The use of HIV Treatment as Prevention (TasP) has radically changed our understandings of HIV risk and revolutionised global HIV prevention policy to focus on the use of pharmaceuticals. Yet, there has been little engagement with the very people expected to comply with a daily pharmaceutical regime. We employ the concept of HIV citizenship to explore responses by people living with HIV in the UK to TasP. We consider how a treatment-based public health strategy has the potential to reshape identities, self-governance and forms of citizenship, domains which play a critical role not only in compliance with new TasP policies, but in how HIV prevention, serodiscordant relationships and (sexual) health are negotiated and enacted. Our findings disrupt the biomedical narrative which claims an end to HIV through scaling up access to treatment. Responses to TasP were framed through shifting negotiations of identity, linked to biomarkers, cure and managing treatment. Toxicity of drugs – and bodies – were seen as something to manage and linked to the shifting possibilities in serodiscordant environments. Finally, a sense of being healthy and responsible, including appropriate use of resources, meant conflicting relationships with if and when to start treatment. Our research highlights how HIV citizenship in the TasP era is negotiated and influenced by intersectional experiences of community, health systems, illness and treatment. Our findings show that the complexities of HIV citizenship and ongoing inequalities, and their biopolitical implications, will intimately shape the implementation and sustainability of TasP.

HIV 治疗作为预防 (TasP) 的使用从根本上改变了我们对 HIV 风险的理解，并彻底改变了全球 HIV 预防政策，将重点放在药物的使用上。然而，对于那些希望遵守日常用药制度的人来说，却几乎没有参与。我们采用艾滋病毒公民身份的概念来探讨英国艾滋病毒感染者对 TasP 的反应。我们考虑基于治疗的公共卫生战略如何有可能重塑身份、自治和公民形式，这些领域不仅在遵守新的 TasP 政策方面发挥着关键作用，而且在艾滋病毒预防、血清不一致关系和（性）健康是经过协商和制定的。我们的研究结果颠覆了生物医学的说法，即通过扩大治疗范围来终结艾滋病毒。对 TasP 的反应是通过不断变化的身份谈判来制定的，与生物标志物、治愈和治疗管理相关。药物和身体的毒性被视为需要管理的东西，并与血清不一致环境中不断变化的可能性相关。最后，健康和负责任的感觉，包括适当使用资源，意味着与是否以及何时开始治疗之间存在冲突。我们的研究强调了 TasP 时代的艾滋病毒公民身份是如何受到社区、卫生系统、疾病和治疗的交叉经验的影响和协商的。我们的研究结果表明，艾滋病毒公民身份的复杂性和持续存在的不平等及其生物政治影响将密切影响 TasP 的实施和可持续性。