A wager on the future: a practicable response to HIV pre-exposure prophylaxis (PrEP) and the stubborn fact of process

Rosengarten, Marsha; Murphy, Dean

doi:10.1057/s41285-019-00115-y

Cited by 9 publications

(5 citation statements)

References 42 publications

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“…The displacement of older ‘safe sex’ norms did not, however, indicate that participants were less invested in community. Many of the PrEP-taking men in this study talked about how other practices related to PrEP such as frequent STI testing and proactive partner notification of diagnoses, advocating for and educating others on PrEP, and participating in research could also be construed as acts of care for partners and community [ 36 ], or a new form of ‘citizenship’.…”

Section: Discussionmentioning

confidence: 99%

What does PrEP mean for ‘safe sex’ norms? A qualitative study

et al. 2021

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While HIV pre-exposure prophylaxis (PrEP) is highly effective, it has arguably disrupted norms of ‘safe sex’ that for many years were synonymous with condom use. This qualitative study explored the culture of PrEP adoption and evolving concepts of ‘safe sex’ in Sydney, Australia, during a period of rapidly escalating access from 2015–2018, drawing on interviews with sexually active gay men (n = 31) and interviews and focus groups with key stakeholders (n = 10). Data were analysed thematically. Our results explored the decreasing centrality of condoms in risk reduction and new patterns of sexual negotiation. With regards to stigma, we found that there was arguably more stigma related to not taking PrEP than to taking PrEP in this sample. We also found that participants remained highly engaged with promoting the wellbeing of their communities through activities as seemingly disparate as regular STI testing, promotion of PrEP in their social circles, and contribution to research. This study has important implications for health promotion. It demonstrates how constructing PrEP as a rigid new standard to which gay men ‘should’ adhere can alienate some men and potentially create community divisions. Instead, we recommend promoting choice from a range of HIV prevention options that have both high efficacy and high acceptability.

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Section: Discussionmentioning

confidence: 99%

What does PrEP mean for ‘safe sex’ norms? A qualitative study

et al. 2021

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“…The pharmakon’s dual nature as remedy/toxin reminds us that within medicine’s capacity to save lives remains its ability to poison the (social) body. To question medicine’s shortcomings is not to diminish its positive attributes, but is rather to ask for a more comprehensive view of what biopolitical futures are possible (Rosengarten and Murphy 2019 ).…”

Section: Ambivalence Reflexivity and The Embodied Researcher: Conclmentioning

confidence: 99%

Ambivalence and the biopolitics of HIV pre-exposure prophylaxis (PrEP) implementation

2021

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Ambivalence, the vacillation between conflicting feelings and thoughts, is a key characteristic of scientific knowledge production and emergent biomedical technology. Drawing from sociological theory on ambivalence, we have examined three areas of debate surrounding the early implementation of HIV pre-exposure prophylaxis, or PrEP, for gay, bisexual, queer, and other men who have sex with men in Canada, including epistemology and praxis, clinical and epidemiological implications, and sexual politics. These debates are not focused on the science or efficacy of PrEP to prevent HIV, but rather represent contradictory feelings and opinions about the biopolitics of PrEP and health inequities. Emphasizing how scientists and health practitioners may feel conflicted about the biopolitics of novel biomedical technologies opens up opportunities to consider how a scientific field is or is not adequately advancing issues of equity. Scientists ignoring their ambivalence over the state of their research field may be deemed necessary to achieve a specific implementation goal, but this emotion management work can lead to alienation. We argue that recognizing the emotional dimensions of doing HIV research is not a distraction from “real” science, but can instead be a reflexive site to develop pertinent lines of inquiry better suited at addressing health inequities.

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“…Instead, as she puts this, it involved a choice 'to pose the problem [HIV] clearly ' [sic] (Stengers, 1997:216.7). Her account does not detail the immense difficulties faced in making this choice, nor does it mention the inventiveness of cultivating the use of condoms as a protective barrier method for sex, in contrast to a public health insistence on abstinence (Kippax and Race, 2001;Rosengarten and Murphy, 2019). Nevertheless, it dramatizes the importance of a formulation of the HIV problem that is relevant to those who live the response to it.…”

Section: Possibles In the Becoming Of A History Without 'End'mentioning

confidence: 99%

“…In a recent article, Dean Murphy and I have suggested that this early phase of the epidemic can be regarded as the cultivation of a pragmatic response to the problem of HIV. Pragmatic in the sense that foremost in the response was a concern that it should be relevant to living with the given reality or the prospect of such a reality of a communicable infection and, moreover, without presuming to know in advance what would become (Rosengarten and Murphy 2019). By working with what was relevant to those affected by the event of AIDS, this early response to what otherwise seemed as a 'given' problem was effectively altered (Kippax and Stephenson 2012;Kippax and Race 2003).…”

Section: Possibles In the Becoming Of A History Without 'End'mentioning

confidence: 99%

An Unfinished History: A Story of Ongoing Events and Mutating HIV Problems

Rosengarten

2021

Social Aspects of HIV

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By reflecting on the thinking that has come to prevail with regard to women and HIV and, doing so, by working back through an albeit brief outline genealogy of the development of PrEP, I examine how the relevancies of HIV prevention regimes have become folded into a particular scientific logic and why this should concern us. Without disputing the affordances of PrEP, in either pill or long-term acting form, I suggest that the WHO/UNAIDS 90-90-90 goals and, no less, an optimism for a future end to the dynamics of the epidemic is founded on a misplaced conception of what is at stake. Drawing on a branch of process philosophy that has earned the term 'event-thinking', I propose that if biomedicine is to be responsive to the relevancies of those affected by HIV, a more open conception of what is assumed by international health authorities as the 'dynamics of the epidemic' may be warranted. With reference to the RCTS discussed in this chapter, namely SMART, FEM-PrEP and VOICE and their carefully constructed bioethical undertaking yet deemed failure, I suggest that efforts to achieve an ethico-biomedical 'solution' may be out-of-kilter with the realities of those for whom it is proposed. Reluctance or outright recalcitrance of trial participants provides an opportunity for reformulating the problem of HIV and for what has become a normative conception of ethics. Insofar as bioethical rules and norms are presupposed to protect research participants, bioethics shares the same world view as science on what matters. An unfinished history: a story of ongoing events and mutating HIV problems

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A wager on the future: a practicable response to HIV pre-exposure prophylaxis (PrEP) and the stubborn fact of process

Cited by 9 publications

References 42 publications

What does PrEP mean for ‘safe sex’ norms? A qualitative study

What does PrEP mean for ‘safe sex’ norms? A qualitative study

Ambivalence and the biopolitics of HIV pre-exposure prophylaxis (PrEP) implementation

An Unfinished History: A Story of Ongoing Events and Mutating HIV Problems

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