列管制度下的醫療治理－「人類免疫缺乏病毒傳染防治及感染者權益保障條例」與新道德權威

Medical Governance, Name-Based HIV Surveillance and the New Moral Authoritarianism

黃道明(Hans Tao-Ming Huang)

《台灣社會研究季刊》 94期 (2014/03) Pp. 107-145

摘要

2007年頒佈、翻修自「後天免疫缺乏症候群防治條例」的「人類免疫缺乏病毒傳染防治及感染者權益保障條例」，因民間團體參與修法及增列權益保障條文而廣被視為愛滋人權倡議的里程碑。然而諷刺的是，1990年以來的高壓公衛防治措施（如愛滋罪刑化）不僅在此法下持續運作，把感染者當嫌疑犯監控的列管制度的重心也從公衛體系逐漸轉移到現行醫療院所施行的「愛滋個案管理師計畫」，衍生諸多權力效應。本文為「愛滋個案管理師計畫」政策的初探，企圖審視列管制度的本體轉化過程及其共構效應。我將論證，此照護政策浮現於2000年代中期非法用藥被問題化的環節；它宣稱以「病人為中心」，卻以一種擴散式的醫療監控模式運作，是國家規訓感染者、打造道德公民權的新式人口政治方案，而它和民間團體連結所造就的「愛滋個管服務產業」則刻畫了此刻的官、民協同治理。我的分析將關注環繞於性和用藥的污名，揭示愛滋列管體制的新道德威權如何以自我淨化的溫馨關懷進行治療支配，同時也詰問現下先行排除愉悅的愛滋人權格局。

關鍵字

愛滋 ； 治理 ； 列管 ； 人口政治 ； 用藥

並列摘要

iwan's HIV Prevention Act in 2007 has been lauded as the landmark of human rights advancement and NGO advocacy, chiefly because of the inclusion of equal protection for HIV positive individuals. Yet ironically, all the punitive and stigmatising measures of public health control that have been in operation since the promulgation of the Act in 1990, measures such as namebased reporting, quarterly-based tracking, mandatory testing, and above all, the criminalisation of HIV transmission, remain firmly in place. Crucially the regime of name-based HIV Surveillance has also undergone a profound transformation under the new Act, thanks to the implantation of a certain Hospital-based HIV Case Management (HCM) Program in 2007. In this essay I offer a preliminary investigation into the apparatus of Hospital-Based HCMby examining its ontological transformations and constitutive effects in neoliberal Taiwan. Tracing its emergence to a context pertaining to the problematisation of drug use and harm reduction, I demonstrate how the apparatus, despite its claim to be 'patient-centred', operates as a diffuse form of medical policing in the state's making of moral citizenship. Further, by marking out the apparatus' linkage with the NGO sector, I point to the emergence of what I term the 'AIDS case management industry' and explicate its role in the intensification of HIV control. A biopolitical assemblage, this regime of HIV control, I argue, enacts a benevolent form of therapeutic domination that is premised on the logic of moral contagion. Contesting the self-purifying culture of compassion that the new regime of HIV control fosters, my analysis attends to the stigma around sex and drug use while questioning the foreclosure of pleasure in the enactments of HIV Rights in Taiwan today.

並列關鍵字

HIV/AIDS ； Governance ； Name-Based HIV Surveillance ； Biopolitics ； Illicit Drug Use

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