Moral Adherence: HIV Treatment, Undetectability, and Stigmatized Viral Loads among Haitians in South Florida

ABSTRACT

In the United States, HIV is rendered a chronic condition, and viral transmission is minimized through strict adherence to pharmaceutical treatment. Treatment reduces viral loads to untraceable levels in the blood, a status known as “undetectable,” as determined by laboratory testing. For Haitians living with HIV in South Florida, “undetectable” has become more than a viral status; it is a means to know and govern themselves as moral actors and to survey and stigmatize others who remain “detectable.” The ethnographic evidence I present here suggests that Haitians adopt novel forms of subjectivity based on undetectability, producing identities entangled in biotechnical categorizations and dominant narratives of responsibility, morality, and health. Haitians’ experiences with these processes reveal the persistence of HIV stigmatization and the centrality of biomedical morality in mediating perceptions of inclusion, value, and worth of people living with HIV.

KEYWORDS:

• HIV
• United States
• medical governmentality
• morality
• stigma
• viral load

Acknowledgments

I am deeply grateful to the Haitians who shared their lives with me. Philomene and Therese deserve special thanks. Several Haitian community leaders also deserve thanks for their emotional and intellectual support throughout my years in Miami-Dade, but especially Jo. I also thank Andrea Flores, Daniel Jordan Smith, J. Andrew Dufton, and Colin Johnson for their gracious feedback. Finally, I am grateful to the anonymous reviewers, Lenore Manderson, and Victoria Team for their constructive and thorough comments.

Funding

This research was funded by the Ruth Landes Memorial Research Fund.

Notes

1. All individual and organizational names are pseudonyms.

2. Undetectability is determined by testing an individual’s viral load and number of CD4 cells in one’s blood. Viral loads indicate the quantity of viral copies per milliliter (mL) of blood; typically, 50 copies are the standard for an undetectable viral load. CD4 counts are the strongest indicator of immunity and predictor of the viral progression. For reference, the CD4 count of a seronegative adult in general good health ranges from 500 cells/mm³ to 1600 cells/mm³. For PLWH, a CD4 drop below 200 cells/mm³ indicates the virus’s advancement to AIDS. Undetectability presumes high CD4 (www.aids.gov).

Additional information

Funding

This research was funded by the Ruth Landes Memorial Research Fund.

Notes on contributors

Chelsea Cormier McSwiggin

Chelsea Cormier McSwiggin is an applied anthropologist with a professional background in public health. Her most recent work considers the social and moral constructions of HIV/AIDS and HIV-related biotechnologies in the Haitian immigrant community in South Florida.