‘HIV has a woman's face’: vaginal microbicides and a case of ambiguous failure

Abstract

The case is a primary unit of knowledge production in the field of HIV research, yet the work that is done to construct cases often goes unremarked. In this paper, the case takes centre stage in an analysis of a set of apparent failures in HIV prevention research, namely a series of clinical trials to test vaginal microbicides. Returning to the genesis of the microbicide concept in the early 1990s, I examine how the discourse of women's empowerment was linked to HIV prevention in a way that mobilized a particular vision of the case, which was both politically and scientifically expedient. Drawing on an in-depth empirical study of one particular trial, I show the success of the case in mobilizing funds and interest in the research, as well its success in accounting for the failure of the pharmaceutical technology. Drawing in alternative scientific accounts of the failure of microbicides, however, a different version of events is indicated, in which what can ultimately be said to have failed is not the technology itself, but the act of casing upon which its testing was founded.

Keywords:

• microbicides
• clinical trials
• HIV
• gender
• case
• failure

Acknowledgements

Special thanks to the staff of the Microbicides Development Programme (MDP) for taking part in this research and to the MDP Programme Liaison Group for permitting me to use MDP as a case study. Thanks also to Judith Green, Robert Pool and Charlotte Watts for constructive criticism, support and guidance during the course of the PhD on which this work is based, and to Patricia Kingori, Salla Sariola and the journal's anonymous referees for their helpful suggestions.

Fieldwork for this research was supported by a small grant from the MDP administered through Imperial College, London, and the London School of Hygiene & Tropical Medicine. Subsequent work on the manuscript was supported by the Netherlands Organization for Scientific Research (NWO), under the Innovational Research Incentives Scheme (Veni) (grant no. 451-11-003). Ethical approval for this study was granted by the London School of Hygiene & Tropical Medicine Ethics Committee and the University of Zambia Biomedical Research Ethics Committee.

Disclosure statement

This research was partially funded by the Mircobicides Development Programme, for whom the author was working at the time of the research. No other potential conflict of interest was reported by the author.

Notes

1. The ODA later became the Department for International Development (DFID).