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ABSTRACT: HIV plasma viral load testing has become more than just a clinical tool to monitor treatment response at the individual level. Increasingly, individual HIV plasma viral load testing is being reported to public health agencies and is used to inform epidemiological surveillance and monitor the presence of the virus collectively using techniques to measure 'community viral load'. This article seeks to formulate a critique and propose a novel way of theorizing community viral load. Based on the salient work of Michel Foucault, especially the governmentality literature, this article critically examines the use of community viral load as a new strategy of government. Drawing also on the work of Miller and Rose, this article explores the deployment of 'community' through the re-configuration of space, the problematization of viral concentrations in specific microlocales, and the government (in the Foucauldian sense) of specific bodies which are seen as 'risky', dangerous and therefore, in need of attention. It also examines community viral load as a necessary precondition - forming the 'conditions of possibility' - for the recent shift to high impact prevention tactics that are being scaled up across North America.
Critical Public Health 12/2012; 22(4):471-483.
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The American journal of bioethics: AJOB 09/2012; 12(9):57-9. · 4.00 Impact Factor
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AIDS (London, England) 07/2012; 26(12):1577-8; authors reply 1578-9. · 4.91 Impact Factor
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ABSTRACT: GAGNON M, JACOB JD and GUTA A. Nursing Inquiry 2012 [Epub ahead of print] Treatment adherence redefined: a critical analysis of technotherapeutics Treatment adherence issues in the context of chronic illnesses have become an important concern worldwide and a top priority in the field of health-care. The development of devices that will allow healthcare providers to track treatment adherence and monitor physiological parameters with exact precision raises important questions and concerns. The aim of this study is to interrogate the use of these new technological devices which allow for previously unavailable data to be recorded on an ongoing basis and transmitted via a tiny microchip inserted into the body. Drawing on the work of Michel Foucault, we analyze how this anatomo-political and bio-political instrument serves to discipline chronically ill individuals and govern the health of entire populations who suffer from chronic conditions. To support our analysis, this article comprises three sections. First, we provide an overview of treatment adherence and technotherapeutics. Then, we explain how technotherapeutics concern the government of bodies and conducts at the individual level and population level more generally. Lastly, we provide an example of how this analysis can be connected to routine nursing practice in the field of HIV.
Nursing Inquiry 03/2012; · 0.64 Impact Factor
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Marilou Gagnon
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ABSTRACT: Facial lipoatrophy has been described as the most distressing and stigmatizing expression of the lipodystrophy syndrome, a syndrome that is caused by antiretroviral combination therapy. In recent years, reconstructive treatments (such as poly-l-lactic acid and polyalkylimide) have been increasingly considered for this condition. These treatments allow for facial contours and facial fullness to be restored while being minimally invasive.
The main objective of this qualitative research was to explore and describe the experience of people who suffer from facial lipoatrophy, specifically in regard to reconstructive treatments.
A qualitative design, which incorporates explorative and descriptive attributes, was thought to be an appropriate choice for this research project. The data was collected using semi-structured interviews and was then analyzed following the principles of thematic analysis.
Over a period of three months, 11 men and 1 woman enrolled in the study which was conducted in Montreal (Quebec), Canada.
Overall, participants explained that facial lipoatrophy had forced them into a situation of intense vulnerability by making them recognizable as persons living with HIV/AIDS and discreditable in the eyes of others. In this sense, they were willing to go to great lengths to restore their facial features and regain a sense of normalcy. Findings revealed that people who suffer from facial lipoatrophy engage in a process of reconstruction to reduce the visibility and disruptiveness of their condition but face many uncertainties along the way.
While the findings of this research corroborated what has been previously stated by other researchers about the impact of reconstructive treatments, they also shed light on the consequences of not making these treatments accessible as well as the undocumented realities of those who cannot afford the recommended course of dermal fillers.
International journal of nursing studies 11/2011; 49(5):539-48. · 1.91 Impact Factor
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ABSTRACT: Over the past decade, the lipodystrophy syndrome has become one of the biggest challenges in the field dof HIV/AIDS. However, few qualitative studies have examined how lipodystrophy affects the lives of people living with HIV/AIDS by reconfiguring their bodies in unexpected ways. The main objective of this qualitative study was to explore and describe the transformation process that women experience following the onset of lipodystrophy. The data was collected using semistructured interviews and was then analyzed following the principles of grounded theory. The purpose of this article is to synthesize our research findings with a particular emphasis on the basis social process (BSP) that emerged during the data analysis, namely, the bodily transformation process. Our objective is to highlight the experiences shared by women who go through this bodily transformation process and the challenges they face as they move progressively from one bodily state to another. Following the presentation of the bodily transformation process, we will discuss the implications of our findings for the advancement of nursing knowledge as well as the development of theories specific to the situations of people who suffer from chronic conditions and undergo a physical transformation as a result of medical treatment. Lastly, we will address the implications of our findings for nursing research and nursing practice.
Research and theory for nursing practice 01/2011; 25(1):23-38.
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ABSTRACT: The purpose of this paper is to engage with the reader in a theoretical reflection regarding the use of the seclusion room as a punitive nursing intervention (behaviour modification technique for instance). To set the stage, we explore the internal structure and functioning (culture) of the psychiatric institution – as total institution – from a Goffmanian perspective. Then, drawing on the work of the late French philosopher Michel Foucault, we introduce the concept of sovereign power and explore how various forms of punishment (as manifestations of power) came into play at different moments in history. Through an exploration of seclusion and its use in the psychiatric domain, we critically examine this practice when used as a behaviour modification technique. Finally, the use of seclusion is discussed in terms of the concept of sovereign power with the purpose of highlighting the political forces surrounding such a coercive practice in psychiatric nursing.
