Socialising the Biomedical Turn in HIV Prevention

This book concerns HIV prevention. The authors argue that until the world focuses its attention on the social issues carried and revealed by AIDS, it is unlikely that HIV transmission will be eradicated or even significantly reduced. Currently we are witnessing the remedicalisation or the continuing biomedicalisation of HIV prevention, which began in earnest in 1996/7 after the development of successful HIV treatment. This biomedical trajectory continues with the increasing push to use HIV treatments as prevention, and it appears to have undermined what has been – at least in many countries – a successful prevention response. This book’s argument is that at least until such time as biomedicine develops an effective prophylactic vaccine and a cure for HIV, the world must rely on the everyday responses of people and communities to combat the virus. Effective HIV prevention hinges on communities and the social practices forged by these communities that reduce the risk of HIV-transmission (primarily safe sexual and safe drug injection practices); people’s willingness to be identified as infected with HIV (HIV testing practices); and, for people living with HIV, people’s commitment to keeping AIDS at bay (HIV treatment practices). Combating HIV also relies on governments to ensure access to HIV prevention tools, including condoms and sterile needles and syringes, as well as to biomedical prevention technologies including those derived from successful antiretroviral treatment (ART) – pre-exposure prophylaxis (PrEP), microbicides and post exposure prophylaxis (PEP), and male circumcision. It requires that governments develop robust health infrastructures to support and enable regular HIV testing and provide access to treatments for those living with HIV. Effective HIV prevention needs governments to adopt pragmatic policies that are not deflected by moralistic or conservative ideologies. Effective responses to HIV, on the part of communities, health professionals and governments are all underpinned by public discussion about sex, sexuality and drug use. More broadly, combating HIV depends on civil society resisting HIV stigma and discrimination against those infected and affected by HIV, and enabling people and communities to discuss sex, sexuality and drug use in ways that promote the development and adoption of safe sexual and drug injection practices.