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題名:台灣愛滋治理與「治療作為預防」之生命政治的考察
作者:李佳霖
作者(外文):Li, Chia-Lin
校院名稱:國立交通大學
系所名稱:社會與文化研究所
指導教授:林淑芬
學位類別:博士
出版日期:2020
主題關鍵詞:愛滋治療作為預防病毒量測不到部署治理生命政治HIV/AIDSTreatment as Preventionundetectable viral loaddeploymentgovernancebiopolitics
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本論文透過生命政治視角,援引部署與治理之概念框架,旨在探討愛滋「治療作為預防」此生物醫療預防典範在全球—在地維度的發展,並深入分析此典範所倚重的「治療」和「病毒量測不到」兩者帶給台灣本地愛滋治理的影響,以及該典範對感染者的性、身體、責任、主體化等面向引發的轉變與效應。
篇章結構安排上,本論文分為兩大部分。第一部分的分析主軸,放在治療作為預防如何在國際和台灣本地被奠定為當今的防治典範(第二、三章)。第二部分則透過我進行的研究訪談,分析這當中關鍵參與者(包含感染者、醫護專業工作者、機構社工)對於該生物醫療預防措施的詮釋、實踐與回應(第四、五章)。
在第一部分,本論文探討國際層次上奠定治療作為預防的推動驅力,點出該生物醫療預防技術的適用效度在男同志與無套性愛的範疇被擴充、深化的現象。而連帶著臨床科學知識的生產,醫療實踐的準則從過去的行為模式,轉為重視服藥之預防效力的生物醫療模式。知識以及醫護工作實踐兩者匯聚而成的權力,布置在感染者個體資訊,使其服藥狀態以及病毒量數值成為治理的核心目標,從而衍生出以數值為基底的國際防治議程和社群動員。在國際層面的探討之後,我將分析焦點拉回到治療作為預防在台灣的接軌及其發展,我以兩項穩固治療作為預防的根基破題:(一)確診即刻服藥;(二)治療準則標準化,並進一步檢視台灣愛滋防治的制度性條件的裝配及轉變,切入分析治療作為預防典範如何透過台灣官方政策、醫療機制、個案管理等相互援引的網絡,得以被部署、組織和落實。
在第二部分,我以服藥工作的座落性和治療意義/異議拉開序幕,分析治療作為預防帶給台灣感染者兩個層面的效應:(一)預防責任化;(二)性的重新組構。接續此分析脈絡,我將探究重心更聚焦在「病毒量」之微觀生命政治,透過觀察病毒量數值主體的生成,探究「病毒量測不到等於不具傳染力」(U=U)帶給感染者的正面影響或改變。然而,我也以問題化的路徑,對U=U本身的限制、再汙名化、正常化,以及新陰性主體難題等重要面向進行討論,並指出病毒量並非科學檢測的客觀數字,U=U也不該被視為一個中立的臨床研究結果。本論文強調,生物醫療預防典範的意義和效應,無論是治療或抑制病毒量,必須在結構與個體層次對其翻譯至紛雜真實世界的動態進行剖析,才能較為清晰地看見它作用於感染者群體的雙向軌跡。
This dissertation, by drawing on conceptual frameworks of deployment and governance, aims to explore HIV/AIDS “Treatment as Prevention” biomedical paradigm and its development on a global-local scale. In so doing, this dissertation delves into “treatment” and “undetectable viral load,” the impacts they have on HIV/AIDS governance in Taiwan, and the transformations and effects such paradigm prompts in terms of HIV-positive sexuality, body, responsibility, and subjectivity.
This dissertation consists of two major sections. The first section focuses on how Treatment as Prevention is consolidated as an international as well as Taiwan's paradigm (chapter 2 & 3). The second section draws on my research interviews and analyzes the key participants' interpretations, practices, and responses to these biomedical prevention measures (chapter 4 & 5).
In the first section, the dissertation explores the international driving forces that consolidate Treatment as Prevention, and elucidates the expanding and deepening of biomedical prevention technology applicability in the domains of gay men and condomless sex. Along with the production of clinical knowledge, medical protocols have transformed from behavioral mode to biomedical mode that underscores the preventive efficacy of treatment. The power converged by such knowledge and practice is deployed upon HIV-positive people's individual information, making their treatment status and viral load marker the objects of governance, thus generating numeric-based international prevention agenda and community campaigns. After discussions on a global scale, I bring my analytic focus back to the integration and development of Treatment as Prevention in Taiwan. By starting with two fundamental factors that uphold Treatment as Prevention: (i) receiving treatment upon confirmation of HIV-positive status; (ii) standardization of treatment guidelines, this dissertation further examines the institutional conditions and assemblages of Taiwan's HIV/AIDS governance, and investigates how such biomedical paradigm is deployed, organized, and put into practice through the intertwining networks of Taiwan's official policy, medical mechanisms, and case management.
In the second section, I begin with the situatedness and complex meaning/dissent of being on medication, and analyze the effects Treatment as Prevention has on people living with HIV (PLWHs) in Taiwan: (i) responsiblization of prevention; (ii) re-organization of sexuality. Based on such analytic context, I direct my focus on the micro-biopolitics of “viral load,” and explore the influences and changes “Undetectable equals Untransmittable” (U=U) brings to PLWHs through the lens of numerical subjectivity formation. However, by means of problematizing, I also discuss the limits, re-stigmatization, normalization, and dilemmas of the new negative subject immanent in U=U. Through such analysis, I argue that viral load is not a scientific, objective number, and U=U is not a neutral result of clinical trials either. This dissertation places emphasis on analyzing the structural and individual dimensions of Treatment as Prevention, as well as how such paradigm is translated into the complexity of real-world settings. In so doing, the dissertation informs the dual trajectories of how biomedical prevention paradigm impacts HIV community.
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(二)中文部分
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