Abstract
This article examines the changing role of ‘confessional technologies’ (Foucault 1990) over the history of the HIV pandemic, beginning when US public health departments first rolled out testing campaigns and continuing in the present day through the expansion of diagnostic practices to support the development and implementation of pharmaceutical technologies for HIV prevention. Across this decades-long history, diagnostic practices have been shaped by ethical principles, legal mandates, and research priorities, which have compelled the individual who is ‘at risk’ of acquiring HIV to speak about their sexual practices and thus reveal hidden truths about one’s self to an intimate Other (Whitacre 2018). Indeed, public health ethics have long focused on confession as a means for disciplining safe sex and managing pleasure (Race 2007) and relied on these techniques to secure resources for survival (Nguyen 2010). I argue that confessions have recently become a productive means by which to generate evidence about the efficacy of pharmaceuticals. Practices of revealing truth have contributed to clinical evidence for pharmaceutical interventions, including the use of antiretrovirals for oral HIV pre-exposure prophylaxis (PrEP). Considering the contemporary use of confessions in enabling the development of drug products and facilitating market growth, I contend that confessing should be understood as a form of labour.
Highlights
Since the earliest years of the HIV/AIDS pandemic, disciplinary techniques have shaped sexual subjectivities (Race 2007)
This research article examines the changing role of diagnostic practices over the history of the HIV pandemic, beginning at the point US public health departments first rolled out testing campaigns and continuing through the present day as HIV testing becomes incorporated into clinical research into the biomedical prevention of HIV
In clinical research for pre-exposure prophylaxis (PrEP), HIV testing became integral to the production of evidence for pharmaceutical efficacy
Summary
Since the earliest years of the HIV/AIDS pandemic, disciplinary techniques have shaped sexual subjectivities (Race 2007). Some scholars have provided key insights into the growing role of diagnostics in global health interventions (Street 2018) and pharmaceutical markets, including through the making of at-risk populations (Dumit 2012) They have examined the role of HIV-prevention practices in the discipline of the neoliberal subject (Race 2007) and the ways in which sexual subjectivity has been remade since the implementation of new biomedical HIV-prevention technologies (Martinez-Lacabe 2019; Thomann 2018; Sandset 2019). As laws determined whether and how healthcare workers should reveal their HIV status, many workers developed fears their HIV status would be disclosed against their will (Reid 1994), and such requirements sparked controversy among nurses, physicians, psychologists, ethicists, and scholars of medical law (Bocchino 1990; McDonald 1989; 1990; Doe 1990; Navran 1990; Christie 2002) These controversies extended to court hearings about the unlawful dissemination of test results, as plaintiffs alleged that the disclosure of highly sensitive and personal information violated their rights to privacy.. I will refer to the ethics of this encounter as ‘intimate ethics’
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