Inside the “black box” of the antibody test: deconstructing the official classification of “risk” in test algorithms used for identifying the Human Immunodeficiency Virus

Conference paper


Corbett, K. 2006. Inside the “black box” of the antibody test: deconstructing the official classification of “risk” in test algorithms used for identifying the Human Immunodeficiency Virus. XVI World Congress of Sociology: Research Committee 23. Sociology of Science and Technology Session 6. The Social and Ethical Implications of Biotechnology. Durban, South Africa
TypeConference paper
TitleInside the “black box” of the antibody test: deconstructing the official classification of “risk” in test algorithms used for identifying the Human Immunodeficiency Virus
AuthorsCorbett, K.
Abstract

This paper interrogates the last 20 years in the British experience of using official antibody test algorithms to detect the human immunodeficiency virus (HIV). Case definitions of the Acquired Immunodeficiency Syndrome (AIDS) cite antibody test methodologies licensed since 1985 for screening purposes and derived from laboratory identification of HIV. Two common (yet surrogate) methodologies are the enzyme-linked immunosorbent assay (ELISA) and the Western blot (WB), both used for screening human populations. Test manufacturers publicise the interpretative flexibility of these tests, which may produce false or indeterminate results, given laboratory identification of HIV is cited as problematic, time-intensive and as using surrogate techniques. Globally, public health officials publish differing algorithms for testing of human subjects. The paper shows how these algorithms (whilst aiming to balance test specificity/sensitivity), are based on perceptions of ‘risk’ of exposure determined during pre-test dialogue: how the test subject is positioned as ‘high’/‘low’ risk and within a hierarchy of exposure categories. The interpretation of indeterminate results is problematic given the possibility of false results, which are ruled out by estimating the risk of exposure (‘window period’) and the seroprevalence in the population of the test subject. It is argued that during the last 20 years experience with these test algorithms the interpretation of the test ‘result’ is not wholly ‘objective’ or laboratory-determined, as it relies as much upon the classification of the test subject as being ‘at risk’ during pre-test dialogue as it does upon the “epidemo logic” of the ELISA or WB, data which often remains ‘black-boxed’ from a critical public scrutiny. Using data from tested subjects and published accounts/texts, the paper deconstructs the classification of ‘risk’ embodied by official test algorithms and analyses how the ambiguity/uncertainty characteristic of antibody-test methodologies have sociological implications for ethical decision-making, self-identity and social movements.

ConferenceXVI World Congress of Sociology: Research Committee 23. Sociology of Science and Technology Session 6. The Social and Ethical Implications of Biotechnology
Publication dates
Print23 Jul 2006
Publication process dates
Deposited22 Oct 2015
Accepted01 May 2006
Output statusPublished
Publisher's version
LanguageEnglish
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