‘It's just an excuse to slut around’: gay and bisexual mens’ constructions of HIV pre‐exposure prophylaxis (PrEP) as a social problem

Abstract

Since the 2012 FDA approval of HIV Pre-exposure Prophylaxis (PrEP) as a method to prevent HIV, its uptake among gay and bisexual men has been met with conflict. Drawing on discussions of PrEP from focus groups with gay and bisexual men in New York City (N = 5 groups, n = 32 participants), we sought to make meaning of the moral debate surrounding the implementation of biomedical HIV prevention medications. Grounded in the constructionist perspective on social problems, this case study focuses on the competing claims making activities gay and bisexual men engage in when framing PrEP and PrEP users. As HIV prevention is a communicative endeavour, analysing the micro level social problems work on PrEP provides key insight into the subcultural norms and values that shape sexual health practices and beliefs within gay and bisexual communities.

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

“…First, much of the negative rhetoric around PrEP stigmatizes PrEP users for wanting to have condomless sex, regardless of whether this behavior actually results in negative outcomes, such as an STI. 54,55 And second, presenting these data legitimizes the consideration of risk compensation as a rationale for limiting PrEP implementation, when it should be irrelevant. Even if PrEP were associated with an increase in STI risk, it is un-equivocally associated with a decrease in HIV infection risk.…”

A tale of two epidemics: gay men's mental health and the biomedicalisation of HIV prevention and care in Toronto

“…GBM have drawn on biotechnology such as antiretrovirals to assess their health, formulate identities and re‐evaluate the moral dimensions of sexual practice (Flowers , Grace et al . , , , Pawson and Grov ). GBM often report ambivalence to the biomedicalisation of HIV, understanding the value of pharmaceutical interventions in controlling HIV incidence, but also expressing reservations over their efficacy, the commodification of the epidemic and the increasing moral and legal obligations to self‐govern vis‐à‐vis biomedicine (Gaspar forthcoming, Young et al .…”

“…). Amongst HIV‐negative men, the daily use of HIV antiretrovirals as pre‐exposure prophylaxis (PrEP) is highly effective at preventing HIV infection, including in instances of condomless anal sex (Pawson and Grov ). In 2015, Health Canada approved prescribing HIV medication as PrEP.…”

“…). Nonetheless, most research on HIV biomedical advances and GBM has concentrated on sexual behaviour (Gaspar forthcoming, Pawson and Grov ). Less is known about how these biomedical advances are influencing mental health.…”

Converting, Monitoring, and Policing PrEP Citizenship: Biosexual Citizenship and the PrEP Surveillance Regime

“…As Kane Race (2016) argues, PrEP is a reluctant object, representing sexuality and morality in queer community discussions of this medication as a wider public health strategy. Since these early considerations published shortly after PrEP's availability in the US (see also Dean 2015), while not universally used and subject to significant racial, gender, and class based disparities (Arnold et al 2017;Bauermeister et al 2013;Cahill et al 2017;Eaton et al 2014;Golub et al 2013), PrEP's acceptance has risen considerably as public health and queer men position it as the superior way to prevent HIV infection (Mustanski et al 2018;Pawson and Grov 2018), as part of an overall strategy to inoculate queer men against infection. As PrEP users and public health officials simultaneously work to prevent HIV at the individual and population levels, we see PrEP as an excellent analytical case (Zussman 2004) to examine the coproduction of surveillance within biosexual citizenship (Epstein 2018).…”