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Accepted Paper:
Ambivalent Hopes of Medicalised Demarginalization: Pharmaceutical HIV-Prevention in Germany
Max Schnepf
(Freie Universität Berlin)
The pharmaceutical HIV-prophylaxis PrEP raised hopes of eradicating HIV and the stigma associated with it. This paper investigates the ambivalences of a medicalized quest for inclusion into mainstream society as ‘respectable citizens’ that is predicated on a self-identification as ‘risk subjects’.
Paper long abstract:
PrEP, short for Pre-Exposure Prophylaxis, is a relatively new drug that provides effective protection against HIV. Since 2019, the costs for the pharmaceutical and concomitant examinations have been covered by German public health insurance for people considered at risk of contracting HIV, most prominently men who have sex with men. With this universal coverage, PrEP raised political and epidemiological hopes of eradicating the spread of HIV alongside the stigma associated with an infection. However, since PrEP allows for safer sex without a condom, the pharmaceutical also reinvigorated long-established stereotypes about risk-taking gays, no longer spreading HIV/AIDS but now (again) other sexually transmitted infections. In accordance with the concepts of ‘pharmaceutical’ and ‘biosexual citizenship’ (Ecks 2005, Epstein 2018), this paper argues that a move away from societal margins is often premised on access to health provision. Based on my ethnographic fieldwork about the pharmaceutical HIV-prophylaxis in Berlin, I present two past efforts of making PrEP available in Germany: an activist group’s information campaign and a pharmacist’s deal with a pharmaceutical company. In conversation with these initiatives, I argue that in the case of PrEP the pharmaceutical hope of demarginalization is an ambivalent one. I point out the complexities of a quest for inclusion into mainstream society as ‘respectable citizens’ that is predicated on a self-identification as ‘risk subjects’. Investigating the subjectivities mobilized by this hope of demarginalization, I finally ask who is able to move away from the margins and which exclusions PrEP might create or reinforce along the way.