Examining PrEP: A “Critically Applied” Approach

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For the 2018 meeting of the American Anthropological Association, we have organized a panel that brings critical, ethnographic engagement to bear on (oral) HIV pre-exposure prophylaxis (PrEP), a novel method of HIV prevention, which requires regular adherence to antiretroviral medication and allows HIV-negative individuals to prevent HIV acquisition. As PrEP uptake rapidly expands into new socio-political contexts, anthropological engagement must keep pace by tracking the logics, practices and discourses through which this innovative technology is entering minds and bodies, revealing intimacies and subjectivities.

By bringing together anthropologists engaged in both critical social theory and public health research about PrEP, the panel also aims to trouble the assumed divide between “theoretical” and “applied” approaches in our discipline. It calls for a “critically applied medical anthropology” (Scheper-Hughes, 1990) of PrEP. The impetus for this panel is to imagine “viable approaches toward a critically as opposed to a clinically applied medical anthropology” (Scheper-Hughes, 1990) that might reshape depoliticized social science engagement with PrEP research and implementation that has focused on measuring attitudes and perceptions among potential PrEP users with the goal of increasing uptake. What might a critically applied approach to issues surrounding PrEP (i.e. adherence; new modalities; desire, risk, and pleasure; policy, promotion, and implementation) — one that that takes seriously the role political economy plays in social relations — add to the growing conversation around biomedical HIV prevention? And how might its applications shape the way anthropologists collaborate with biomedical practitioners and researchers as it challenges the economic and power relations that undergird not only PrEP but the HIV epidemic itself?

Collectively, the papers trace how this novel method to prevent HIV moves across diverse geographies, including in sub-Saharan Africa, northern Europe, and the United States, and enters various systems of care, linking public health clinics to private pharmacy delivery services — in-person and online. Along the way, authors adapt analytics from critical social theory to understand how PrEP reveals entrenched health disparities, signals the ongoing pharmaceuticalization of HIV prevention, and takes form at the nexus of risk, pleasure, and desire. Further, these authors aim to understand the intended subject of PrEP: he, she, they who is preconfigured as the patient-consumer that might benefit from using the drug, as deemed appropriate by providers and the subjects themselves. While reviewing national prescription guidelines and tracing how ‘target populations’ are identified, these authors also inquire about the very possibility of addressing disparities through a new pharmaceutical intervention. In this configuration, risk, pleasure, and desire seem unevenly distributed across borders, identities, and subjectivities. They shift, as they cut across race, gender, nation and sexual orientation.

Presenter(s)

Matthew Thomann, Assistant Professor, University of Memphis

Nicole Laborde, Contractor, Bridge HIV, SFDPH

Shana Hughes, Specialist, University of California, San Francisco
Jennifer Syvertsen, Assistant Professor, University of California, Riverside
Tony Sandset, University of Oslo

Discussant

Ryan Whitacre, Postdoctoral Fellow, The Graduate Institute, Geneva