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This article revisits long-standing critiques of the role of metaphor in immunological discourse. Drawing on Alfred North Whitehead’s speculative philosophy of organism, I focus on the use of metaphor to explain the process by which COVID-19 vaccine research is able to generate protective antibodies, the challenge of autoimmune disease and dengue fever antibodies. I suggest that metaphors are provoked by the perplexity that arises from presupposing that distinct morphological substances are the first order of reality. I conclude that rather than seeing metaphors as typically skewing conceptions of the body, as has been previously argued, those of memory, recognition and misrecognition may be instructive of a body in transition. Indeed, a process of transition that shows degrees of creativity. When gesturing towards the processual nature of infection and immunity, metaphors invite new modes of shared thinking across the disciplinary divide.

In this article, we reflect on the possibilities that PrEP (HIV pre-exposure prophylaxis) raises for HIV specialist clinicians. Often neglected, yet a direct participant at the intersection of a complex tension within public health debates on how to reduce HIV transmission and the sexual sociability of individuals, we reflect on current thinking of health practitioners involved in the day-to-day practice of prescribing PrEP. Drawing on interviews with practitioners in the context of UK sexual health and HIV specialist medicine, while bearing in mind neoliberal critiques and process studies of medical science, we propose that PrEP invites the possibility for reconstituting approaches to sex and risk.

In this article we focus on public health’s wager on the social implications of a daily antiretroviral pill to prevent HIV, referred to as PrEP (pre-exposure prophylaxis). The wager is shown to rely on modes of inquiry overly tied to what is known of the present in order to predict the future. Although such inquiry is not unusual when social research is called upon to assist health policy, predictive methodologies are unable to appreciate the dynamic and thus indeterminate nature of process. We ask: what mode of inquiry might practicably appreciate that what happens in the present will have a bearing on the future, without foreclosing on unknown possibles? Drawing on speculative and pragmatic philosophy, we reflect on our own qualitative research on PrEP to suggest that conventional methodological approaches can contribute to the future without seeking to determine what it will become.

This special section reflects on the challenges and achievements of HIV/AIDS activism in the historico-political context of the European region. While there is substantial literature on activist-driven policy shifts in the different and, particularly, the early stages of the epidemic, much of this has studied Western Europe. Considerably less attention has been given to the broader European region and its constituent countries, especially those along its economic, social and political peripheries. Against this background, through a series of case-studies from differing disciplinary perspectives, this collection offers insights into the evolving conceptions of state state-citizenship relations in the complex and entangled histories of HIV/AIDS in Europe.

By reflecting on the thinking that has come to prevail with regard to women and HIV and, doing so, by working back through an albeit brief outline genealogy of the development of PrEP, I examine how the relevancies of HIV prevention regimes have become folded into a particular scientific logic and why this should concern us. Without disputing the affordances of PrEP, in either pill or long-term acting form, I suggest that the WHO/UNAIDS 90-90-90 goals and, no less, an optimism for a future end to the dynamics of the epidemic is founded on a misplaced conception of what is at stake. Drawing on a branch of process philosophy that has earned the term ‘event-thinking’, I propose that if biomedicine is to be responsive to the relevancies of those affected by HIV, a more open conception of what is assumed by international health authorities as the ‘dynamics of the epidemic’ may be warranted. With reference to the RCTS discussed in this chapter, namely SMART, FEM-PrEP and VOICE and their carefully constructed bioethical undertaking yet deemed failure, I suggest that efforts to achieve an ethico-biomedical ‘solution’ may be out-of-kilter with the realities of those for whom it is proposed. Reluctance or outright recalcitrance of trial participants provides an opportunity for reformulating the problem of HIV and for what has become a normative conception of ethics. Insofar as bioethical rules and norms are presupposed to protect research participants, bioethics shares the same world view as science on what matters.

