Counselling anomie: clashing governmentalities of HIV criminalisation and prevention

Abstract

HIV criminalisation is a term that describes the criminal prosecution of persons in instances of HIV transmission, exposure and so-called non-disclosure of their HIV serostatus. In the United States (US), there have been over 500 reported instances of HIV criminalisation. Over the past decade, several negative consequences of HIV criminalisation have been identified, including its capacity to increase stigma and social injustice. In addition, scholars have built an evidence base demonstrating that HIV criminalisation has the potential to undermine HIV prevention and that it is thus harmful to public health. This article contributes to that evidence base by (1) combining Foucaultian studies of ‘governmentality’ with the sociology of ‘anomie’ to theorise the larger implications of HIV criminalisation for the institution of public health, and (2) presenting interviews with public health service providers working in Tennessee, USA. This state is an important site for studying the public health implications of HIV criminalisation because, between 2008 and 2012, it was reported to have led all American jurisdictions in prosecutions of HIV-specific criminal offences. Concentrating on discussions of post-test counselling, this article argues that a major system-level effect of HIV criminalisation is the propagation of an anomic affective climate, which makes it difficult to establish norms of HIV prevention.

Keywords:

• disclosure
• HIV counselling
• HIV criminalisation
• HIV prevention
• HIV testing

Acknowledgements

I would like to thank the numerous friends and colleagues who discussed with me at length the ideas presented herein. Thanks especially to Eric Mykhalovskiy and Heather Martin for their heroic editorial efforts, and to the anonymous reviewers, for providing insightful feedback on earlier versions of this manuscript. Many thanks, also, to the Social Sciences and Humanities Research Council of Canada for funding a post-doctoral fellowship, which enabled me to gather the data presented in this article (Grant # 756-2010-0741). Finally, this research would not have been possible without the time, effort and insight given me by my amazing study participants – thank you all.

Disclosure statement

No financial interest or benefit has arisen from the direct application of this research.

Notes

1. Reported in December of 2013, the figure of 541 cases is described as ‘almost certainly a substantial undercount’, since there is no national-level, systematic tracking of such cases, and since data-sets used to arrive at this figure are not easily comparable (Hernandez, 2013a, 2013b).

2. It should be noted, furthermore, that in cases alleging HIV transmission, establishing the direction of transmission (e.g. that one person clearly ‘infected’ another person) is no straightforward matter. For instance, while phylogenetic analysis can establish a degree of relatedness between genetic sequences, current ‘techniques are not reliable enough to estimate the direction of transmission’ (Bernard, Azad, Vandamme, Weait, & Geretti, 2007).

Additional information

Funding

This work was supported by the Social Sciences and Humanities Research Council of Canada [Grant # 756-2010-0741].