Abstract
In both HIV science and public health policy, efforts to end the HIV epidemic are increasingly focusing on molecular HIV surveillance as a helpful tool for identifying, intervening in and controlling the disease. HIV surveillance is meant to identify clusters of genetically similar viral strains in near real-time in communities and areas where transmissions occur, and then to intervene by means of enhanced public health approaches. This article critically engages with how molecular HIV surveillance—a practice and technology portrayed as a benign public health intervention—empties and purifies many of the social and political contexts of HIV transmissions. McClelland et al. (Crit Public Health 1–7, 2019) see the rise of molecular HIV surveillance as a form of “repurposing” of clinical phylogenetic testing done in the context of HIV care. In this article, I argue that this so-called repurposing can be understood as a form of “translation”. Looking at how phylogenetic HIV testing has been translated from clinical, patient-centered use to a form of molecular HIV surveillance, I seek to map some of the potential ethical and epistemological pitfalls of such a translational process. More specifically, I look at the unintended consequences of translating a particular evidence-based practice—phylogenetic HIV testing—from one usage to another. To this end, I engage with Michel Foucault and his work on the biopower of medicine, exploring how such power disciplines subjects into undergoing a form of medical surveillance that influences norms and behaviors. Ultimately, I argue that the translation of phylogenetic testing from patient-centered care in the clinic to a form of epidemiological surveillance needs to be critically examined in order to avoid ethical and potentially detrimental consequences for HIV-affected communities.
Highlights
Efforts to end the HIV epidemic are increasingly focusing on molecular HIV surveillance as an identification and intervention tool (Control, 2018; Oster et al, 2018a, 2018b)
The US Centers for Disease Control (CDC) has heralded molecular surveillance as a “critical step toward bringing the nation closer to the goal of no new infections.”1 Molecular HIV surveillance is practiced in Canada (Poon et al, 2016), and studies on its usage have been conducted in Spain (GonzálezAlba et al, 2011), Italy (Lai et al, 2020), and France (Chaillon et al, 2017; Wirden et al, 2019)
This article critically engages with how molecular HIV surveillance—a practice and technology portrayed as a benign public health intervention—empties and purifies many of the social and political contexts of HIV transmission (McClelland et al, 2019, p. 2)
Summary
Efforts to end the HIV epidemic are increasingly focusing on molecular HIV surveillance as an identification and intervention tool (Control, 2018; Oster et al, 2018a, 2018b). I argue that the repurposing of phylogenetic testing is a form of translation wherein phylogenetic testing moves out of the clinic and into the domain of epidemiological surveillance It implies a crossover from clinical care to public health and extends the knowledge extracted from phylogenetic HIV testing into public health surveillance. This extension is important, for in the translational process this knowledge ceases to cover HIV drug resistance alone and suddenly concerns transmissions chains and risk networks as well. As I see it, the act of repurposing phylogenetic HIV testing entails change, transformation, and the creation of new connections and associations These connections often differ from those previously linked to the clinical, patient-centered application of the testing—a situation that leaves this new usage open to myriad potential pitfalls. Repurposing phylogenetic testing for HIV surveillance involves radically transforming the clinical usage of this test and making the knowledge extracted from the same data – blood samples – serve one set of purposes in the clinic and another entirely in the name of public health surveillance
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