Background:In public health emergencies, evidence, intervention, decisions and translation proceed simultaneously, in greatly compressed timeframes, with knowledge and advice constantly in flux. Idealised approaches to evidence-based policy and practice are ill equipped to deal with the uncertainties arising in evolving situations of need. Key points for discussion:There is much to learn from rapid assessment and outbreak science approaches. These emphasise methodological pluralism, adaptive knowledge generation, intervention pragmatism, and an understanding of health and intervention as situated in their practices of implementation. The unprecedented challenges of novel viral outbreaks like COVID-19 do not simply require us to speed up existing evidence-based approaches, but necessitate new ways of thinking about how a more emergent and adaptive evidence-making might be done. The COVID-19 pandemic requires us to appraise critically what constitutes ‘evidence-enough’ for iterative rapid decisions in-the-now. There are important lessons for how evidence and intervention co-emerge in social practices, and for how evidence-making and intervening proceeds through dialogue incorporating multiple forms of evidence and expertise. Conclusions and implications:Rather than treating adaptive evidence-making and decision making as a break from the routine, we argue that this should be a defining feature of an ‘evidence-making intervention’ approach to health.

Viral outbreaks and public health emergencies obligate an urgent need for evidence to inform rapid responses. In the case of SARS-Cov-2, a novel virus linked to the fast-moving COVID-19 pandemic, mathematical models projecting disease outbreaks and the potential effects of interventions are playing a critical role. Modelled projections are not only evidence-making policy decisions, but are afforded power-of-acting in public understandings and in social life. We propose here that COVID-19 is coming to be known in maths and models. We trace this process not only in policy but in media stories of maths, mathematicians and models. We accentuate the social life of maths and models, which feed citizen science and social actions in relation to COVID-19. There are general lessons from the emergent evidence-making of COVID-19 for how we do science for public health.

What counts as knowledge and expertise and how these are produced, afforded authority to underpin practice—in diverse health-related settings—is a theme explored in many of the books published in the HTS Series. Extracts from four books help us to understand how knowledge and associated evidence claims are produced, how they gain value yet are often contested, and how they shape the framing of the meaning of (ill) health by diverse actors, and what is to count as its management and treatment. The four books are: Brosnan et al. (Eds.) (Complementary and alternative medicine. Exploring health and technology through personal medical devices. Basingstoke: Palgrave Macmillan, 2018) challenge the assumption that complementary and alternative medicine is outside of conventional biomedical orthodoxy to show how it has been incorporated into biomedical and its knowledge production. Michael and Rosengarten (Innovation and biomedicine. Ethics, evidence and expectation in HIV. Basingstoke: Palgrave Macmillan, 2013) focus on the development and testing through a randomised control trial (RCT) of a drug to treat HIV. Sleeboom-Faulkner (Global morality and life science practices in Asia. Assemblages of life. Basingstoke: Palgrave Macmillan, 2014) takes us into the related but much broader area of biotechnology, especially in regard to genetic testing and biobanks, in China, India, and Japan. Mesman (Uncertainty and medical innovation: Experienced pioneers in neonatal care. Basingstoke: Palgrave Macmillan, 2008) examines how staff on a neonatal intensive care intervene differently in the constitution of knowledge and how this may lead to frictions in the decisions about responsibility, timing, and end of life.

Expanding on Savransky's pragmatic defence of speculative thought, Rosalyn Diprose explores the politics of speculation in the field of impact-driven agendas in higher education and in the governance of research, particularly as it concerns research in the humanities. She argues that speculation operates by virtue of 'inspiration', that is, 'the pulse within the corporeal, affective, and embedded fabric of experience', a pulse that, when cultivated, leads to innovation. Reclaiming speculation demands care, and it requires that one devices propositions to relay the potential of the concept in practice, but also that one attends to the constraints with which such propositions may avoid falling prey to the conditions they seek to alter. Against the connotations that associate speculation with human excesses and hubris, Michael Halewood proposes a situated mode of speculation whose constraint is that of 'realizing that the world has its own concerns, some of which involve us and some of which do not'.

