Helping HIV-Positive Adolescents Become Healthy Adults: Balancing Individual and Population-Level Health Needs in an Era of Biomedical HIV Prevention

Morgan Philbin, Columbia University

This paper explores how adolescent healthcare providers balance individual and population-level health needs as the scale-up of biomedical HIV prevention measures brought HIV/AIDS clinical treatment guidelines into alignment with national public health prevention goals. From 2010-2012, I conducted fifty semi-structured interviews with providers in adolescent medicine clinics in eleven U.S. cities and eighteen months of observations in weekly clinical case reviews and grand rounds at an adolescent HIV clinic. My research suggests that providers may not apply clinical treatment guidelines and instead focus on helping adolescents become adherent adults. Clinicians also remained accountable to patients who did not adhere to medication and thus progressed to AIDS, or even death. It is critical to understand how shifts in discourse around the biomedicalization of HIV and—more concretely—in population-level policy around the provisioning of treatment and care for HIV-positive individuals, have affected clinical practice and the lived experiences of HIV-positive adolescents.