An unfinished history: a story of ongoing events and mutating HIV problems

By reflecting on the thinking that has come to prevail with regard to women and HIV and, doing so, by working back through an albeit brief outline genealogy of the development of PrEP, I examine how the relevancies of HIV prevention regimes have become folded into a particular scientific logic and why this should concern us. Without disputing the affordances of PrEP, in either pill or long-term acting form, I suggest that the WHO/UNAIDS 90-90-90 goals and, no less, an optimism for a future end to the dynamics of the epidemic is founded on a misplaced conception of what is at stake. Drawing on a branch of process philosophy that has earned the term ‘event-thinking’, I propose that if biomedicine is to be responsive to the relevancies of those affected by HIV, a more open conception of what is assumed by international health authorities as the ‘dynamics of the epidemic’ may be warranted. With reference to the RCTS discussed in this chapter, namely SMART, FEM-PrEP and VOICE and their carefully constructed bioethical undertaking yet deemed failure, I suggest that efforts to achieve an ethico-biomedical ‘solution’ may be out-of-kilter with the realities of those for whom it is proposed. Reluctance or outright recalcitrance of trial participants provides an opportunity for reformulating the problem of HIV and for what has become a normative conception of ethics. Insofar as bioethical rules and norms are presupposed to protect research participants, bioethics shares the same world view as science on what matters.