Is another future possible? So called ‘late modernity’ is marked by the escalating rise in and proliferation of uncertainties and unforeseen events brought about by the interplay between and patterning of social–natural, techno–scientific and political-economic developments. The future has indeed become problematic. The question of how heterogeneous actors engage futures, what intellectual and practical strategies they put into play and what the implications of such strategies are, have become key concerns of recent social and cultural research addressing a diverse range of fields of practice and experience. Exploring questions of speculation, possibilities and futures in contemporary societies, Speculative Research responds to the pressing need to not only critically account for the role of calculative logics and rationalities in managing societal futures, but to develop alternative approaches and sensibilities that take futures seriously as possibilities and that demand new habits and practices of attention, invention, and experimentation.

We surveyed Australian gay and bisexual men, assessing belief in HIV treatment as prevention (TasP) and support for early treatment. We identified the characteristics of participants who believed in TasP and supported early treatment using multivariate logistic regression. In 2013, 1316 men participated; 1251 participated in 2015. Belief in TasP increased from 2.6 % in 2013 to 13.1 % in 2015 (p

Expanding on the recent call for a ‘critical medical humanities’ to intervene in questions of the ontology of health, this article develops a what we call a ‘speculative’ orientation to such interventions in relation to some of the ontological commitments on which contemporary biomedical cultures rest. We argue that crucial to this task is an approach to ontology that treats it not a as a question of first principles, but as matter of the consequences of the images of nature that contemporary biomedical research practices take for granted when they make claims to evidence, as well as the possible consequences of imagining different worlds in which health and disease processes partake. By attending to the implicit ontological assumptions involved in the method par excellence of biomedical research, namely, the randomised controlled trial (RCT), we argue that the mechanistic ontology that tacitly informs evidence-based biomedical research simultaneously authorises a series of problematic consequences for understanding and intervening practically in the concrete realities of health. As a response, we develop an alternative ontological proposition that regards processes of health and disease as always situated achievements. We show that, without disqualifying RCT-based evidence, such a situated ontology enables one to resist the reduction of the realities of health and disease to biomedicine’s current forms of explanation. In so doing, we call for medical humanities scholars to actively engage in the speculative question of what nature may be capable of.

We assessed attitudes to medicines, HIV treatments and antiretroviral-based prevention in a national, online survey of 1,041 Australian gay men (88.3% HIV-negative and 11.7% HIV-positive). Multivariate analysis of variance was used to identify the effect of HIV status on attitudes. HIV-negative men disagreed with the idea that HIV drugs should be restricted to HIV-positive people. HIV-positive men agreed and HIV-negative men disagreed that taking HIV treatments was straightforward and HIV-negative men were more sceptical about whether HIV treatment or an undetectable viral load prevented HIV transmission. HIV-negative and HIV-positive men had similar attitudes to pre-exposure prophylaxis but divergent views about 'treatment as prevention'.

In this introduction, we address some of the complexities associated with the emergence of medicine’s bodies, not least as a means to ‘working with the body’ rather than simply producing a critique of medicine. We provide a brief review of some of the recent discussions on how to conceive of medicine and its bodies, noting the increasing attention now given to medicine as a technology or series of technologies active in constituting a multiplicity of entities – bodies, diseases, experimental objects, the individualization of responsibility for health and even the precarity of life. We contrast what feminist theorists in the tradition of Judith Butler have referred to as the question of matter, and Science and Technology Studies with its focus on practice and the nature of emergence. As such we address tensions that exist in analyses of the ontological status of ‘the body’ – human and non-human – as it is enacted in the work of the laboratory, the randomized controlled trial, public health policy and, indeed, the market that is so frequently entangled with these spaces. In keeping with the recent turns toward ontology and affect, we suggest that we can regard medicine as concerned with the contraction and reconfiguration of the body’s capacities to affect and be affected, in order to allow for the subsequent proliferation of affects that, according to Bruno Latour, marks corporeal life. Treating both contraction and proliferation circumspectly, we focus on the patterns of affects wrought in particular by the abstractions of medicine that are described in the contributions to this special issue. Drawing on the work of A.N. Whitehead, we note how abstractions such as ‘medical evidence’, the ‘healthy human body’ or the ‘animal model’ are at once realized and undercut, mediated and resisted through the situated practices that eventuate medicine’s bodies. Along the way, we touch on the implications of this sort of perspective for addressing the distribution of agency and formulations of the ethical and the political in the medical eventuations of bodies.

