Active-offer PrEP for HIV prevention: control, discipline, and public health nursing practice

ABSTRACT

Whereas public health efforts to prevent HIV transmission used to focus exclusively on HIV diagnosis and reductions in the practices that transmit HIV, they now include the provision of HIV medication to HIV-negative persons before potential contacts when transmission could occur; this is known as pre-exposure prophylaxis (PrEP). To increase PrEP uptake, recent efforts have begun to include the provision of PrEP referrals by public health nurses as part of their mandated follow-up with patients diagnosed with sexually transmitted infections (STIs). This occurred due to research showing high rates of HIV seroconversion among those diagnosed with infectious syphilis and rectal bacterial STIs. In this way, public health practices have incorporated PrEP as part of standard STI follow-up. While this approach of offering PrEP to those at highest risk for HIV acquisition can be considered a public health success, we review it using the works of Foucault and Deleuze, ultimately arguing that what we call active-offer PrEP can also be seen as a combination of discipline and control; that is, as a mechanism of social regulation. As a final point, however, we caution against rejecting active-offer PrEP, arguing that while critique is necessary, ethical practices are as well, which includes providing much needed services, such as PrEP, to those affected by HIV. We assert that critique should not lead to inaction, but should be used to dismantle social inequities and misguided public health practices.

KEYWORDS:

• HIV
• PrEP
• public health
• Foucault
• Deleuze

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Ontario HIV Treatment Network, from whom O'Byrne holds a research chair in public health and HIV prevention.