HIV/AIDS

Contemporary debates about sexual ethics are dominated by a consent-oriented approach—consensualism. This position well explains the immorality of such acts as rape, pedophilia, bestiality and necrophilia. However, consensualism faces difficulties when it comes to adultery or HIV transmission. This article analyzes such unacquired moral obligations not to engage in consensual sex. A new natural law approach is proposed to explain and justify these obligations. This position places central importance in the evaluation of sexual acts on whether they are aimed at (...) achieving some common good and whether they harm some other good. As will be shown, the new natural law overcomes the difficulties of consensualism and grounds unacquired obligations in sexual ethics. And if this approach is combined with a pluralistic view of the goods that are realized in sex, then the new natural law does not allow the conservative conclusions about sexual morality inherent in the old natural law theory. (shrink)

Public funders of health research have been widely criticized on the grounds that their allocations of funding for disease-specific research do not reflect the relative burdens imposed by different diseases. For example, the US National Institutes of Health spends a much greater fraction of its budget on HIV/AIDS research and a much smaller fraction on migraine research than their relative contribution to the US burden of disease would suggest. Implicit in this criticism is a normative claim: Insofar as the scientific (...) opportunities are equal, each patient merits research into their condition proportional to the burden of disease for which that condition is responsible. This claim—the proportional view—is widely accepted but has never been fully specified or defended. In this paper, I explain what is required to specify the view, attempt to do so in the most charitable way, and then critically evaluate its normative underpinnings. I conclude that a severity-weighted proportional view is defensible. I close by drawing out five key lessons of my analysis for health research priority-setting. (shrink)

Gay men have been severely affected by the AIDS crisis, and gay subjectivity, sexual ethics, and politics continue to be deeply influenced by HIV to this day. PrEP (Pre-Exposure Prophylaxis) is a new, drug-based HIV prevention technique, that allows disentangling gay sex from its widespread, 40 yearlong association with illness and death. This article explores PrEP's fundamental impact on gay subjectivity, sexual ethics, and politics. It traces the genealogy of gay politics regarding homophobia and HIV stigma, suggesting a new biopolitical (...) and body political framework that accounts for the agency of activists as well as pharmapower, and proposing that PrEP is an example of democratic biopolitics. Highlighting the entanglement of medical technology, sexual ethics, and politics, the article shows how conservative and homonormative gay politics developed as a reaction to HIV stigma and how, by overcoming this stigma, PrEP enables a new era of intersectional queer politics and solidarities. It thereby develops a Foucauldian account of sexual liberation beyond the repression hypothesis that accounts for the ambivalence of sexual subjectification and the political potential of sexuality. (shrink)

Le politologue, philosophe et sociologue Karsten Schubert examine le lien entre sexualité et politique gay et se demande quel type de politique a été favorisé ou au contraire entravé suivant la situation liée à la pandémie de VIH. Il présente deux thèses à cet égard.

Introduction: Universal health coverage (UHC) was introduced in Iran in 2014. The aim of this study was to evaluate the usage rate of health services by human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients after UHC implementation. Material and methods: In 2018, in a cross-sectional study, we evaluated the outpatients’ needs (within its previous month) and inpatients’ needs (within its previous 6 months) of HIV/AIDS patients in Isfahan province (the center of Iran). Concurrently, we estimated the essential health care services (...) that HIV/AIDS patients have to receive regularly, including vaccination for hepatitis B, measurement of CD4, tuberculosis (TB) assessments and TB treatment, anti-retroviral therapy, examination of viral load, treatment approach, and drug side effects counseling. Two checklists were used for assessing the utilization of health services and essential health cares for HIV/AIDS patients, validated by the Ministry of Health and Medical Education of Iran. Data were analyzed by χ2 test, Pearson’s correlation coefficient, and Spearman’s correlation test. Results: Two hundred and thirteen HIV/AIDS patients completed the questionnaires. The mean age of participants was 41.14 ± 9.23. The outpatient service utilization rate was 31.94% in the previous month and the rate of hospitalization was 126 per 1,000 HIV/AIDS patients in the previous 6 months. The majority of HIV/AIDS patients received essential health services more often than the national standard goals estimation. Conclusions: After UHC implementation, the utilization rate of outpatients and inpatients services in HIV/AIDS patients was more than similar indices in the general population. In addition, HIV/AIDS patients received essential health services adequately. (shrink)