This photo-essay highlights the ways in which medicine features in the Occupied Palestinian Territories (OPT) and uses it to reflect on the nature of ethical obligation set out by Judith Butler in her work on state-achieved precarity. Although medical infrastructure of even the most basic type is tragically lacking and in some areas shockingly absent in the OPT, it is the particular way in which medicine comes to be needed that we focus on. Leaving aside the rhetoric that has claimed authority over what can or cannot be said of the Occupation, we focus on its geo-technological arrangements. By placing photos and case studies of medical obstruction within an analysis of the Occupation, we forge an encounter between reader and the Occupation to raise questions about the use of medicine in this context and the manner in which conventional ethics can give legitimacy to this use. On the basis of what we show through visual and textual documentary material, we propose ethics be understood as inherent to the geo-technological arrangements that make life possible or, as in this case, undermine, obstruct or deliberately take life. Hence the ethical obligation that Butler calls upon is reiterated in ways that encompass the everyday features of occupation including those active in the emergence of medicine as a tactic of war.

In this article we explore how two enactments of HIV – the UN’s AIDS Clock and clinical trials for an HIV biomedical prevention technology or pre-exposure prophylaxis (PrEP) – entail particular globalizing and localizing dynamics. Drawing on Latour’s and Whitehead’s concept of proposition, and Serres’ call for a philosophy of prepositions, we use the composite notion of pre/pro-positions to trace the shifting topological status of HIV. For example, we show how PrEP emerges through topological entwinements of globalizing biomedical standardization, localizing protests against PrEP trials and globalizing ethical principles. We go on to examine how our own analysis manifests a parallel topological pattern in which we deploy a globalizing argument about the localizing of the globalizing found in the AIDS Clock and the PrEP trails. Finally, we consider how the movement of ‘topology’ into the social sciences might itself benefit from a topological treatment.

Objective We assessed interest in using rectal microbicides to prevent HIV transmission among gay men in Australia. Methods A national online survey was conducted in 2013. Interest in using rectal microbicides was measured on a seven-item scale (α=0.81). Factors independently associated with greater interest in using a microbicide were identified using multivariate logistic regression. Results Data were collected from 1223 HIV-negative and untested men. Mean age was 31.3 years (SD=10.8, range 18–65); 77% were born in Australia and 25% reported any condomless anal sex with a casual partner in the previous 6 months. Overall, there was moderate interest in using rectal microbicides (M=3.33, range 1–5). In multivariate analysis, greater interest in using microbicides was independently associated with being born outside Australia (adjusted OR (AOR)=1.59; p=0.009), greater self-perceived likelihood of becoming HIV positive (AOR=3.40; p Conclusions Interest in using rectal microbicides was associated with self-perceived vulnerability to HIV, engaging in sexual practices that increase the risk of HIV acquisition and less uncertainty about the efficacy of microbicides. There appears to be a group of men who would benefit from, and are highly motivated to use, a rectal microbicide product.

