a School of Nursing and Health Studies , University of Washington Bothell , Bothell , WA , USA.
b Anthropology and Sociology , Kalamazoo College , Kalamazoo , MI , USA.
Glob Public Health. 2018 Aug;13(8):960-971. doi: 10.1080/17441692.2017.1365373. Epub 2017 Aug 22.
In the past decade, discourses about AIDS have taken a remarkable, and largely unquestioned, turn. Whereas mobilisations for treatment scale-up during the 2000s were premised on perceptions of an 'epidemic out of control', we have repeatedly been informed in more recent years that an end to AIDS is immanent. This new discourse and its resulting policies are motivated by post-recession financial pressures, a changing field of global institutions, and shifting health and development priorities. These shifts also reflect a biomedical triumphalism in HIV prevention and treatment, whereby shorter term, privatised, technological, and 'cost-effective' interventions are promoted over long-term support for antiretroviral treatment. To explore these changes, we utilise Treichler's [(1987). How to have theory in an epidemic: Cultural chronicles of AIDS. Durham, NC: Duke University Press] view of AIDS as an 'epidemic of signification' to develop a review of 'End of AIDS' discourses in recent years. We use this review to investigate the political and philanthropic interests served by efforts to rebrand and re-signify the epidemic. We also hold up these discourses against the realities of treatment access in resource-poor countries, where 'Ending AIDS' has not heralded the end of an epidemic per se, but rather the end of external support for treatment programmes, highlighting new difficulties for sustaining treatment in this new era of the epidemic.
在过去的十年中，关于艾滋病的讨论发生了显著的变化，而且在很大程度上没有受到质疑。在 21 世纪 00 年代，为了扩大治疗规模而进行的动员是以对“失控的疫情”的认识为前提的，但近年来我们反复被告知，艾滋病即将终结。这种新的论述及其导致的政策是由后经济衰退的财政压力、全球机构领域的变化以及不断变化的卫生和发展重点驱动的。这些转变也反映了在艾滋病毒预防和治疗方面的生物医学胜利主义，即短期、私有化、技术化和“具有成本效益”的干预措施被推广，而长期支持抗逆转录病毒治疗的措施则被忽视。为了探讨这些变化，我们利用特雷彻（Treichler）[(1987)。如何在疫情中拥有理论：艾滋病的文化纪事。达勒姆，北卡罗来纳州：杜克大学出版社]将艾滋病视为一种“意义的疫情”，对近年来“艾滋病终结”的论述进行了回顾。我们利用这一回顾来研究重新塑造和重新定义疫情的努力所服务的政治和慈善利益。我们还将这些论述与资源匮乏国家治疗机会的现实相对照，在这些国家，“艾滋病终结”本身并没有预示着疫情的终结，而是外部支持治疗方案的终结，在这一新的疫情时代，维持治疗面临着新的困难。
