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Paper short abstract:

Findings from an ethnographic study in Tanzania among men who have sex with men and transgender women show that even though Pre-exposure prophylaxis (PrEP) as HIV prevention do reduce the risk of contracting HIV, PrEP may introduce new types of risks and uncertainties into PrEP user's lives.

Paper long abstract:

At a study site in Dar es Salaam, transgender women and men who have sex with men come to get the novel biomedical technology: Pre-exposure prophylaxis (PrEP). PrEP is a pill proven to reduce the risk of contracting HIV by up to 99%. While PrEP may reduce the risks of contracting HIV, this paper argues that PrEP can also introduce new risks and uncertainties to their users’ lives. The data draws on ethnographic fieldwork mainly located at the PrEP study site for ten months in 2021/2022. Rumours and stories about PrEP users becoming HIV positive made people uncertain about the promised 99% effectiveness. Furthermore, the complexity of PrEP also brought uncertainty to people’s lives: what happens if a pill is taken at the wrong time or not at all? How would this affect the known 99% protection covered by PrEP? These concerns and worries contributed to serostatus uncertainty. Secondly, some interlocutors experienced social uncertainty about whether their PrEP use could impose a stigma on them, as PrEP was associated with HIV positivity and promiscuity/sex work. Lastly, the projectivization of PrEP programming, local stock-out and delays in the nationwide scale-up of PrEP contributed to an uncertain provision of PrEP to its users. While PrEP has shown to be important to the interlocutors in this study, PrEP also contributes to current uncertainties about life on PrEP here and now, but also a concern about the risks and uncertainties of whether their future would become HIV positive or remain HIV negative.