O câncer é comumente descrito como a reprodução descontrolada de células anormais no corpo. Essa definição classifica a doença como um processo local, cuja temporalidade é linear. Nesse trabalho, colocamos em questionamento tal enfoque a partir de um estudo de caso sobre o câncer de mama, analisado através da teoria do ator-rede. Começando desde a concepção da doença como uma trajetória semiótico-material, estabelecemos o papel desempenhado pela regulação e os processos de diagnósticos pré-sintomáticos na materialidade do câncer. Fazendo eco à proposta de A. N. Whitehead, definimos o câncer com um objeto potencial. Logo, descrevemos como as proposições biomédicas se articulam nos pacientes, afetam sua anatomia e estabelecem uma materialização autêntica que se comporta como um agenciamento sócio-material. Concluímos que é necessário pensar em intervenções que considerem a heterogeneidade de aspectos materiais que origina o câncer concebido por essa perspectiva.

This paper is about expectations of oral PrEP, ‘a pill a day’ HIV pre-exposure prophylaxis that could be the first systemic form of HIV prevention for sexual or needle stick exposures. If found safe and effective—a difficult criteria to establish and, as such, is central to this paper—PrEP has the potential to significantly alter HIV prevention, well ahead of a vaccine or topical microbicide. Hence, despite uncertainty about PrEP's viability, the potential significance of its impact on the HIV field requires early planning. In order to address this potentiality, we use a methodological approach drawn from the sociology of expectations to examine interviews with United States-based scientific stakeholders in the trialing of PrEP. We identify how PrEP is anticipated as both stable object and process involving multiple contingencies. These divergent conceptions enable us to illuminate a range of social, cultural, ethical, pharmaceutical and medical possibilities understood to potentially arise with PrEP. Further, they lead us to propose that the multiple contingencies that enact PrEP as an emergent entity offer scope for rethinking PrEP and, more broadly, the challenges of HIV prevention.

The impetus for this special issue on HIV came from a discussion a few years ago during which we established a shared interest in a revival of the sort of scholarly innovation that characterized the early years of the HIV epidemic. As far back as the early 1980s, social theorists, cultural, critics, artists and others created a vibrant body of work on HIV/AIDS. Working from various theoretical and disciplinary sites they steadfastly emphasized the 'social' for understanding the significance of AIDS and opened up new avenues for critiquing and re-imagining scientific, cultural and social responses to infectious disease. At its best, this work served also as an impetus for queer theory, various feminist critiques and a range of research under the rubric of science, medicine and technology studies.

In this paper we examine the work of bioethics in the enactment of medically drugged bodies by focusing on the development of an oral pre-exposure chemo (drug) prophylaxis for preventing HIV, calle...

This article explores problems posed by HIV anti-retroviral combination therapies by focusing on the UK media promotion of Trizivir (a GlaxoSmithKline three-drugs-in-one tablet). Using the substance of the figural in the style of feminist critiques of science and borrowing from actor network theory, a synergistic relationship comprising HIV, anti-HIV drugs, drug manufacturers and their media, medical publications, consumer representative treatment information and mass media is shown to construct a worrisome set of choices. The coming together of otherwise divergent interests and media raises questions about a certain adherence to drug manufacturer ‘facts’. But more provocative is the Trizivir campaign itself. For it suggests a stridency that goes well beyond the limits of its choices and, in doing so, offers the possibility for renewed consumer activism.

(2002). On the Biology of Sexed Subjects. Australian Feminist Studies: Vol. 17, No. 39, pp. 261-277.

We assessed interest in using rectal microbicides to prevent HIV transmission among gay men in Australia.A national online survey was conducted in 2013. Interest in using rectal microbicides was measured on a seven-item scale (α=0.81). Factors independently associated with greater interest in using a microbicide were identified using multivariate logistic regression.Data were collected from 1223 HIV-negative and untested men. Mean age was 31.3 years (SD=10.8, range 18-65); 77% were born in Australia and 25% reported any condomless anal sex with a casual partner in the previous 6 months. Overall, there was moderate interest in using rectal microbicides (M=3.33, range 1-5). In multivariate analysis, greater interest in using microbicides was independently associated with being born outside Australia (adjusted OR (AOR)=1.59; p=0.009), greater self-perceived likelihood of becoming HIV positive (AOR=3.40; p0.001), less uncertainty about the efficacy of microbicides (AOR=0.65; p=0.009), any condomless anal sex with casual partners in the previous 6 months (AOR=1.78; p=0.03) and ever having received postexposure prophylaxis (AOR=1.53; p=0.04). Interest in using microbicides was not associated with age, number of male sex partners or the HIV status of regular male partners.Interest in using rectal microbicides was associated with self-perceived vulnerability to HIV, engaging in sexual practices that increase the risk of HIV acquisition and less uncertainty about the efficacy of microbicides. There appears to be a group of men who would benefit from, and are highly motivated to use, a rectal microbicide product.

