Can women s narratives on emergent HIV biotechnologies gained during medical research reveal future practice and possibilities?

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1 Can women s narratives on emergent HIV biotechnologies gained during medical research reveal future practice and possibilities? Shelley Lees London School of Hygiene and Tropical Medicine

2 biomedical technology and HIV development on biomedical technologies in response to the HIV epidemic including anti-retroviral medications (ARV) for treatment emerging as preventive technologies, including preexposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), treatment as prevention (TasP) and as formulations for microbicides draw on existing social and political discourses that both privilege and frame their development

3 microbicides knowledge of women s vulnerability led to the idea of women-controlled technology a chemical substance that women could insert into their vaginas, secretly if need be, to act as a barrier against HIV transmission through vaginal intercourse championed by feminist activists, who have drawn on ideas about the sexual lives and agency of African women that are linked to risk and vulnerability

4 feminist technology in this way microbicides were imagined as a feminist technology: that is, as a technology that has a transformative and empowering effect on women s lives implies that women will be enabled to take control of their health and HIV prevention this feminist discourse has been reiterated in the promotion of microbicides

5 randomised control trials technological. interventions applied to impact on the HIV epidemic can be seen as technologies social practice in which technologies such as microbicides are moved from laboratories to individual women s bodies, which are themselves situated in particular local complexities

6 doing anthropological research Within trial procedures and the gel explore gel use, acceptability adapt procedures for retention, adherence Of broader social, political and economic considerations of emergent HIV technologies social practice of the trial

7 knowledge Kujua afya yangu women sought knowledge about their bodies and well-being trust in the clinical trial staff who they were aware were linked to global scientific institutions

8 context experience of the microbicides was situated within the broader context of relationships with men, and the socioeconomic conditions of their lives Poverty and gender inequalities driving their HIV vulnerability

9 effectiveness Understood that the gel may or may not work by chance (bahati nasibu) that they might be using a placebo However: hoped the gel worked and that they were using an active gel experienced relief from bruising, lacerations and dirt (chafu) which they related to HIV vulnerability

10 sexuality experiences of the gel were articulated through their own broader concerns with sexuality tradition respect/male control modernity promiscuity/equality did not challenge these discourses of promiscuity and male control but contributed to ideas of equality and respect by making possible communication about sexual matters with intimate partners ideas of women s control of sexual pleasure and risk

11 future practice and possibilities knowledge important resource to deal with uncertainty in their lives: about health; relationships with men; the HIV epidemic hope emerged as an important narrative linked to the ways the women managed uncertainty, including participating in the trial imbued into the technology itself power discourse of empowerment resonated with the women and was made meaningful by their experiences with the technologies (microbicides and trial)

12 however.. concerns with biopower and inequalities remain may allow greater surveillance of Tanzanian women s bodies and sexual lives they could enhance inequalities by situating the full responsibility for HIV protection with women

13 conclusion social science within and of clinical trials can tell us about future possibilities however, as a social practice that differs from the social practice of health services imbues ideas of chance and hope denote global connections which can bring dis/trust suggests that future practice in relation to microbicide use remains unknown

14 acknowledgements Women participants and their partners Social science research team Microbicide Development Programme Mwanza Intervention Trials Unit, Mwanza - National Institute for Medical Research, Mwanza African Medical and Research Foundation, Mwanza Medical Research Council, UK and Department for International Development