PrEP (Präexpositionsprophylaxe) ist ein relativ neues Mittel zur Prävention von HIV-Infektionen. HIV-negative Menschen nehmen antivirale Medikamente ein, die verhindern, dass der Kontakt mit dem Virus zu einer Infektion führt. Im Gegensatz zum Kondomgebrauch basiert dieses Präventionsverfahren auf Medikamenten und nicht auf einer Verhaltensänderung. Aus der Perspektive der Biopolitik fügt sie sich in einen größeren Trend in Richtung Medikalisierung, des Anstiegs der Macht der Pharmaindustrie und der Reglementierung des Risikos ein. Sexuelles Verhalten ist das Ergebnis der Subjektivierung, des Prozesses, durch den (...) soziale Normen Subjekte und ihre Wünsche bilden. Die Medikalisierung von schwulem Sex durch PrEP verändert die sexuelle Subjektivierung und geht daher mit einer Veränderung der Praktiken von schwulem Sex einher. Nach einer kurzen Erläuterung der medizinischen Besonderheiten und der Geschichte von PrEP (1) vereint dieser Artikel eine Rekonstruktion zeitgenössischer theoretischer Ansätze zur Biopolitik im Zusammenhang mit PrEP (2) mit einer Darstellung aktueller politischer Debatten um PrEP (3). Die Untersuchung zeigt, dass sich Gouvernementalitätsstudien und die Italienische Theorie auf repressive Machtverhältnisse konzentrieren und daher die Komplexität der Debatte nicht berücksichtigen können, die sich aus der Subjektivität und Handlungsfähigkeit verschiedener beteiligter Akteure, insbesondere schwuler PrEP-Aktivisten, ergibt. Dennoch werden Interpretationen von PrEP als repressiver Macht auch von einigen Akteuren in der politischen Debatte um PrEP genutzt, meist ohne ausdrücklichen Bezug zur biopolitischen Theorie. Nikolas Roses und Paul Rabinows differenziertes Konzept der Biopolitik bietet einige Ansätze wie diejenigen der biopolitischen Bürgerschaft und der somatischen Ethik, um die Debatte um PrEP und die damit verbundenen komplexen Verhandlungen über Sexualität zu beschreiben. Ausgehend von diesen Ideen entwickle ich ein neues Konzept der ‚demokratischen Biopolitik‘ von PrEP, die eine weitere Demokratisierung der Sexualität im biopolitischen Zeitalter ermöglicht. (shrink)

Die Einführung der HIV-Prophylaxe PrEP ist ein Beispiel für demokratische Biopolitik und macht Hoffnung auf eine Beendigung von Sexnegativität und Stigmatisierung, findet Dr. Karsten Schubert.

PrEP (Pre-Exposure Prophylaxis) is a relatively new drug-based HIV prevention technique and an important means to lower the HIV risk of gay men who are especially vulnerable to HIV. From the perspective of biopolitics, PrEP inscribes itself in a larger trend of medicalization and the rise of pharmapower. This article reconstructs and evaluates contemporary literature on biopolitical theory as it applies to PrEP, by bringing it in a dialogue with a mapping of the political debate on PrEP. As PrEP changes (...) sexual norms and subjectification, for example condom use and its meaning for gay subjectivity, it is highly contested. The article shows that the debate on PrEP can be best described with the concepts ‘sexual-somatic ethics’ and ‘democratic biopolitics’, which I develop based on the biopolitical approach of Nikolas Rose and Paul Rabinow. In contrast, interpretations of PrEP which are following governmentality studies or Italian Theory amount to either farfetched or trivial positions on PrEP, when seen in light of the political debate. Furthermore, the article is a contribution to the scholarship on gay subjectivity, highlighting how homophobia and homonormativity haunts gay sex even in liberal environments, and how PrEP can serve as an entry point for the destigmatization of gay sexuality and transformation of gay subjectivity. ‘Biopolitical democratization’ entails making explicit how medical technology and health care relates to sexual subjectification and ethics, to strengthen the voice of (potential) PrEP users in health politics, and to renegotiate the profit and power of Big Pharma. (shrink)

