'On December 1, 2015, sex changes. Forever': Pre-exposure prophylaxis and the pharmaceuticalisation of the neoliberal sexual subject

• Published in: Global public health Vol. 13; no. 8; pp. 997 - 1006
• Main Author: Thomann, Matthew
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 03.08.2018; Taylor & Francis Ltd
• Subjects: 21st century; Acquired immune deficiency syndrome; AIDS; Anti-HIV Agents - administration & dosage; Antiretroviral drugs; Antiretroviral therapy; biomedical interventions; Campaigns; Discourses; Disease prevention; Drugs; HIV; HIV Infections - prevention & control; HIV prevention and treatment; Homosexuality; Homosexuality, Male; Human immunodeficiency virus; Humans; Individual responsibility; Male; Medical treatment; Men who have sex with men; Morality; Neoliberalism; Pharmaceuticals; Pre-Exposure Prophylaxis; Prevention; Prevention programs; Preventive medicine; Prophylaxis; Public buildings; Public health; Responsibility; Risk; Sex education; Sexual and Gender Minorities; Sexual Partners; United States; Uptake; United States; HIV prevention and treatment; neoliberalism; Pre-exposure prophylaxis; men who have sex with men; biomedical interventions
• ISSN: 1744-1692; 1744-1706; 1744-1706
• DOI: 10.1080/17441692.2018.1427275

The global scale-up of AIDS treatment initiatives during the first decade of the twenty-first century has been referred to as a kind of 'pharmaceuticalisation' of public health, a trend that is now building in the area of HIV prevention. This paper traces the emergence and increased uptake of pre-exposure prophylaxis (PrEP), antiretroviral medications that can keep HIV negative individuals from becoming infected, placing it within the broader (re)casting of HIV prevention as a medical and technological problem that has been central to the recent 'end of AIDS' discourse. While HIV prevention discourses have been grounded in a neoliberal calculus of individual responsibility since the late 1990s, PrEP constitutes a pharmaceutical extension of the responsibilised sexual subject. Central to this extension are the acknowledgment of one's risk and a willingness to take pre-emptive medical action to secure a future without HIV. For men who have sex with men, a population heavily targeted for biomedical interventions in the United States, PrEP marks a shift in moral discourses of what it means to be a responsible sexual subject. Characteristics of the pharmaceutical extension of the neoliberal sexual subject are explored through an examination of a New York City-based PrEP promotional campaign.