Category Archives: Self-medication

This is the introduction to a paper I am developing for this week’s HIV Social Research conference, Silence and Articulation, on the topic of Pre-Exposure Prophylaxis.  Would love to hear any input or thoughts you may have on the topic!

Update: Here is a link to a DRAFT COPY of the full paper.

To see a live version of this paper delivered as guest speaker of the CIHR Social Research Centre in HIV Prevention, Social Drivers Speakers Series on 11 April 2013 in Vancouver, visit Reluctant Objects

This is a speculative paper that attempts to make sense of gay men’s relation to Pre-Exposure Prophylaxis (“PREP”).  It emerges from a series of encounters and an overall impression, based on my participation in gay culture, of what I would venture as a surprising state of disengagement with PREP.  PREP, I will argue, takes the shape of a reluctant object: an object that may well make a tangible difference to people’s lives, but whose promise is so threatening or confronting to enduring habits of getting by in this world, that it provokes aversion, avoidance, even condemnation and moralism.  I will suggest that thinking about gay men’s engagement, or rather dis-engagement, with PREP stands to tell us much about gay men’s self-understanding as subjects of risk in the present moment of the HIV epidemic: If, for Althusser, interpellation describes the ‘hey you!’ moment when a person recognises themselves as a subject of official discourse, we might approach this topic as an inquiry into uninterpellation: the conditions in which one is led to turn away, to linger in a state of non-confrontation, to avoid recognising oneself as a subject of risk.  The object of PREP also forces us to contend with what scares us, not only about risk, but about sex: the ways in which condoms, for example, have operated in the citizenship arena not only as a latex but also a symbolic prophylactic  against the terrifying prospect of unbridled homosexuality.

By positioning PREP as a reluctant object I do not mean to suggest, of course, that PREP is an unproblematic object, or that concerns about PREP are unfounded.  It is certainly the case that PREP poses considerable challenges with regard to its effective implementation, use, and resourcing, that are by now well recognised in the international field.  The issues of non-adherence, risk compensation, unwanted toxicity, and the possible development of resistant virus in the context of sero-conversion and suboptimal treatment are real and must be addressed.  However, in this paper I bracket these concerns, primarily because these are not the concerns I have encountered when raising the issue of PREP with HIV-negative sexual partners and friends.  People outside the HIV sector haven’t even got that far in thinking about it, in my experience.  Rather, what I am attempting to understand is the affective reaction with which news of PREP is often greeted: a reaction of aversion – often powerful aversion and repudiation – among men who are otherwise familiar with, and often have sensible and well-considered approaches to, the challenge of HIV prevention.  Understanding this reaction may be useful for thinking through how to present PREP to the relevant publics, and have the added advantage of framing HIV prevention as a matter of affective attachments and investments: i.e. how people come to attach themselves to particular objects, practices, devices, identities and positions in their attempts to avoid HIV infection.