(2000). Thinking Menstrual Blood. Australian Feminist Studies: Vol. 15, No. 31, pp. 91-101.

In this chapter we begin to explore the ‘singularization’ of the PrEP RCT. We pose the question: how are the pill, the RCTs and their bioethics each enacted as singular? As such, we mean to investigate how each is performed as a unitary object or event. Of course, we shall see that RCTs, the pill and bioethics are contested and we shall trace how they are interpreted in conflicting ways. However, ‘behind’ these interpretations there is a commonly accepted underlying ‘essence’ that appears to exist beyond ‘differences of opinion’. Put differently, in order for there to exist an ‘essence’ — here, for example, a PrEP pill that has at its core the primary quality of a pharmaceutical preparation condensed into a pill — a further set of ‘secondary’ qualities are necessary to explain variation in effect. In tracing out the process of singularization by drawing on a range of empirical material including interviews with HIV trial investigators we also point to the ways that other types of entities — most notably trial participant groups — both enter into the enactment of PrEP and themselves come to be enacted in particular and, importantly, problematic ‘singularized’ ways. Indeed, as we show later in the chapter, the bifurcation of trial participants in the form of a (recalcitrant) subject/ (experimental) body split participates in threatening the viability of PrEP as an ‘efficacious’ entity.

Drawing on process thinkers as Whitehead, Deleuze and Stengers, Innovation and Biomedicine develops a framework for the analysis of Biomedical Innovation. With its sustained focus on the Pre-Exposure Prophylactic (PrEP) pill for the prevention of HIV infection, the volume explores the ethical, medical and political elements entailed in the pill's testing through offshore randomized control trials(RCTs). To this end, the key concept of 'eventuation' is elaborated and deployed in the scrutiny of 'gold standard' status of RCTs, the role of ethics in RCTs, and the enactment of the PrEP pill as a singular entity. Further, the authors engage with affective, topological and virtual dimensions to show how PrEP's eventuation also allows for new scientific and ethical questions to be crafted.

In this chapter we once again attend to the complex eventuations of PrEP RCTs but broaden our analytic horizons to situate these within an account of the relationship between globalization and localization. In other words, we look at the ways in which the specific emergence and role of abstraction in PrEP RCTs are played out as convolutions or, better, ‘involutions’ of globalizing and localizing processes. By drawing on the idea of involutions, in which the global emerges out of the local and vice versa, we return to the idea that PrEP RCTs are part of an assemblage that entails multiple and heterogeneous relations. Moreover, we imagine this assemblage topologically: topology, used circumspectly, seems to us to throw an inventive light on what PrEP RCTs are and can become. Most notably, topology allows us to trace how seemingly distal relations play a part in the eventuation of PrEP and clinical trials.

It is a commonplace to worry about the pace of innovation in biomedicine. From the perspective of some actors, innovation moves too quickly, throwing up complex regulatory issues and ethical dilemmas that are sometimes barely tractable. For others, innovation cannot take place fast enough: in the here and now, there are lives to be saved and there is suffering to be eased. Often these two contrasting apprehensions toward biomedical innovation reside simultaneously in a single actor (whether that actor be individual or collective). This ambivalence reflects the contradictory character of much that passes for biomedical innovation. With the development and arrival of a new drug, technology, procedure or intervention, not only might lives be saved, but they can also be endangered at one and the same time.

