Navigating HIV citizenship: identities, risks and biological citizenship in the treatment as prevention era

Young, I. , Davis, M., Flowers, P. and McDaid, L. M. (2019) Navigating HIV citizenship: identities, risks and biological citizenship in the treatment as prevention era. Health, Risk and Society, 21(1-2), pp. 1-16. (doi: 10.1080/13698575.2019.1572869) (PMID:31105468) (PMCID:PMC6494283)

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The use of HIV Treatment as Prevention (TasP) has radically changed our understandings of HIV risk and revolutionised global HIV prevention policy to focus on the use of pharmaceuticals. Yet, there has been little engagement with the very people expected to comply with a daily pharmaceutical regime. We employ the concept of HIV citizenship to explore responses by people living with HIV in the UK to TasP. We consider how a treatment-based public health strategy has the potential to reshape identities, self-governance and forms of citizenship, domains which play a critical role not only in compliance with new TasP policies, but in how HIV prevention, sero-discordant relationships and (sexual) health are negotiated and enacted. Our findings disrupt the biomedical narrative which claims an end to HIV through scaling up access to treatment. Responses to TasP were framed through shifting negotiations of identity, linked to biomarkers, cure and managing treatment. Toxicity of drugs – and bodies – were seen as something to manage and linked to the shifting possibilities in sero-discordant environments. Finally, a sense of being healthy and responsible, including appropriate use of resources, meant conflicting relationships with if and when to start treatment. Our research highlights how HIV citizenship in the TasP era is negotiated and influenced by intersectional experiences of community, health systems, illness and treatment. Our findings show that the complexities of HIV citizenship and ongoing inequalities, and their biopolitical implications, will intimately shape the implementation and sustainability of TasP.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Flowers, Professor Paul and Young, Dr Ingrid and McDaid, Professor Lisa
Authors: Young, I., Davis, M., Flowers, P., and McDaid, L. M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:Health, Risk and Society
ISSN (Online):1469-8331
Published Online:31 January 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Health, Risk and Society 21(1-2):1-16
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727631SPHSU Core Renewal: Relationships & Health Improvement Research ProgrammeLisa McDaidMedical Research Council (MRC)MC_UU_12017/11IHW - MRC/CSO SPHU
727641SPHSU Core Renewal: Setting and Health Improvement Research ProgrammeKathryn HuntMedical Research Council (MRC)MC_UU_12017/12IHW - MRC/CSO SPHU
656571Sexual Health and Families ProgrammeLisa McDaidMedical Research Council (MRC)MC_UU_12017/2IHW - MRC/CSO SPHU
Chief Scientist Office (CSO)SPHSU11
Chief Scientist Office (CSO)SPHSU12