HIV Interventions: Biomedicine and the Traffic between Information and Flesh

6. Conclusion

101 6 Conclusion I think maybe I might go and find I don’t have it [HIV] because how come my viral load is undetectable? It used to be medium and now they [doctors] say it is “undetectable.” I often ask myself should I go to another clinic and have another [HIV antibody] test there. Because I feel it might be negative. The viral load test has been an important source of inquiry throughout this book, and recalling the above statement by a woman I interviewed some years ago, here named Leila, seems an especially poignant way to conclude. The statement was made in the context of a discussion about her experience of living with HIV and how—having come to the UK from Zimbabwe and when, on becoming ill, an HIV antibody test confirmed a diagnosis of AIDS—she had been put on ARVs and had “recovered ” her health. That is to say, the statement could be read as indicating some confusion about the meaning of an antibody test result because of its ready linking with her initial visible/experiential HIV infection. But to see her query as such would be to miss the performative function of the information/flesh distinction and its curious contrary fixing of a dynamic according to which interventions are then designed. Although for those in the medical field there will be no doubt about Leila’s HIV antibody positive status and continued infection with HIV, her conjecture is based on empirical grounds that it is the presence of the virus—with its potential or apparent deleterious effects on the body (most notably on immune system cells) and communicable possibility—that is the real concern for those who are found to carry HIV antibodies.1 Her conjecture captures much of what I have sought to convey throughout this book, signaled by the phrase, “a traffic in information as flesh.” I take her statement not simply as about a 102 Conclusion test reading of virus but about the work of a biomedical test. Leila’s query can be readily understood as: What does it mean to be HIV antibody positive if the virus is not apparent? How does it matter that a person may carry antibodies to the virus, if the virus itself—the destructive force—is not only “undetectable” but not developing into AIDS? I draw these questions in particular because they foreground two interlinked themes of this book—information as flesh and the work of intervention—and reiterate the need for concepts akin to the dynamic nature of “nature.” Tests to detect antibodies to HIV or HIV viral particles have featured in almost every chapter and always with some reference to their performative function . Despite their enactment as mere observational or diagnostic devices presumed to provide transparent access to their object, inevitably such tests come to be embedded in the materialization of their object. What allows a test to be viewed as a mere observational device is the presumption that information and flesh are distinct. For the bifurcation of “information and flesh” or “sign and materiality” obscures the performative process. And this, I have argued, hinders the potential for a more reflexive and refined (or redefined) approach to intervention. By holding fast to the bifurcation, it is difficult—perhaps nearly impossible—to perceive the generative force of our interventions and, critically, how this force might be intercepted in novel ways. From Leila’s query and the suggestion that another clinic might retest her antibody status to find she is no longer “HIV-positive,” we might deduce that sign or information alone—in this account, antibody status—has little or at least a different meaning if siphoned off from the real (detectable virus) fleshed entity. Of course, and as I have already indicated, according to current medical understanding, “undetectable” does not mean not present. And while Leila is quite possibly aware of this, she remains, not surprisingly, sceptical of the reading of her result as it does not sufficiently comply or, to be more succinct, appears as information but without flesh. Agency and Ethics The point of orientation for my own queries of HIV has been the decoupling of HIV from AIDS with the introduction of ARVs. More than twelve years since the establishment of ARVs as effective for suppressing viral replication , it is apparent that what once seemed like a pharmacological triumph Conclusion 103 has had profound effects. While most of those...