In this chapter we provide a partial history of randomized controlled trials (RCTs) as they have been applied within the HIV field in pursuit of prevention technologies. These RCTs are mostly prior to pre-exposure prophylactics (PrEP) and the account presented here is meant to contextualize our main object of study, PrEP, and particularly the controversies that surrounded the first round of PrEP RCTs. Central to the story of the early PrEP trials as told by various interested parties (for example, activists, trialists) was the question of whether these trials were devised in what amounts to an unethical manner. Also at stake in these debates was whether these concerns could be equally applied to other HIV prevention trials. As we shall see, some actors have been adamant that the PrEP trials in which they were involved were ethical; others have maintained that the requirements to inform and protect participants were not met; and a third group have questioned why the early PrEP trials provoked controversy when, in their view, issues of protecting participants were not so different to other prevention trials. Informing all three positions are some key assumptions that underpin the rationale for clinical trials — a rationale in which RCTs come to be regarded as the ‘gold standard’ for achieving evidence-based research within the HIV field.

This book has been about biomedical innovation and the practical, local, analytic, distributed efforts to determine whether a relatively mundane intervention (a pre-existing pharmaceutical drug or a combination of pre-existing pharmaceutical drugs for the treatment of HIV infections) amounts to a viable prophylactic against HIV infection. Toward the beginning of this book, we drew a contrast between mundane and exotic technologies as a way of situating PrEP and yet, as we have illustrated throughout, this distinction is not easy to sustain (see especially Chapter 3). All sorts of novelties and multiplicities flow in the wake of PrEP’s testing — novel bodies, relations, virus, pharmaceuticals, politics, clinical and social arguments. So, despite the comparative lack of innovation that ostensibly marks PrEP, it has occasioned all sorts of inventiveness. In this respect it is no different from other sorts of mundane technology which have precipitated novelty (conversely, it is the mirror image of supposedly exotic technologies which simply reproduce or reinforce existing values or functions — see, for example, Michael, 2000; Barry, 2001). So, this book has concerned itself with tracing some of the patterns of invention and non-invention that have characterized the recent history of PrEP, its randomized control trialling and accompanying bioethics.

In the previous chapter, we were concerned to trace the way that PrEP as a pill, PrEP RCTs and bioethics were collectively and mutually singularized. By focusing on various entities, not least through an engagement with expert and practitioner accounts, we showed how these were enacted as quantitative objects: that is to say, they were stabilized in relation to a set of criteria, measurements, parameterizations or standards that seemingly stood ‘outside’ of the complex events that comprise the trialling of the PrEP pill.

Objectives: To investigate willingness to use HIV preexposure prophylaxis (PrEP) and the likelihood of decreased condom use among Australian gay and bisexual men. Methods: A national, online cross-sectional survey was conducted in April to May 2011. Bivariate relationships were assessed with c2 or Fisher’s exact test. Multivariate logistic regression analysis was performed to assess independent relationships with primary outcome variables. Results: Responses from 1161 HIV-negative and untested men were analysed. Prior use of antiretroviral drugs as PrEP was rare (n¼6). Just over a quarter of the sample (n¼327; 28.2%) was classified as willing to use PrEP. Willingness to use PrEP was independently associated with younger age, having anal intercourse with casual partners (protected or unprotected), having fewer concerns about PrEP and perceiving oneself to be at risk of HIV. Among men who were willing to use PrEP (n¼327), only 26 men (8.0%) indicated that they would be less likely to use condoms if using PrEP. The likelihood of decreased condom use was independently associated with older age, unprotected anal intercourse with casual partners (UAIC) and perceiving oneself to be at increased risk of HIV. Conclusions: The Australian gay and bisexual men the authors surveyed were cautiously optimistic about PrEP. The minority of men who expressed willingness to use PrEP appear to be appropriate candidates, given that they are likely to report UAIC and to perceive themselves to be at risk of HIV.