Abstract -/- “The Obvious Invisibility of the Relationship Between Technology and Social Values” -/- We all too often assume that technology is the product of objective scientific research. And, we assume that technology’s moral value lies in only the moral character of its user. Yet, in order to objectify technology in a manner that removes it from a moral realm, we rely on the assumption that technology is value neutral, i.e., it is independent of all contexts other than the context (...) in which it is used morally or immorally by someone. However, there is a power to technology. At the very least, technology should be seen as reflecting the values that it rises from: a developmental context. Consequently, we can make the invisible moral realm visible as we investigate the relationship between culture and technology. Pragmatically, we can trace how cultural values inform what counts as a scientific question. When we look at the 1980s epidemiological model for AIDS we see how the presuppositions within a culture frame the type of question asked, i.e. What population do we see AIDS occurring in? This question initially leads scientific research away from actual individual behaviors until a different question is asked that leads the question towards behavioral epidemiological models rather than population models. Secondly, we can make visible the circumstance that depicts that what constitutes a scientific problem has a direct relationship to the types of technologies that are developed. We can more clearly see this circular relationship between culture and technology by looking at clinical research and practice regarding heart disease. Men who were dying of diagnosed heart disease were showing symptoms of problems in large arteries of the heart. Women were also dying of heart disease, but since their large arteries were not overwhelmingly compromised they were not being properly diagnosed until recently. Different technologies and protocol were needed to “see” different symptoms in the smaller vessels of women. Thirdly, I show how the types of technology developed, in turn, can create new values or enhance preexisting values within a culture. DNA research can be used to investigate long, unanswered questions about qualitative dimensions of life in quantitative manners. Yet, long held unanswered questions about a biological basis of race or intelligence are themselves rarely challenged as uninteresting or misguided even when they are tied to prejudicial qualitative assumptions if the chance of a “scientific” answer is possible. When existing technologies or modifications of existing technologies can be used they seem to direct human reactions and behaviors in predictable ways. The technologies themselves may be said to direct culture in ethically valenced manners. (shrink)

Multiple drug resistant strains of HIV and continuing difficulties with vaccine development highlight the importance of psychologi- cal interventions which aim to in uence the psychosocial and emo- tional factors empirically demonstrated to be significant predictors of immunity, illness progression and AIDS mortality in seropositive persons. Such data have profound implications for psychological interventions designed to modify psychosocial factors predictive of enhanced risk of exposure to HIV as well as the neuroendocrine and immune mechanisms mediating the impact of such factors (...) on disease progression. Many of these factors can be construed as unconscious mental ones, and psychoanalytic self-psychology may be a useful framework for conceptualizing psychic and immune de- fence as well as bodily and self-integration in HIV infection. Al- though further prospective studies and cross-cultural validation of research are necessary, existing data suggest that psychoanalytic insights may be useful both in therapeutic interventions and evaluative research which would require an underlying epistemology of the complementarity of mind and matter. (shrink)

I defend a certain claim about rationing in the context of HIV/AIDS, namely, the 'priority thesis' that the state of a developing country with a high rate of HIV should provide highly active anti-retroviral treatment (HAART) to those who would die without it, even if doing so would require not treating most other life-threatening diseases. More specifically, I defend the priority thesis in a negative way, by refuting two influential and important arguments against it inspired by the Kantian principle of (...) respect for persons. The 'equality argument' more or less maintains that prioritizing treatment for HIV/AIDS would objectionably treat those who suffer from it as more important than those who do not. The 'responsibility argument' says, roughly, that to ration life-saving treatment by prioritizing those with HIV would wrongly fail to hold people responsible for their actions, since most people infected with HIV could have avoided the foreseeable harm of infection. While it appears that a Kantian must think that one of these two arguments is sound, I maintain that, in fact, respect for persons grounds neither the equality nor responsibility argument against prioritizing HAART and hence at least permits doing so. If this negative defence of the priority thesis succeeds, then conceptual space is opened up for the possibility that respect for persons requires prioritizing HAART, which argument I sketch in the conclusion as something to articulate and defend in future work. (shrink)