Dalla Lana School of Public Health, University of Toronto, Canada.
College of Health Professions, Pace University, USA.
Soc Sci Med. 2022 Apr;298:114863. doi: 10.1016/j.socscimed.2022.114863. Epub 2022 Feb 24.
Positive Plus One is the first large-scale mixed methods study of mixed HIV serostatus couples in Canada. We aimed to understand how biomedicalization i.e., a social process of commodification and expansion of the jurisdiction of medicine over health, influenced the everyday relationships of these couples. We completed 51 semi-structured interviews among a purposive sample of HIV-positive (n = 27) and HIV-negative (n = 24) partners in current or past mixed-serostatus relationships. Participants were recruited after completing an online survey where they consented to be re-contacted for qualitative interviews. Participants represented a diversity of sexual orientations, gender identities, and other sociodemographic characteristics. Drawing on inductive thematic analysis to identify patterns within couples, across serostatus and sexual orientations, we argue that everyday lives of mixed-serostatus couples were shaped by biomedical knowledge and enacted through routine adherence to obtain and maintain viral load undetectability. Our findings illustrated the importance of learning biomedical knowledge for mixed-serostatus couples in this study, the empowering influence of undetectable = untransmittable (UU) discourse, and its role in rendering HIV mundane through routine ART adherence. We introduce the concept of 'dual pharmaceutical citizenship' to underscore a process by which particular biopolitical and biomedical expectations are fulfilled in mixed-serostatus relationships. These findings have implications for people who do not readily accept or have access to biomedical knowledge, particularly when treatment-as-prevention frames a "right" and "wrong" approach to HIV management. Future studies should focus on couples where at least one partner does not readily accept or have access to biomedical knowledge.
“阳性加一”是加拿大首例关于混合 HIV 血清学状况夫妇的大规模混合方法研究。我们旨在了解生物医学化（即医学对健康的管辖范围扩大和商品化的社会过程）如何影响这些夫妇的日常关系。我们对当前或过去处于混合血清学关系中的 HIV 阳性（n=27）和 HIV 阴性（n=24）伴侣进行了 51 次半结构化访谈。这些参与者是在完成在线调查后被招募的，他们同意在被重新联系进行定性访谈时同意。参与者代表了不同的性取向、性别认同和其他社会人口特征。通过对夫妇之间、血清学状况和性取向之间的模式进行归纳主题分析，我们认为混合血清学夫妇的日常生活受到生物医学知识的塑造，并通过常规坚持获得和维持病毒载量不可检测来实现。我们的研究结果说明了在这项研究中，混合血清学夫妇学习生物医学知识的重要性，不可检测即无传染性（UU）论述的赋权影响，以及其通过常规抗逆转录病毒治疗（ART）依从性使 HIV 变得平凡的作用。我们引入了“双重药物公民身份”的概念，以强调在混合血清学关系中满足特定的生物政治和生物医学期望的过程。这些研究结果对那些不易接受或无法获得生物医学知识的人，特别是当治疗即预防框架将 HIV 管理视为“正确”和“错误”的方法时，具有重要意义。未来的研究应集中在至少有一方不易接受或无法获得生物医学知识的夫妇上。
