Abstract
The use of HIV Treatment as Prevention (TasP) has radically changed our understandings of HIV risk and revolutionised global HIV prevention policy to focus on the use of pharmaceuticals. Yet, there has been little engagement with the very people expected to comply with a daily pharmaceutical regime. We employ the concept of HIV citizenship to explore responses by people living with HIV in the UK to TasP. We consider how a treatment-based public health strategy has the potential to reshape identities, self-governance and forms of citizenship, domains which play a critical role not only in compliance with new TasP policies, but in how HIV prevention, serodiscordant relationships and (sexual) health are negotiated and enacted. Our findings disrupt the biomedical narrative which claims an end to HIV through scaling up access to treatment. Responses to TasP were framed through shifting negotiations of identity, linked to biomarkers, cure and managing treatment. Toxicity of drugs – and bodies – were seen as something to manage and linked to the shifting possibilities in serodiscordant environments. Finally, a sense of being healthy and responsible, including appropriate use of resources, meant conflicting relationships with if and when to start treatment. Our research highlights how HIV citizenship in the TasP era is negotiated and influenced by intersectional experiences of community, health systems, illness and treatment. Our findings show that the complexities of HIV citizenship and ongoing inequalities, and their biopolitical implications, will intimately shape the implementation and sustainability of TasP.
Highlights
In July 2016, the social media campaign #U = U (Undetectable = Untransmittable) was launched by the Prevention Access Campaign, a collection of clinicians, researchers, community and HIV organisations (Prevention Access Campaign, 2016)
While most HIVand community organisations actively endorsed this message, the Global Network of People Living with HIV (GNP+) – one of the biggest organisations of people living with HIV – were initially highly critical of the campaign
As Treatment as Prevention (TasP) is rolled out globally as a core ingredient of HIV prevention policy, what are the implications of this disconnect between policy, implementation and the experiences of those diagnosed with HIV – those tasked with the responsibility to comply with a daily ARV regime? In this article we explore responses to TasP among people living with HIV in the UK
Summary
We see a sense of self-care and access to treatment, but a responsibility towards others in the form of self-monitoring to maintain undetectable viral loads These changes signal increasing complexity in ways of living with and/or embodying HIV, HIV identities and enactments of HIV citizenship. Paparini and Rhodes call for further research on emerging forms of patient citizenship linked to care and pharmaceutical demands, especially in light of increased competition for public funding They suggest it will be important to analyse how biological citizens may be increasingly made individually responsible for more than their own health in the context of TasP.
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