‘If you aren’t married yet, you’ll be married to your treatment from now on’: embodied mediations in a women’s HIV peer advisory project in Mexico

Abstract

Treatment as Prevention is a key biopolitical intervention on the HIV epidemic but relies on individual adherence to antiretroviral treatment in order to have an effect on the population as a whole. Informed by a discussion of biopower, this paper analyses the complex relationships between discourses of competent authorities and modes of subjectification through a qualitative analysis of findings from 5 years of fieldwork associated with the action-research project Yantzin: Women HIV Peer Advisors in Mexico. It looks at the production of subjects of adherence, whereby peer advisors emerge as key agents at the interface between scientific and experiential knowledge. Contradictorily, the desire to live becomes feasible only by engaging with these biopolitical interventions. We discuss how peer advisors twist these technologies in such a way that they provide not only operations of power but also courses of action for desire. Through embodied mediation strategies that critique obedience to medical prescription and translate scientific information into bodily and emotionally shared experiences, peer advisors’ work goes beyond the behavioural rationality of biomedical models offering embodied proof for other women that, even when living with HIV, a project of happiness is possible.

Keywords:

• Women
• HIV
• Mexico
• peer work
• subjectivation

Acknowledgements

We thank Karina, Mariel, Laura, Tere, Andrea and Luci, Yantzin’s peer advisors, for their support for women’s projects of happiness. We thank Gabriela Velásquez Rosas, director, and the staff of CAPASITS Oaxaca; Norma Beatriz García, director of the Morelos State AIDS Council, Morelos, Francisco Belaunzarán Zamudio, Director of the HIV/AIDS Clinic, National Institute of Medical Sciences and Nutrition, and Ubaldo Ramos Alamillo, Director of the Clínica Especializada Condesa, Mexico City, for their commitment to the health care of women with HIV. We thank Yantzin’s team members for their contribution to this project: Elena Langarica and Adriana Hernández, social worker and psychologist at CEC in Mexico City, respectively; Mónica Cervantes, psychologist in CAPASITS Oaxaca; Jessica Mejía, psychologist at the HIV Clinic in Nutrition Institute; Mónica Duarte, narrative therapist, and research associates Nancy Lombardini and Irene López, from UAM-Xochimilco.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 For the sake of confidentiality and anonymity, we use pseudonyms throughout.

2 Yantzin is a Nahua word meaning ‘companion’.

3 We thank Gary Dowsett for suggesting this concept.

4 Ethnographic studies suggest that urban gay culture is more prominent in Mexico City than in more rural states (Carrillo 2002; Parrini 2018; Núñez 2007), where many men who have regular partnerships with women also have sex with men, without necessarily developing a distinctive sexual identity. Such men are often not reached by HIV prevention campaigns.

5 In line with the UN Sustainable Development Goal of reducing HIV vertical transmission to less than 2%, the Mexican Ministry of Health launched a programme to prevent vertical detection that reached 65% of women in prenatal care in 2013, and 59% in 2014 (CENSIDA 2015b).

6 UNAIDS’ adoption of the principle of Greater Involvement of People Affected by HIV in policy and action is one of the main outcomes of this political struggle (UNAIDS 2007)

7 In Mexico, many civil society organisations – founded and led mainly by gay men in urban settings - have carried out HIV peer interventions. Although some of these included women, their specific needs and demands were often left behind. As a result, women’s organisations working for women with HIV have focused mainly on influencing HIV policy, and only a few have carried out peer education. Yantzin is one such collective, but it is the only one that conducts research as well (Amuchástegui and Reartes 2017, Amuchástegui 2018, Amuchástegui and Lombardini 2018).

8 These clinics provide services to populations without health insurance, serving some of the poorest and more marginalised people in the country.

9 For logistic reasons, only group sessions could be carried out in Cuernavaca.

10 All excerpts from fieldwork records have been translated by the authors.

Additional information

Funding

This project was funded by CNEGSR (National Center of Gender Equity and Reproductive Health), CONACyT (National Council of Science and Technology) under Grant # 0177946, CENSIDA (National Center for AIDS Prevention and Control) and The Elton John AIDS Foundation.