Abstract

This book concerns HIV prevention.  In it the authors argue that until the world focuses its attention on the social issues carried and revealed by AIDS, it is unlikely that HIV transmission will be eradicated or even significantly reduced. The book argues that we are currently witnessing the remedicalisation or the continuing biomedicalisation of HIV prevention, which began in earnest after the development of successful HIV treatment, and that this biomedical trajectory continues with the increasing push to use HIV treatments as prevention, undermining what has been in many countries a successful prevention response. This wide-ranging study argues that HIV prevention involves enabling people and communities to discuss sex, sexuality and drug use and, informed by these discussion, devising locally effective strategies for promoting safe sexual and drug injection practices.

“Kippax and Stevenson elegantly argue a difficult but critical message that needs to be heard.” —Alan Whiteside OBE, Balsillie School of International Affairs, Wilfrid Laurier University and University of KwaZulu-Natal

This book concerns HIV prevention.  The authors argue that until the world focuses its attention on the social issues carried and revealed by AIDS, it is unlikely that HIV transmission will be eradicated or even significantly reduced. Currently we are witnessing the remedicalisation or the continuing biomedicalisation of HIV prevention, which began in earnest in 1996/7 after the development of successful HIV treatment. This biomedical trajectory continues with the increasing push to use HIV treatments as prevention, and it appears to have undermined what has been – at least in many countries – a successful prevention response.

This book’s argument is that at least until such time as biomedicine develops an effective prophylactic vaccine and a cure for HIV, the world must rely on the everyday responses of people and communities to combat the virus. Effective HIV prevention hinges on communities and the social practices forged by these communities that reduce the risk of HIV-transmission (primarily safe sexual and safe drug injection practices); people’s willingness to be identified as infected with HIV (HIV testing practices); and, for people living with HIV, people’s commitment to keeping AIDS at bay (HIV treatment practices).

Combating HIV also relies on governments to ensure access to HIV prevention tools, including condoms and sterile needles and syringes, as well as to biomedical prevention technologies including those derived from successful antiretroviral treatment (ART) – pre-exposure prophylaxis (PrEP), microbicides and post exposure prophylaxis (PEP), and male circumcision.  It requires that governments develop robust health infrastructures to support and enable regular HIV testing and provide access to treatments for those living with HIV. Effective HIV prevention needs governments to adopt pragmatic policies that are not deflected by moralistic or conservative ideologies. Effective responses to HIV, on the part of communities, health professionals and governments are all underpinned by public discussion about sex, sexuality and drug use. More broadly, combating HIV depends on civil society resisting HIV stigma and discrimination against those infected and affected by HIV, and enabling people and communities to discuss sex, sexuality and drug use in ways that promote the development and adoption of safe sexual and drug injection practices.

“Combining insightful analysis with trenchant critique, this book offers a readable and refreshing new perspective on what must be done.” —Peter Aggleton, University of New South Wales

“Theoretically sophisticated, empirically grounded, and analytically rigorous – this is the most important work to be published on the HIV epidemic in decades.” —Richard Parker, Columbia University

Susan Kippax is Emeritus Professor at the University of New South Wales, Sydney, and a Fellow of the Academy of the Social Sciences of Australia.

Niamh Stephenson is a Senior Lecturer in Social Science at the University of New South Wales.