Compliance/Adherence, HIV, and the Critique of Medical Power

Abstract

The established social critique of compliance was written in the late 1970s and early 1980s by a group of sociologists and anthropologists. Drawing on a humanist perspective, it argued that compliance operated as a form of medical control over patients that ignored their experiences of medications or defined them in terms of professional expectations. In this paper we draw on the theoretical work of Smith and Foucault and on original research on the ‘healthwork’ of people living with HIV/AIDS to revise this critique. Our analysis foregrounds the heterogeneity of power relations exercised through contemporary relations of compliance/adherence. We argue that in the contemporary context of HIV/AIDS, compliance/adherence operates as a fundamental discursive ground of people's healthwork and is constitutive of, rather than hostile to, experience and the self. Considered as a technology rather than concept, adherence groups together a host of strategies designed to cultivate a particular relation of self to treatment in ways that do not operate with the uniform force suggested by the early social critique. At the same time, compliance is not simply about liberal forms of self-governance. It is a site where multiple forms of power – biomedical authority, population-based forms of risk governance, and liberal techniques of the self – intersect in relations of tension, negotiation, and support.