Paper short abstract:

What do global health interventions do? What do they enable in unanticipated ways? This paper examines the scaling-up of HIV testing among MSM in China, and how this intervention turns tests into commodities and procurement into profit. In doing so, I consider possibilities for future interventions.

Paper long abstract:

In 2007, the Bill and Melinda Gates Foundation launched a $50 million HIV/AIDS program in China to target HIV prevention in vulnerable populations; most notably, among men who have sex with men (MSM). The foundation came at an opportune moment in the HIV/AIDS community just as donors began reprioritizing their funding away from the epidemic. By 2009, however, this program had become highly contested and controversial, culminating in a New York Times article that described the practice of payments in return for HIV tests from gay men as part of this initiative. The report foregrounded three important trends emerging from this program: the turn to scaling-up testing as a form of prevention; the deployment of community-based organizations (CBOs) to facilitate testing; and the use of "incentives" to encourage testing among MSM. In this paper, I examine the impacts and the effects (both intended and unintended) this program has had on the broader HIV/AIDS landscape and MSM population in China. In particular, I explore how this program has transformed HIV tests into commodities and their procurement into profit. I am less interested in "what went wrong" rather than what it is these interventions do. That is, what have these interventions enabled in unanticipated ways? And how do these unintended impacts help us rethink our intended aims? In raising these questions, I consider potential challenges and possibilities for future interventions in global health.