Dissertation Research: Resistant to Treatment: Medicine, Molecules, and the Global Politics of Drug-Resistant HIV

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This Science and Technology Studies Dissertation Improvement Grant is a multi-sited ethnographic research project, and will involve qualitative interviews with HIV scientists and participant-observation at selected sites relevant to the production of knowledge about drug-resistant HIV. Research will be conducted over 14 months, beginning in August 2004. Twelve of these months will involve fieldwork based in the San Francisco Bay Area, where interviews and participant-observation will be conducted with North American researchers studying HIV drug resistance in the U.S. and in Africa. In addition, interviews and participant-observation will be conducted at several scientific conferences over the course of the 14-month fieldwork period. NSF funds will primarily support the remaining three months spent conducting fieldwork in Uganda, where interviews and participant-observation will be conducted with Ugandan scientists and clinicians involved in research on HIV treatment and drug resistance. The background for this fieldwork is that the certainty expressed by some researchers and health policymakers regarding the danger of drug-resistant HIV emerging from Africa contrasts sharply with the uncertainty surrounding the scientific definition and measurement of antiretroviral resistance. Following in the tradition of the social study of science, this dissertation project seeks to examine this paradox by examining how scientific uncertainty over the measurement, description, and meaning of resistance to antiretroviral medications is negotiated in the context of politically and racially charged debates over the role of the industrialized West in preventing and treating AIDS in Africa. Specifically, the project will pursue two interrelated research questions: first, how (through what practices and technologies) do scientists construct knowledge about antiretroviral resistance; and second, in doing so, how do they construct knowledge about Africa? This project makes two principal contributions to social science knowledge and theory. First, it makes an innovative contribution to the anthropology of AIDS by applying the analytic tools of the social study of science to the global epidemic. Currently there is very little social science scholarship that critically examines the biology of HIV/AIDS, antiretroviral medication, or drug resistance. Secondly, this project will contribute to the development the anthropology of science by contextualizing the science of HIV drug resistance within a broader network of social, political, and economic relations. Within the last year and a half, there has been a substantial increase in international support for AIDS treatment in Africa. As treatment access expands, the science and politics of antiretroviral resistance is likely to become both more prominent and more complex. Biological questions about the pharmacogenomics of drug resistance in Africans, the genetic and geographic diversity of HIV strains, and clinically optimal treatment will emerge deeply enmeshed with political questions regarding cost-effectiveness, international pharmaceutical patents, race, geography, and inequality. The increasingly complex biology of HIV drug resistance will remain inextricable from the global politics of HIV treatment. By tracking the biopolitics of drug-resistant HIV, this project aims to expand our understanding of the relationship between science and policymaking and to contribute to the growing efforts to improve access to antiretroviral medications in the developing world.