Paper short abstract:

The PrEP pill, intended to prevent HIV, also puts users at risk of different types of stigmatization related to gender, promiscuity and HIV. Social anthropology enables us to examine global health critically, explore the users' lived experiences, and understand what stigma means to PrEP users.

Paper long abstract:

Based on 11 months of ethnographic fieldwork following a Pre-exposure prophylaxis (PrEP) study for men who have sex with men and transgender women in Dar es Salaam, this study observed how the PrEP pill, intended to prevent HIV, also put users at risk of experiencing several types of social stigmatization. Anthropological perspectives and methods enable us to examine global health interventions critically, explore the users' lived experiences and employ theory to make sense of what, in this example, stigma means to PrEP users. Stigma was, above all, related to social exclusion when living with HIV, and being identified as a PrEP user might be (mis)read by the users' social environment to indicate HIV positivity. In this respect, PrEP use was mistaken for the use of ARVs. While neither PrEP use nor living with HIV was mainly linked to homosexuality, men who have sex with men were targets for PrEP interventions; PrEP users ran the risk of being stigmatized as "homosexual" or "gay". Lastly, for persons assigned male gender at birth who did sex work, PrEP became an important HIV preventative measure and enabled safer sex and more partners. However, the social risk of exposing PrEP use to clients was, for some, a constant concern, as their status as PrEP users could mark them off as promiscuous and as living with HIV. These findings show that HIV stigma persists and that interventions aimed at biomedically preventing HIV transmission may have the somewhat paradoxical effect of triggering different forms of stigmatization.