Accomplished normalization, enduring exceptionalism: Aging with HIV in the era of antiretroviral treatment.

Abstract

This article examines how adults aged 50 years and older living with HIV in Norway negotiate the contemporary shift from AIDS exceptionalism to biomedical normalization, and what this reveal about the endurance of exceptionalism "by other means." Drawing on 21 semi-structured life-course interviews with people living with HIV, including long-term survivors diagnosed prior to combination ART in 1996, and analyzed through reflexive thematic analysis, the study identifies three patterned meanings. First, participants described "accomplished normalization": HIV was narrated as clinically stable and increasingly comparable to other age-related conditions, supported by simplified ART routines and routinized follow-up care. Second, normalization was "disrupted" and at times actively contested, through stigma encounters, disclosure dilemmas, and especially sexuality and intimacy reactivated HIV as exceptional despite biomedical control. Third, participants articulated "discursive undetectability": viral suppression was experienced as a biomedical achievement, yet many perceived declining public and professional knowledge about contemporary HIV, producing renewed fear, misrecognition, and incentives to conceal serostatus. The findings suggest that later-life HIV is characterized by an ambivalent coexistence of clinical normalization and social exceptionalism, and that meaningful normalization requires sustained public education and recognition alongside pharmaceutical efficacy.