In this chapter we examine the challenges identified in the development of a pharmaceutically based oral HIV pre-exposure prophylaxis referred to as PrEP, and how the issues raised in the course of early and current clinical trials enable a rethinking of the possibilities for HIV prevention. Drawing on an ethnographic study of PrEP involving new theoretical developments in the field of Science and Technology Studies (STS) we pose PrEP and HIV prevention, more generally, as an assemblage that is ontologically open rather than, as more usually conceived, made up of stable and distinct objects: drugs, bodies, condoms and virus. Biomedical and non-biomedical forms of prevention lend themselves to the concept of assemblage as the latter conveys a dynamic involving inter-relationships between heterogeneous phenomena. The processual nature of this inter-relationality produces an open system of ‘complex becoming and multiple determinations’ (Venn, 2006: 107) through which the potential to intercept an unwanted form of inter-relationality — the achievement of viral viability or, put more simply, infection — can take place.

This paper focuses on the relationship of HIV medical technologies to current styles of medical practice and highlights issues posed by the technologies for those working and/or living with HIV. The paper examines HIV anti-retroviral combination therapies and associated tests from the perspective of their prescribers. The prescribers were interviewed during the later part of 2002 at three London HIV clinics. Their comments, considered in light of other recent studies in the field, suggest that current therapies are part of a transitional phase in the epidemic which informs the identification and negotiation of known risks and uncertainty. An undetermined but extended life expectancy, afforded by anti-retroviral therapies, is understood against risk of iatrogenic diseases and/or viral drug resistance. The tension arising in this situation of unwanted and even uncertain phenomena poses ethical dilemmas and affects doctor/patient relations. Indeed, it also contributes to a reconfiguring of the lived experience of managing HIV. While the new technologies have offered considerable advances in the medical management of HIV, they are altering the nature of HIV medicine both materially and socially. The scenario is further complicated by the uneven allocation of resources and different patient health and disease states. The heterogeneity of resources, disease states and technological effects points to the need for ongoing and extended evaluation as the relationship between these and the everyday practice of medicine continues to change.

Clinical medicine and biotechnology increasingly utilise and transform human bodily tissues in novel ways. Today more and more tissues—blood, whole organs, ova, embryos, sperm, skin, bone, heart valves, cellular material, bone marrow and corneas—can be transferred between donors and recipients. Hence more and more people in developed nations have the experience of giving a fragment of their body to another, or receiving such a fragment as part of some kind of therapy. These systems for the circulation of tissues raise the question of what we have termed ‘bioidentity’. Bioidentity describes our common-sense understanding of our bodies as ‘ours’, as both supporting and being included in our social and subjective identities. Within this framework, how are we to understand the status of detachable bodily fragments like blood, ova or organs? As parts of our bodies do they retain a trace of our identity after donation, or are they detachable things? What is our relationship, if any, to the patient who receives our tissues as part of their treatment? This paper investigates the specific case of blood transfusion and donation. It draws upon in depth interviews with 55 people who have specific experience with blood. They either have hepatitis C (are HCV+) acquired by transfusion or intravenous drug use, or have donated blood or received a blood transfusion but are free of hepatitis C (are HCV). We analyse this material according to the themes—Donated Blood as ‘Self’, Blood as Alienable, Blood as Communal Substance, and Contaminated Gifts and the Blood of Strangers. We find that, generally speaking the HCV+ and HCV groups share very similar ideas about blood donation and transfusion. For a minority of both groups, blood was understood as a decisive site of self irrespective of location, but for the remainder donated blood was either ambiguous with regard to identity, a shared substance, or not considered to have any lingering relationship to the self once given. However both groups regarded blood as strongly imbued with ‘risk identity’. In particular the HCV+ interviewees regarded their blood as a dangerous personal attribute, one that they must be careful to withhold from circulation, whereas the blood donors felt obliged to donate their blood precisely because they considered it clean and risk free.