Short abstract:

Facts are particularly hard to settle when they encounter the presumptive waywardness of sexuality. This paper argues this point by examining responses to the Swiss Statement (2008), which communicated working assumptions about HIV viral suppression and transmission risk to people with HIV.

Long abstract:

In 1984 Gayle Rubin observed, “sex is presumed guilty until proven innocent. Virtually all erotic behaviour is considered bad unless a specific reason to exempt it has been established”. When it comes to HIV prevention and HIV positive sexuality, the evidentiary threshold for establishing such exemptions is unusually high, keenly patrolled and borders on the phobic. Facts are particularly hard to settle when they encounter the presumptive waywardness of sexuality. This paper argues the case by examining the evolution of discourses of HIV Treatment as Prevention, in particular the Swiss Statement of 2008, which aimed to communicate the latest thinking on HIV viral suppression and transmission risk to people with HIV but encountered intense backlash from medical practitioners and public health specialists around the world. This is surprising considering the same proposition was by now routinely informing the work of modelers, population scientists and global health strategists. Though regarded as reliable enough to inform the work of modelers busy forecasting the prevention benefits of lifelong treatment regimes in whole populations — with momentous implications for global HIV policy and programming — viral suppression science was treated as too dangerous to be handled by individuals with HIV and their sexual partners, whose sexual decision-making would supposedly be compromised by the same evidence and needed no encouragement. This paper situates the backlash as a case of sexual gatekeeping on the part of HIV scientists and a crucial backstory to the sloganization of science embodied in today's U=U campaign (2016-present).