Social scientists have much to contribute to the analysis of the real and potential contribution of pre-exposure prophylaxis (PrEP) to HIV prevention around the world. Beyond just a matter of clinical efficacy and getting pills into people's mouths, PrEP raises a number of important social-psychological questions that must be attended to in order to translate biomedical and clinical findings into uptake of PrEP among enough people at risk of HIV infection to produce population-level effectiveness. PrEP is a dynamic phenomenon with “dialectical” attributes that invite both optimism and cynicism as a desirable and effective HIV prevention strategy. PrEP disrupts traditional notions of “safe” and “unsafe” sex; it confers on its users a level of agency and control not generally achieved with condoms; and it affects sexual practices and sexual cultures in meaningful ways. As these dynamics play out in different contexts, and as new modes of PrEP administration emerge, it will be important for social scientists to be engaged in assessing their impact on PrEP implementation and effectiveness.
This article explores the meanings 18 HIV-negative gay male participants in San Francisco attributed to their positional identity as 'bottoms'. In particular, I analyze two dominant, mutually constitutive sets of sexual scripts participants invoked in their bottom narratives: first, that bottoms are men who desire to produce pleasure for their partners; and second, that bottoms are men who desire to submit sexually to their partners. I argue that these scripted conceptions both give possibility to and constrain the ways in which participants interpret and experience their sexual practices and desires. I conclude by examining how these scripts operate as structurated social phenomena that shape the ways in which participants are able to navigate scenarios in which these scripts conflict directly with 'safer sex' scripts, potentially resulting in what I term 'pleasure/risk dilemmas'.
Despite not originating in Spain, the 1918 influenza pandemic is commonly known as the “Spanish flu”—a name that reflects a tendency in public health history to associate new infectious diseases with foreign nationals and foreign countries. Intentional or not, an effect of this naming convention is to communicate a causal relationship between foreign populations and the spread of infectious disease, potentially promoting irrational fear and stigma. I address two relevant issues to help contextualize these naming practices. First is whether, in an age of global hyperinterconnectedness, fear of the other is truly irrational or has a rational basis. The empirical literature assessing whether restricting global airline travel can mitigate the global spread of modern epidemics suggests that the role of travel may be overemphasized. Second is the persistence of xenophobic responses to infectious disease in the face of contrary evidence. To help explain this, I turn to the health communication literature. Scholars argue that promoting an association between foreigners and a particular epidemic can be a rhetorical strategy for either promoting fear or, alternatively, imparting a sense of safety to the public.
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