Resisting Public Health Surveillance: Anonymous HIV Testing and the Imperative of Health

Abstract

To date, there has been little research published about public health surveillance and HIV testing/prevention. Accordingly, an exploratory project was undertaken, involving a detailed review of local public health law, and the distribution of surveys about self-reported STI testing/diagnosis, HIV testing practices, and sexual behaviours among gay, bisexual, and other men who have sex with men. A review of the public health law indicated that, in the local context, there is a pervasive public health surveillance apparatus that requires mandatory reporting of identified communicable diseases, including HIV. Results of the survey indicated that individuals who reported a preference for, or use of, anonymous HIV testing were more likely to have reported having (a) been tested for, and diagnosed with, STIs, (b) a self-reported history of anal sex, (c) more sexual partners, and (d) been aware of criminal prosecutions against people living with HIV for not disclosing their HIV status. At first glance, it appeared as though anonymous HIV testing represented a form of resistance to public health surveillance; a strategy by which individuals who are likely to test positive for HIV circumvent surveillance. However, when these results were examined using Lupton’s “Imperative of Health” framework, it became clear that one must appreciate the two-pronged nature of anonymous HIV testing. On the one hand, knowing one’s HIV status can be beneficial; for example, it corresponds with decreased HIV transmission and improved quantity / quality of life for people living with HIV. On the other hand, anonymous testing represents a complicit acceptance of the imperative of health, and an internalization of public health surveillance. From this perspective, true resistance to public health surveillance would manifest as an absolute rejection of HIV testing.