Making sense of HIV-related viral load: One expert or two?

This paper examines how patients with HIV and their doctors jointly interpret 'viral load'. We show that the term 'viral load' is multiply coded: It calls up the idea of a biological property of the HIV positive body, but the term is also used as an indicator of drug treatment effectiveness, of patient compliance, and of overall wellness. Such multiple codings can be problematic because they index multiple and potentially conflicting discourses. Three distinct discourses which inform HIV medicine are identified: health measurement, health care, and health experience. These are described in terms of their semantic, lexicogrammatical and interactional patterns to illustrate how doctors and patients navigate their paths through them. In practice, what a viral load result is taken to mean depends on the alignment of patient and doctor in terms of their respective interdiscursive positions. The ability to recognize and flag discursive shifts should be considered a central component of doctors' professional expertise, particularly as a means of supporting patients in contributing their own expertise to clinical decision making.