HIV pre-exposure prophylaxis, stigma and condomless sex: the experience of stigma among men who have sex with men using PrEP
Paper short abstract:
In this paper, I consider both the values underpinning the stigma associated with HIV pre-exposure prophylaxis (PrEP) and how this is experienced by PrEP users. Additionally, I discuss the ways in which this stigma has been challenged by PrEP users and advocates.
Paper long abstract:
HIV pre-exposure prophylaxis (PrEP) is the use of antiretroviral therapy by HIV negative persons to prevent HIV infection. Large-scale, randomised contral trials have shown PrEP to be an effective HIV prevention strategy, whether condoms are used during sex or not. PrEP uptake by men who have sex with men (MSM) has been accompanied by a concern that PrEP might negatively impact the use of condoms, an object that has been imbued with significant social, cultural, and moral capital from the earliest years of the HIV/AIDS epidemic. At one extreme, PrEP users have been portrayed as promiscuous, having a reckless disregard for their own health and that of others, as well as being either unable or unwilling to use condoms. These portrayals have been widely interpreted by many PrEP users as inherently stigmatising. At the same time, however, PrEP has been portrayed by some PrEP advocates and users as a superior form of HIV prevention than condoms. Alongside PrEP-related stigma, then, a stigmatisation of those who only use condoms to prevent HIV has also emerged. This paper draws on multi-sited fieldwork conducted in 2018 among MSM communities in Melbourne, Australia, as well as observations of the social media pages of two Australian-based PrEP advocacy groups. In this paper, I consider both the values underpinning PrEP-related stigma and how this stigma is experienced. I demonstrate that even as PrEP users have been stigmatised as high risk individuals, PrEP users have challenged this through discourses of PrEP's superiority as a harm-reduction strategy.
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