Paul Flowers

Views:
 
Category: Entertainment
     
 

Presentation Description

No description available.

Comments

Presentation Transcript

The impact of HIV health technologies: potential issues for prevention : 

The impact of HIV health technologies: potential issues for prevention Dr Paul Flowers Glasgow Caledonian University

Aims: 

Aims Learn lessons from a historical perspective Encourage critical thinking about prevention Encourage discussion regarding prevention Raise Questions

Structure: 

Structure Uncertainty and shared risks The HIV antibody test and it’s serodivide New tests and what they may mean? Potential issues for prevention?

The beginning: labeling an epidemic and a community: 

The beginning: labeling an epidemic and a community GRID - Altman (1995) Collective gay response (safer sex, buddying, community strengthening) shared risk at high risk group level Assumption of universal positivity

Risk and GRID: 

Risk and GRID Cos at that time nobody really knew what the hell was going on, and, there was no safe sex – well, at that time there wasn’t, there was obviously safe sex was when you sit at opposite ends of the bed saying what you’d like to do to each other if you had the guts. Nobody knew what the hell was, and what the hell wasn’t risky (HIV negative gay man)

Measuring risks and constructing safety: 

Measuring risks and constructing safety Number of times at baths or sex clubs (McKusick et al., 1985) Celibacy, Monogamy, avoidance of anonymous partners HIV risk reduction = Reduction in number of partners

Shifting risk: the identification of the virus: 

Shifting risk: the identification of the virus 1983 virus identified, Mid-1984 antibody test available Correlating blood with reports of sexual behaviour, map out transmission routes From risk group – to individual risk practice: the embodiment of HIV/AIDS Generic bodies and their sexual coupling became a new focus of risk management

Measuring HIV risks and constructing risk takers: 

Measuring HIV risks and constructing risk takers Simple measures of condom use for anal sex as ‘always’. ‘sometimes’, ‘never’ (Ross 1988, Valdiserri et al., 1988, Fitzpatrick, 1989, Catania et al., 1991) Critically those previously categorised as at high risk could now be categorised as at low risk HIV risk reduction = Use a condom every time

Antibody test as preventive health technology: 

Antibody test as preventive health technology HIV testing adopted, assimilated and utilised by people in home grown risk management strategies Recognition of lay expertise in managing risks as home grown risk management becomes legitimated and reformulated within new public health policy - Negotiated safety in Talk Test Test Trust- ACON, (Kippax et al, 1997) Again those at high risk in past now measured and constructed as at low risk These approaches demand that test results are disclosed and negotiated within sexual interactions Internet and casual disclosure of HIV status HIV risk reduction = Use a condom every time (Unless explicit negotiation of sero-concordance)

Antibody testing as health technology: 

Antibody testing as health technology HIV antibody test eroded solidarity of gay men Risks were no longer shared and positive bodies could be ‘othered’ Risks = Positive men infecting negative men Responsibility of HIV management differs according to status Prevention needs of HIV positive people and HIV negative people clearly different

Status related influences upon testing: the scene and gossip: 

Status related influences upon testing: the scene and gossip P: I think that back to that scenario again where you know people find out [that sex with a known positive partner has occurred] then you’d be tarred with the same brush, and oh, they can’t have that, you just can’t have that, otherwise your name will be branded, you know, and you will be segregated from the rest. I: - just for having sex- P: just for having sex with someone who was HIV positive, em, which is a shame really, but you’re not going to change people’s minds that way, no matter what happens, people are individuals, you know that, em, what one guy doesn’t mind doing, or whatever, someone else does, and they just don’t, personally I just don’t think they’d appreciate that sort of thing, because you’d need to talk about it [status], and they don’t like to talk about it, so, so they won’t do it. (HIV untested man)

New treatments and new tests as health technologies: 

New treatments and new tests as health technologies Medical technologies transformed HIV diagnosis from ‘death sentence to life sentence’ Reduced death rates, reduced opportunistic infections Effectiveness of treatments demands their assimilation into people’s everyday lives Impact upon prevention (e.g. treatment optimism) and testing (UK sexual health strategies)

Treatments and tests and prevention: 

Treatments and tests and prevention The virus itself is changing, the meaning of being positive is changing Norms around unprotected sex and HIV antibody testing are changing The epidemic is changing What use are ‘old’ studies and ‘old’ evidence for our contemporary epidemic?

Treatments and tests and prevention: 

Treatments and tests and prevention Tests of viral load and resistance erode solidarity of positive gay men New risks created between positive men Risks = Positive men infecting positive men with resistant virus? Prevention needs of HIV positive people differ according to viral load, viral type, time on treatment, treatment regime, time known positive? Does responsibility for HIV management differ between people (e.g. those with supervirus)?

Treatments and tests and prevention: 

Treatments and tests and prevention Measures of viral load Disclosure issues? Negotiation issues? How reliable? Differences in VL between day of testing and time of disclosure? Measures of viral resistance- Disclosure issues? Negotiation issues? Compartmentalisation of virus (Difference in virus between pre-cum/blood/semen/vaginal fluids?)

New uncertainties concerning prevention?: 

New uncertainties concerning prevention?   Yeah, it makes you less infectious, but it doesn’t get rid of it, and it’s always gonna be there. But hospitals don’t test semen to see how much virus is in the semen, or, so they don’t know permanently how infectious semen is, whether your viral load’s undetectable below fifty or a hundred thousand. So…(HIV positive gay man)

Contemporary measures of risk: 

Contemporary measures of risk UAI? Dipping? Strategic positioning? HIV status Resistance testing in blood, semen, pre-cum? Presence of STI’s Relationship status and of disclosure of test results

Dilemmas for prevention?: 

Dilemmas for prevention? Since the epidemic has changed, are our old prevention strategies redundant? What should we make of an evidence base produced within a different epidemic? What should be done regarding the issue of disclosure of HIV status, viral load, resistance? As prevention gets more complex how do new generations of gay men manage increasing complexity?

authorStream Live Help