The surrogate marker and its discontents: pluralism in immunity maintenance among HIV-infected persons in Taiwan.

Immunity has emerged as a popular health concept across different cultures, in particular concerning persons with human immunodeficiency virus (HIV). Attentiveness to immune status is encouraged and governed by a powerful clinical and public health surveillance system where two surrogate markers, CD4 counts and viral load, are chosen to monitor not only the effects of the biomedical intervention ART (antiretroviral treatment) but also individuals' effort in adherence and improving lifestyle practices. By interviewing 103 HIV participants, we delineate the reality they encountered while living with these two markers. We explore how they, in response to the doctrine surrounding the markers, shaped their peculiar immunological literacy and beliefs, and tactics for enhancing immunity. We found that the assumed validity of CD4 counts in health surveillance was challenged. The participants' conceptualisation of immunity was largely pluralistic, characterised by a blending of biomedical knowledge and Chinese health concepts and worldviews, strongly reflecting idiosyncrasy and eclecticism rather than universalism in reasoning about these markers and their relevance to immune status and overall wellbeing. Living with clinical markers is becoming a common experience in daily life; their meanings, their impacts on laypersons, and the utility claimed for them by the biomedical community, need further scrutiny.