HIV prep

‘Can a pill a day prevent HIV?’

After more than a decade of clinical trials that entertained the question, “can a pill a day prevent HIV?” the iPrEx trial responded with an enthusiastic ‘yes!’in 2010. To date, this answer has been confirmed by several similar studies. Following FDA approval of Truvada for PrEP in 2012, such enthusiasm is continuing forward through demonstration projects and PrEP is being incorporated into primary care.

Current studies have moved past the question ‘can a pill a day prevent HIV?’ to ask, ‘will this pill be taken everyday and by whom?’ If not, why not, and how often? And will the pill influence risky sex? If so, how? Ultimately, is this cost-effective, by what measure, and for whom? Of course, pharmaceutical firms have their own questions about PrEP, like which other national regulatory agencies approve PrEP? How, and when? Will they use Truvada or pursue generic alternatives? As this novel HIV prevention strategy travels into the shifting landscape of US health care, several pressing inquiries need to be answered.

For a nice overview of the central issues and tensions that give life to these inquiries, see a compelling three-part series about PrEP presented by VICE.

The social life of a pill

My dissertation research follows the social history of PrEP by tracing a wide range of issues, including the earliest clinical trials that tested the safety and efficacy of PrEP, and recent measures within health care reform that influence how people access it, as well as questions about what might come after PrEP, like how will the oral tablet affect the development of injectable and microbicide forms of PrEP or HIV vaccines?

By outlining this history, my research seeks to draw attention to the diverse elements and actors that make PrEP possible, including several institutions (FDA, CDC, Gilead, SFDPH, SFAF), forms of knowledge (biostatistical, epidemiological), and economic arrangements (especially as affected by the ACA) that have produced PrEP in its current form. Moreover, my research emphasizes the human relationships that are integral to the very possibility of PrEP – that is, I’m interested in the fact that there would be no PrEP without casual, romantic and mixed-status sex, and what this means for the way we think about biomedical innovation. In short, my dissertation seeks to show how diverse institutional histories, economies and intimacies are built into this little pill we call PrEP.

For this research, I am reviewing research articles and policy documents and conducting interviews with people who take PrEP and those who provide their care. I am also conducting participant observation in PrEP clinics, primarily shadowing providers and other clinic staff during patient visits. To date, I have reviewed extensive amounts of literature and completed several interviews. While I will continue each of these research activities, for the next 6 months I am shifting focus toward participant observation in clinics.

At this stage, I am hoping to identify a few teams of PrEP care providers that are interested in my research, and willing to work with me to round out my research.