Bullets, balance, or both: medicalisation in HIV treatment

• Published in: The Lancet (British edition) Vol. 369; no. 9562; pp. 706 - 707
• Main Author: Patton, Cindy, Dr
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 24.02.2007; Elsevier Limited
• Subjects: Anti-HIV Agents - adverse effects; Antiretroviral agents; Cardiovascular disease; Endocrinology; Health care; HIV; HIV Infections - drug therapy; HIV Infections - metabolism; HIV-Associated Lipodystrophy Syndrome - chemically induced; HIV-Associated Lipodystrophy Syndrome - metabolism; Human immunodeficiency virus; Humans; Internal Medicine; Lipids; Male; Medical practices; Medical research; Metabolic disorders; Middle Aged; Patients; Physician's Role; Virology
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(07)60322-5

In interactions between patient and doctor, doctor and drug-company representatives, and endocrinologiste and HIV doctors, I have noted how the two medical specialties-HIV care as evolved in the context of research virology, and endocrinology as practiced in the clinical setting-each with its own culture and self-image, compete and collaborate, as they try to balance the problem of viral load (addressed with antiretroviral therapy) with that of disordered blood lipid and glucose concentrations and visible physical changes (addressed with drugs, diet, exercise, and sometimes cosmetic surgery). The history of AIDS has been full of complicated challenges to the internal coherence of science led by activists and patients against biomedicine, but also by practitioners within the emerging specialty of AIDS care, as different research communities struggled to define and explain the emergent syndrome.3 Through the 1980s, a strong coalition formed between people highly identified with their medical diagnosis (people with AIDS) and a class of medical specialists: the AIDS doctors.