HIV, public health, and the "unwilling or unable" person living with HIV

This paper responds to recent calls from advocates for research on the public health governance of HIV. Drawing on a critical social science with public health approach and theoretical insights from Dorothy Smith and Michel Foucault, we offer a study of key texts that guide public health efforts to prevent HIV transmission in Canada. We explore how the texts lay out case management as an objectified course of action linking risk assessment and public health intervention in ways coordinated by the concept of the "unwilling or unable" person living with HIV or "U2" individual. Our analysis emphasizes how the "U2" concept: (1) establishes a kind of person as a problem that requires public health intervention and management; (2) is implicated in forms of risk assessment and intervention that amplify risk and create discursive conditions that can encourage public health overreach; and (3) propels calls for cross-sector collaboration that can lead to the over-surveillance of people living with HIV, while underestimating the harms of introducing criminal legal system actors into HIV case management. Our hope is that highlighting these concerns can support dialogue among public health authorities, people living with HIV, advocates, and others to improve public health guidance on reducing HIV transmission.