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Short abstract:

This paper analyzes US initiatives to end HIV/AIDS epidemics. I develop the concept of a “sanguine governmentality” to describe naively optimistic strategies for managing HIV that emphasize using routine blood work data reported to public health surveillance systems to pursue unrealistic targets.

Long abstract:

This paper analyzes the implementation of recent US federal HIV/AIDS initiatives to develop the concept of a “sanguine governmentality.” This framework draws on the Foucauldian framework of governmentality and theories of datafication to describe strategies for managing epidemics that use routine clinical blood work data reported to public health agencies to pursue unrealistic population health targets. I draw on analyses of policy documents and ethnographic fieldwork in Atlanta’s HIV/AIDS safety net from 2016-2019. I have observed actors enthusiastically promoting datafied public health surveillance systems as vehicles for pursuing unachievable HIV viral suppression targets, given the country’s inequitable healthcare system. Surveillance data are used for epidemic response, including for resource allocation, epidemiology, and outreach to people living with HIV. I call this strategy for managing HIV “a sanguine governmentality” because it is rooted in the naïvely optimistic–or sanguine–promise of a future that never arrives: the “End of AIDS” or “Zero” new infections. Those goals are so utopian that their failure is written into their pursuit. In this future-always-deferred, every person living with HIV is incorrectly imagined as being able to access medical care, physiologically capable of becoming virally suppressed, and personally able to remain adherent to medications. However, datafied strategies for governing HIV are also “sanguineous,” as in “of, relating to, or containing blood,” because they rely on routine clinical blood tests reported to public health. Sanguine governmentalities offer a useful lens for other cases in the governance of biosocial problems that mobilize data systems, blood tests, and forms of optimism.