Often, patients who test positive but say that they do not have HIV are said to be “in denial,” and their perspectives are positioned in opposition to medical and scientific discourse. However, Eva and Paula’s rejection of HIV-positive status illustrates their efforts to negotiate and engage with the complicated, varying ideas about HIV created within the clinic walls. This paper examines how ideas about HIV are created through destigmatization, ARV treatment, and work to provide patients with legal assistance, food, and housing.

Paula’s and Eva’s articulations are analyzed at the intersection of two major themes. The first is normalization. Clinic staff and patients work not just to fight a virus, but also to help patients build livable, normal lives. Staff members liken HIV to diabetes, and encourage patients to work and to build relationships. However, all patients said that HIV was capable of making them feel abnormal and stigmatized.

The second major factor that influences Eva’s and Paula’s articulations about their health is conceptual multiplicity. At different points in treatment, clinic staff and technologies articulate what amount to complex, often paradoxical ideas about HIV. For instance, after certain patients take ARVs, their viral loads are said to be reduced to an “undetectable” point – that is, to a point where a lab machine cannot detect the virus. Doctors also discourage many HIV-positive patients from labeling themselves as “sick,” suggesting that someone can be both HIV-positive and healthy. Yet, clinic staff simultaneously stress that patients are different than others: they can never forget about their status and they must take ARVs daily.

Eva’s and Paula’s assertions that they do not have HIV should not be viewed merely as “denial” but also as alternative methods for achieving normalcy in a context where clinical efforts to do so leave gaps. The two patients acknowledge that something is in their blood that could potentially harm their health and the health of their partners, but both patients reject the idea of sickness and the label of “HIV-positive.” Their explanations are situated in a setting where HIV has multiple, multifaceted meanings.

Patients may appropriate and creatively reformulate ideas about HIV according to their needs and circumstances. While planning and implementing treatment, service providers should think through the framings of sickness and health that they offer to patients, and engage with these about their understandings of health issues.