Expanding the Gaze: Gender and the Politics of Surveillance by Emily van der Meulen & Robert Heynen

Author:Emily van der Meulen & Robert Heynen
Language: eng
Format: epub
Publisher: University of Toronto Press
Published: 2016-04-17T16:00:00+00:00

Chapter 7

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Gendering the HIV “Treatment as Prevention” Paradigm: Surveillance, Viral Loads, and Risky Bodies

ADRIAN GUTA, MARILOU GAGNON, JENEVIEVE MANNELL, AND MARTIN FRENCH

The medical and public health response to HIV has long provided an important site for empirical and theoretical inquiry. Of particular interest to social science scholars has been the ways actors in the HIV movement have continued to mobilize to improve access to prevention information and lifesaving treatments. An activist slogan from the late 1980s declared the need to get “drugs into bodies.” Since then much progress has been made in terms of prevention messaging and the development of more effective drug treatments. Most recently the HIV sector has undergone a paradigm shift to “treatment as prevention” (TasP), which promotes scaling up testing and treatment for people living with HIV with the goal of preventing new infections. Here, individual medical outcomes have become linked to public health outcomes. In this chapter we revisit the AIDS activist slogan “drugs into bodies” within the TasP paradigm and consider the implications for those most affected. While recognizing the importance of testing and the benefits of HIV pharmacological treatment, we consider the potential for TasP to lead to a convergence of medical and juridical power targeted at individuals and communities already subject to myriad forms of control. Specifically, we seek to identify the ways in which TasP is leading to new ways of seeing the body as virally suppressed/unsuppressed, and the implications of this categorization for the securitization of HIV and other infectious diseases globally.

Drawing on Michel Foucault’s (2007) conception of governmentality and “arts of government,” we identify and problematize the ways that TasP (along with related programs and technologies) is producing new relationships between individuals, communities, and the state through seemingly neutral surveillance strategies. We complement Foucault’s broad interest in systems of governance with Armstrong’s (1995) writing on “surveillance medicine” (p. 395) and more recent contributions to surveillance studies. Our analysis contributes to the literature by highlighting the role of gender in this project, drawing on a gendered analysis to connect seemingly disparate domains of knowledge and expertise with TasP. We are especially interested in gendered subject positions and how their categorization has become a target of medical and public health surveillance focused on medication adherence, sexual “risk taking,” and viral load monitoring and suppression. Here we examine surveillant efforts to track and regulate HIV in bodies as a way of understanding, more generally, the gendered dynamics of the gaze as they take shape in, and in relation to, bodies and embodiment. We ask: Who is being targeted, and to what end?

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