Doing serodiscordant intimacy in the era of HIV biomedicalisation: A qualitative investigation of the lived experience of gay and bisexual men in serodiscordant relationships in the UK

Witney, Tom (2020). Doing serodiscordant intimacy in the era of HIV biomedicalisation: A qualitative investigation of the lived experience of gay and bisexual men in serodiscordant relationships in the UK. PhD thesis The Open University.

Abstract

HIV ‘treatment as prevention’ (TasP) is a biomedical concept in which antiretroviral drugs are deployed to prevent HIV transmission. TasP originated as an epidemiological concept created in order to tackle the HIV pandemic but is expected to have transformative potential for people in mixed HIV status (serodiscordant) relationships. Hailed in medical circles as a ‘game changer’, TasP has been framed in the ‘U=U’ community discourse as providing certainty about the lack of transmission risk and as an opportunity to tackle stigma. I argue that although TasP was produced through studies of people in serodiscordant relationships, it neglects the intimate contexts in which it operates. Serodiscordant relationships have been constructed as troubled sites of transmission risk. In light of the biomedical transformation of HIV prevention, these risk-centric conceptions have been contested as couples draw on TasP to realise new forms of serodiscordant intimacy. This thesis provides an examination of how gay and bisexual men in serodiscordant relationships practice intimacy and how these practices are structured through biomedical and social influences. It presents the findings of a study of the lived experience of serodiscordant relationships in the UK drawing on a phenomenologically informed thematic analysis of data generated in individual (n=28) and couple interviews (n=6). Participants incorporated biomedical practices, such as taking treatment, into their everyday practices of intimacy and engaged in emotion work to establish a sense of normality. They engaged with biomedically transformed risk and the relationality of serodiscordancy to redefine ‘safer sex’ and ideas of responsibility. Participants managed their serodiscordant identity in order to deal with stigma, selectively engaging with others outside their relationship. In contrast with the certainty that is central to community articulations of the meanings of TasP, uncertainty underpinned participants’ everyday experiences of serodiscordancy. This thesis contributes to sociological literature on intimate relationships to understanding of how biomedical transformations more generally are lived. By combining biomedicalisation and intimacy theories with a focus on the everyday, it provides a novel framework through which to examine serodiscordancy.

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