIV transmission articulate with, but are distinct from, the ethical implications of such knowledge for sexual relations.