Biopolitics of HIV
My dissertation, titled “(Re)distribution of Blame: The Politics of Biomedical HIV Knowledge Among Youth in Lesotho,” was based on two years of multi-sited, mixed-methods ethnographic fieldwork on HIV prevention education aimed at youth in both urban and rural settings of Lesotho, southern Africa. During my experiences as a public health worker in Lesotho in 2004, I recognized firsthand the discord that often exists between the claims, directives, and prerogatives of the biomedical expert and locals most impacted by health inequities. I returned to the area to examine responses to competing and often contradictory HIV prevention messages in Lesotho, a country with one of the highest prevalence of adult HIV in the world. The dissertation advanced the concept of biocommunicability; critically examining the circulation of biomedical knowledge, the different actors involved, and the implications for these defined roles in further promoting disease within certain populations.
My research into VMMC revealed resistance to what is perceived as an externally imposed agenda. Identified as one of the 14 priority countries for VMMC scale-up, Lesotho has not met targets, despite male circumcision existing as part of cultural traditions. In this light, not only does VMMC challenge established identities, but also by design, the approach suggests that individuals cannot behave responsibly (practice safe sex). Exploring the possibilities of Pre-Exposure Prophylactic (PrEP) delivery in Lesotho, my co-author and I argued that social environments (low wages, limited economic opportunities) limit the ability of individuals to act responsibly. Consequently, the model of delivery we suggested (existing clinics in clothing factories) not only account for, but also further undermined individual patient/consumer self-governance.
In 2017, I conducted preliminary research into the new Dapivirine impregnated intravaginal ring technologies currently in clinic trials in South Africa. Reflecting on the advancement of HIV technologies over the past four decades, this work explores if this new technology has brought about:
- new citizen-state relationships (reflecting on the theoretical perspectives of therapeutic and biomedical citizenship offered by Nguyen and Robbins, respectively),
- a recognition that there is little value in trying to limit and control access to new technologies (reflecting on Latour’s notion of immutable mobiles), and
- a willingness to embrace the idea that scientific advancements can be co-developed with patients/consumers as one idea becomes transformed into another (the development of PrEP through the misuse of HIV treatments, McDonnell’s application of cultural entropy with regards to HIV prevention messaging).