PrEP as machine: The biomedical turn and the end of HIV prevention labor

Authors: Matthew Thomann*, Kalamazoo College
Topics: Medical and Health Geography
Keywords: Pre-exposure prophylaxis, biomedicine, HIV prevention, neoliberalism
Session Type: Paper
Day: 4/11/2018
Start / End Time: 5:20 PM / 7:00 PM
Room: Riverview I, Marriott, River Tower Elevators, 41st Floor
Presentation File: No File Uploaded


The global scale-up of AIDS treatment initiatives during the first decade of the 21st century has been referred to as a kind of ‘pharmaceuticalization’ of public health, a trend that is now building in the area of HIV prevention. While prevention discourses have been grounded in a neoliberal calculus of individual responsibility since the late 1990s, pre-exposure prophylaxis (PrEP), antiretroviral medications that can keep HIV negative individuals from becoming infected, constitutes a pharmaceutical extension of the responsibilized sexual subject and radically alters HIV prevention labor. This paper traces the emergence and increased uptake of PrEP, placing it within the broader (re)casting of HIV prevention as a medical and technological problem that has been central to recent ‘end of AIDS’ discourses. Discursive and material backing from the World Health Organization and the US Centers for Disease Control for PrEP scale-up, particularly among sexual and gender minorities, may signal the return to AIDS as a medical problem that can be solved through narrow, technological solutions and best left up to experts, constituting a biomedical turn in HIV prevention labor. In a neoliberal policy environment, the reframing of HIV prevention as a medical and technological issue is an attractive shift. Experts may now intervene at the molecular level to control risk, allowing interventions and investment to move away from the ‘messy’ stuff of desire, structural violence, and inequality often addressed by community-based prevention initiatives.

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