title: Adherence and the Lie in a HIV Prevention Clinical Trial.
abstract: The lie has been presented as a performance that protects identities against moral judgment in the context of power imbalances. We explore this assertion from the perspective of a pre-exposure prophylaxis trial to prevent HIV for African women in South Africa, in which context biological evidence of widespread lying about product adherence was produced, resulting in a moral discourse that opposed altruistic and selfish motivations. In this article, we seek to understand the meaning of the lie from the perspective of women trial participants. Seeing the trial as representing a hopeful future, and perfect adherence as sustaining their investment in this, participants recited scripted accounts of adherence and performed the role of the perfect adherer, while identifying other participants as dishonest. Given that clinical trials create moral orders and adherence is key to this, we argue that women embraced the apparatus of the clinical trial to assert their moral subjectivities.
authors.affiliation: a Wits Reproductive Health and HIV Institute, University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Stadler
authors.affiliation: a Wits Reproductive Health and HIV Institute, University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Fiona
authors.initials: F
authors.lastname: Scorgie
authors.affiliation: b Department of Medicine , University of California , San Francisco , California , USA.
authors.forename: Ariane
authors.initials: A
authors.lastname: van der Straten
authors.affiliation: c Department of Anthropology , University of Hawaii , Mānoa , Hawaii.
authors.forename: Eirik
authors.initials: E
authors.lastname: Saethre
mesh_terms: D060432:Anthropology, Medical; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D008192:Deception; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000208:ethnology / Q000517:prevention & control; D006801:Humans; D008297:Male; D055118:Medication Adherence; D010817:Physician-Patient Relations; D065129:Pre-Exposure Prophylaxis; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; clinical trials; lying; morality; pre-exposure prophylaxis