揭露的邏輯：臺灣愛滋感染者牙科就醫經驗之質性研究

Abstract

過去十年以來全球愛滋病治理模式轉向「病毒量監管控制」，「Undetectable＝Untransmittable (U＝U)」已成為各國政府與 NGO 進行倡議的重要標語。然而，U＝U 作為一項科學論述進入醫療實作時，其在現場的轉譯與接受程度，特別是在牙科等非感染專科醫療場域中，仍充滿挑戰。實證研究中指出感染者在牙科醫療場域中受到拒診的狀況仍十分常見，多數利害關係人對於 U＝U 的科學效力仍存有懷疑跟不信任態度，感染者主動揭露感染身分可能換來醫療場域的歧視或差別待遇，隱形的污名在醫療場域中持續運作。 本研究結合自我民族誌與深度訪談，透過 15 位愛滋感染者的牙科就診經驗，爬梳在牙科診間中的揭露策略與社群中資訊交換經驗。研究發現，感染者對於 U＝U 的理解與使用並不一致，反映出台灣社會對病毒量與不可傳染性之間的連結仍具有不確定性。其次，感染者揭露過程中常面臨醫療人員對 U＝U 術語的陌生與質疑，加上牙科診間缺乏隱私、溝通空間有限，導致揭露行為帶有高度身分曝光風險與情緒負擔。此外，在面臨拒診與歧視風險的處境下，感染者仍透過社群行動積極建構屬於自己的醫療資訊交換網絡，並與部分牙科醫師共同發展出跨越診間的照護實踐。 本研究重新審視 U＝U 在實務中的應用，指出感染者的揭露策略並非單一行動，而是持續修補關係、協商知識與建構信任的動態過程，亦突顯口號與醫療現場之間的落差。醫療平權應從感染者的經驗出發，理解感染者如何在不確定性中實作照護，以更貼近在地處境的方式推動去污名與醫療平權。

Over the past decade, global HIV governance has increasingly shifted toward the control of viral load. The slogan "Undetectable = Untransmittable (U=U)" has become a key advocacy tool adopted by governments and NGOs alike. However, when U=U enters clinical practice as a scientific discourse, its translation and acceptance—particularly in non-HIV-specialized settings such as dental care—remain highly contested. Empirical studies show that people living with HIV (PLHIV) continue to experience denial of care in dental settings. Many stakeholders remain skeptical of U=U’s scientific validity, and disclosure of HIV status can often lead to stigma and discrimination in healthcare settings, where invisible stigma persists. This study combines autoethnography with in-depth interviews to examine the dental care experiences of 15 PLHIV, tracing their disclosure strategies in dental clinics and their practices of information exchange within community networks. Findings reveal inconsistencies in how PLHIV understand and utilize U=U, reflecting ongoing scientific uncertainty in Taiwanese society regarding the link between undetectable viral load and non-infectiousness. Furthermore, the disclosure process is often met with unfamiliarity and skepticism from healthcare professionals. The lack of privacy and limited space for communication in dental clinics heightens the emotional burden and risk of identity exposure for PLHIV. In response to the risks of denial and discrimination, PLHIV actively engage in community-based strategies to build their own networks for medical information exchange and, in collaboration with certain dental practitioners, co-develop care practices that transcend the confines of the clinic. This study reexamines the implementation of U=U in practice, suggesting that disclosure by PLHIV is not a singular act but a dynamic process of relationship repair, knowledge negotiation, and trust-building. It highlights the gap between advocacy slogans and the lived realities of medical practice. The study calls for healthcare equity efforts to begin with the experiences of PLHIV, in order to understand how care is practiced under uncertainty, and to develop more localized and stigma-sensitive approaches to equitable healthcare.