The undiagnosed and untreated: The ‘unhealthy others’ of the HIV treatment as prevention era?

Stream: Critical Perspectives on Pre-Exposure Prophylaxis (PReP)
Date: Friday, 1 April 2016
Time: 2.00 pm – 3.45 pm


Drawing on Treichler’s concept of the ‘epidemic of signification’ and Crawford’s HIV-positive ‘unhealthy other’, this paper considers how the treatment as prevention era is generating new meanings and ‘others’ against which healthy, responsible selves can be situated.

In the early years of HIV, ‘high risk groups’ became the contaminated others for the general population. During the 1990s, oppositions between HIV-negative and HIV-positive people were observed as well as between HIV-positive people who ‘successfully’ or ‘unsuccessfully’ managed living with HIV. In the combination prevention era, we see new meanings and contrasts: the diagnosed and undiagnosed, the treated and untreated, and those with detectable and undetectable viral loads.

These oppositions are an outcome of treatment as prevention – those who avoid testing, do not access treatment or cannot attain an undetectable viral load become irresponsible, recalcitrant others who can be blamed for the failure to limit the epidemic. While some of these others can recognise, speak for and defend themselves (e.g. the untreated), some cannot so easily (e.g. the undiagnosed).

This analysis shows the ongoing performativity and potential divisiveness of biomedical discourse, and the creation of respectable identities through opposition with unhealthy, irresponsible others.


Martin Holt (Presenter), Centre for Social Research in Health
Associate Professor Martin Holt has worked at the Centre for Social Research in Health since 2003. He leads the Gay Community Periodic Surveys, the COUNT study of undiagnosed HIV and the PrEPARE Project, a study of gay and bisexual men's attitudes to biomedical HIV prevention.