From HIV’s Exceptionalism to HIV’s Particularity

Abstract

This chapter examines convergences and conflicts between contemporary positions that people take in relation to HIV, in policy and in everyday lives. The quotations above present three such positions. The first, an optimistic assessment of the current possibilities for prevention and treatment, particularly those arising from new biomedical developments, suggests that HIV may soon cease to be an emergency in the world. I will call this the ‘naturalisation’ position. It assumes not that HIV will no longer exist, but rather that AIDS will disappear and that HIV will become a regular, natural part of the biosocial order of things, still difficult, but no longer to be seen in catastrophic terms.²

We are at a moment of extraordinary optimism in the response to the human immunodeficiency virus (HIV). A series of scientific breakthroughs, including several trials showing the partial efficacy of oral and topical chemoprophylaxis and the first evidence of efficacy for an HIV vaccine candidate, have the potential to markedly expand the available preventive tools. There is evidence of the first cure of an HIV-infected person. And most important, the finding that early initiation of antiretroviral therapy can both improve individual patient outcomes and reduce the risk of HIV transmission to sexual partners by 96% has led many to assert what had so long seemed impossible: that control of the HIV pandemic may be achievable.

(Havlir and Beyrer 2012: 685)

The most significant impact [of the economic crisis] is that we’re seeing more people dying. During the Global Fund grant, we achieved reductions in mortality. But now people are not adhering to their treatment because the social and nutritional support they need to do so is not there.

Joan Didier, Executive Director, St Lucia AIDS Action Foundation (quoted in UNAIDS 2012b: 14–5)

Yah, you know, really, the HIV is a complicated issue …it affects your health, economic, (social life), people disclose, sometimes you don’t disclose your status. And sometimes your health is up and down, and create many many disease, you have blood pressure, hypertension, diabetes and all those, kidney infection, all organs. Yeah this hard when you start with medication and you have to stick with time of medication and you have to eat some kind of food … whereas because even the medication is not like any (laughs) another pills. Many, many three, four tablet, and sometimes the sideeffect, you know when you take it you feel pain, you feel like nausea, like headache, like rash, that’s all those things. And sometimes you feel difficult to take with you, you know, especially when around the community, all the people around you. … Or if you miss it that is another problem for you. … And I saw this when I started medication, I saw even my memory is not like before. Really I forgot many people, and even some people they start to ask me ‘what, your shape is changed, and what happened?’ My friend he ask me, ‘why you took a lot of tablets?’ I say ‘no this is because I have got some’ — sometime I have to lie — ‘no, no! I have got some problem with my kidney or my ulcer and the doctor, prescribed me that all those things.’ And secondly, you know family, they don’t know {my status}, that is another barrier. And your lifestyle, for to have a partner this is another issue, because you have to stick with someone in the same situation. Otherwise it is affecting the law and how that is. And even when you have sex, and you have caution about that, if you have to use condoms. Also if sometimes the lady, say ’why you use condoms?’ also suspect you or something, I say ‘no no because it’s safe for you and for me’ … For me because I didn’t marry for wife people started — because I have got HIV before wife, maybe for fifteen years, yes — people asking me many ‘why why why’s’ especially that’s in our culture you have to {have a wife}.¹

Quentin (United Kingdom 2011)