International Journal of Culture and Mental Health 12/2009; 2(2):75-85.
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ABSTRACT: Forensic psychiatric nurses work with individuals who may evoke feelings of empathy as well as feelings of disgust, repulsion, and fear. The main objective of this theoretical paper is to engage the readers in a theoretical reflection regarding the concepts of abjection and fear since they both apply to the experiences of caring for mentally ill individuals in forensic psychiatric settings. Our contention is with the potential impact of feelings such as disgust, repulsion, and fear on the therapeutic relationship and, more particularly, with the boundaries imposed on this relationship when these feelings are unrecognized by nurses. Acknowledging that patients may evoke feelings of disgust, repulsion, and fear is essential if nurses wish to understand the implications of these emotions in the therapeutic process. In forensic psychiatric settings, caring for so-called "monsters" in the face of abjection and fear is not an easy task to achieve given the lack of theoretical understanding regarding both concepts. Given the actual state of knowledge in forensic nursing, we argue that theoretical (conceptual) analyses, as well as ethical and political discussions, are paramount if we wish to understand the specificities of this complex field of nursing practice.
Journal of Forensic Nursing 02/2009; 5(3):153-61.
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ABSTRACT: In 1998, the US Supreme Court first held that asymptomatic HIV infection constituted a disability when it ruled on the case of Bragdon v. Abbott. The use of yet another label (disabled) to identify women living with HIV has been rarely (if ever) questioned. While we do value the use of this label as an anti-discriminatory strategy, we believe that there is a need to examine how language and more specifically, the use of words such as disability, limitation, and impairment may create new forms of identities for women living with HIV. Using this legal case as a starting point, the goal of this paper is to critically examine the 'fabrication' of asymptomatic HIV infection as a disability. Grounded in a feminist poststructuralist perspective, this paper exposes the relationship between language, social institutions, subjectivity, and power in the construction of difference. By doing so, it addresses the identification of women living with HIV/AIDS as disabled and the self-differentiation process that they must go through in order to live as normally as possible.
Nursing Philosophy 02/2009; 10(1):42-52. · 0.84 Impact Factor
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ABSTRACT: In this paper the development of a self-management program to optimize long-term adherence to antiretroviral therapy for people living with HIV/AIDS is presented. The program is based on intervention mapping: that is, a framework that facilitates the use of theory and empirical evidence in intervention development. In the preparatory phase we conducted a needs-assessment. The results of this phase were then used in the operational phase in which the program was elaborated as follow: in Step 1 we established program objectives; in Step 2 we translated theoretical methods into practical strategies; and in Step 3 we integrated the strategies into a self-management program which were designed to help individuals mobilize their skills to cope with their antiretroviral therapies (ART). These particular abilities are: ability to integrate ART in daily routine, to cope with side effects, to handle situations in which ART is difficult to take, to interact with health professionals and to maintain relationships with social contacts. To address individuals' resources and skills in conjunction with the experience of taking the medication, we developed two different modalities to deliver the intervention: direct support and virtual support. Direct support consists of four 45-minute individualized, face-to-face sessions with a health professional. The Web application involved at least four interactive sessions with a computer. This application was developed with the intention to support individuals in managing their therapy, in a punctual, real-time mode. Treatment adherence behavior is an indicator or gauge that can reveal problems in being able to manage the therapy.
AIDS patient care and STDs 01/2009; 22(12):965-75. · 2.68 Impact Factor
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ABSTRACT: The aim of this article is to critically discuss routine HIV testing policy in the United States by locating its origins within health promotion efforts to govern masses and the neoliberal construction of the individual as free, autonomous, responsible, and empowered. Basing our approach on the work of the late French philosopher Michel Foucault, we describe routine HIV testing as a bio-political intervention that redefines the norms and social practices pertaining to HIV testing with the goal of regulating the population's health. From a neoliberalist perspective, routine HIV testing is also introduced as a practice of self-care that should be undertaken by any rational person who performs good health practices around HIV/AIDS. The objective of this article is to situate routine HIV testing policy in relation to nursing practice and, most important, to demonstrate how this policy should not be considered in isolation from the political context in which it was created.
Policy Politics & Nursing Practice 12/2008; 9(4):264-73.
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Journal of Evaluation in Clinical Practice 11/2008; 14(5):663-4. · 1.23 Impact Factor
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ABSTRACT: The purpose of this article is to move beyond the biomedical standpoint in the field of HIV/AIDS in order to contribute to the recognition oflipodystrophy as a phenomenon that reaches far beyond its current definition as an unfortunate side effect of highly active antiretroviral therapy (HAART). This article hopes to demonstrate how theory, while remote to the clinical setting, can allow nurses to understand the experience of lipodystrophy as a social phenomenon and address it likewise in their practice. The specific aim of this article is to apply the concept of stigma to the experience of lipodystrophy in people living with HIV/AIDS. The objective of this theoretical piece is to fill the gaps in the way nurses address lipodystrophy in the clinical setting and to demonstrate the richness of Goffman's concept of stigma (1963) in understanding the experience of lipodystrophy.
Research and theory for nursing practice 02/2008; 22(4):228-40.
