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

这项科学和技术研究论文改进补助金是一个多地点的人种学研究项目，将包括对艾滋病毒科学家的定性采访，以及在与产生抗药性艾滋病毒知识相关的选定地点进行参与者观察。研究将从2004年8月开始，为期14个月。其中12个月将在旧金山湾区进行实地考察，在那里将对研究美国和非洲艾滋病毒耐药性的北美研究人员进行采访和参与者观察。此外，在为期14个月的实地考察期间，将在几个科学会议上进行访谈和参与者观察。国家科学基金会的资金将主要用于支持在乌干达进行实地考察的剩余三个月，在那里将对参与艾滋病毒治疗和耐药性研究的乌干达科学家和临床医生进行访谈和参与者观察。这项实地工作的背景是，一些研究人员和卫生政策制定者对非洲出现抗药性艾滋病毒的危险表示的确定性，与围绕抗逆转录病毒耐药性的科学定义和衡量的不确定性形成鲜明对比。遵循科学社会研究的传统，本论文项目试图通过检查在抗逆转录病毒药物耐药性的测量、描述和意义上的科学不确定性是如何在关于工业化西方在非洲预防和治疗艾滋病中的作用的政治和种族争论的背景下谈判的，来检验这一悖论。具体地说，该项目将寻求两个相互关联的研究问题：第一，科学家如何(通过哪些做法和技术)构建关于抗逆转录病毒耐药性的知识；第二，在这样做的过程中，他们如何构建关于非洲的知识？该项目在社会科学知识和理论方面做出了两个主要贡献。首先，它通过将科学社会研究的分析工具应用于全球流行病，对艾滋病人类学做出了创新性的贡献。目前，很少有社会科学学术对艾滋病毒/艾滋病的生物学、抗逆转录病毒药物或耐药性进行批判性研究。其次，该项目将通过将艾滋病毒耐药性科学置于更广泛的社会、政治和经济关系网络中，促进科学人类学的发展。在过去一年半的时间里，国际社会对非洲艾滋病治疗的支持大幅增加。随着治疗途径的扩大，抗逆转录病毒耐药性的科学和政治可能会变得更加突出和复杂。关于非洲人耐药性的药物基因组学、艾滋病毒毒株的遗传和地理多样性以及临床最佳治疗的生物学问题将与诸如成本效益、国际药品专利、种族、地理和不平等等政治问题深度交织在一起。艾滋病毒耐药性的日益复杂的生物学仍将与艾滋病毒治疗的全球政治密不可分。通过跟踪抗药性艾滋病毒的生物政治学，该项目旨在扩大我们对科学和政策制定之间关系的理解，并促进在发展中世界改进获得抗逆转录病毒药物的日益增长的努力。

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.