http://orcid.org/0000-0002-1388-4103
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ABSTRACT
Although pre-exposure prophylaxis (PrEP) has dramatically impacted HIV prevention, deep engagement with PrEP-takers’ own accounts of their sexual behavior is still rare. We report findings from semi-structured interviews with male participants of the US PrEP Demonstration Project. In their narratives, interviewees variously foregrounded their individual selves, interactions with sexual partners, and the biopolitical and historical context of their lives. PrEP served to discursively integrate the multiple selves populating these stories. We argue that medical anthropological notions can help make sense of men’s accounts, and PrEP’s role in them, advancing a holistic conception of personhood that includes but transcends concern with HIV.
Acknowlegements
We thank the research participants who shared their stories, as well as Demo Project investigators and staff. We are grateful to the Sex and Sexuality Writing Group at CAPS, the anonymous reviewers, and Lenore Manderson for providing constructive feedback in the editing process.
Supplementary material
Supplemental data for this article can be accessed on the publisher’s website.
Notes
1. Participants at the Washington, DC site were not sampled for interviews.
2. Telephone connection with one Miami participant was lost mid-interview and we were unable to re-establish contact. The partial interview was transcribed and analyzed to the degree possible.
3. In his telling of this encounter, Marco’s confidence in PrEP’s efficacy influenced his behavior. However, during the interview he also ruefully mentioned the “many times” past sexual “missteps” had left him “running to get tested.” Hence, condomless sex with outside partners was not novel for him and should not be attributed exclusively to PrEP. Nonetheless, the role PrEP played as one of several factors contributing to this behavior in this instance highlights the contingent, processual nature of these interactions.
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Notes on contributors
Shana D. Hughes
Shana D. Hughes, PhD, MPH is a specialist at the Center for AIDS Prevention Studies at the University of California San Francisco. Her research on HIV and HIV prevention conceives of sexual practices and notions of risk as biocultural phenomena, framed by personal, social, and structural factors. She is the co-editor, with Dr. Asha Persson, of Cross-Cultural Perspectives on Couples with Mixed HIV Status: Beyond Positive/Negative.
Nicolas Sheon
Nicolas Sheon is an assistant professor at the Center for AIDS Prevention Studies at the University of California San Francisco. Dr. Sheon has a PhD in medical anthropology from UC Berkeley and has conducted research on HIV prevention since 1993. Dr. Sheon’s research focuses on HIV and cancer risk counseling, clinical trial recruitment, and addiction.
Erin V. W. Andrew
Erin V. W. Andrew (MPhil, University of Cambridge, 2008) has served as project manager and qualitative researcher in multiple research projects. She has investigated end-of-life care in Belgium, malaria prevention during pregnancy in Papua New Guinea, and uptake of and adherence to PrEP among MSM in the United States. Ms. Andrew is currently pursuing a career as a Certified Nurse Midwife at the University of Pennsylvania and continues to be involved in research.
Stephanie E. Cohen
Stephanie E. Cohen, MD, MPH is an infectious disease physician and the medical director of San Francisco City Clinic. She was a protocol co-chair and site co-principle investigator of the PrEP Demo Project. Her research focuses on PrEP implementation and STD prevention in the biomedical HIV prevention era.
Susanne Doblecki-Lewis
Susanne Doblecki-Lewis, MD, is an associate professor of Clinical Medicine in the Division of Infectious Diseases at the University of Miami, Miller School of Medicine. She served as a co-investigator and medical director for the Miami site of the PrEP Demo Project. Her research and clinical practice focuses on PrEP implementation in Miami.
Albert Y. Liu
Albert Y. Liu is the clinical research director at Bridge HIV at the San Francisco Department of Public Health. Over the past decade, he has conducted research on the safety and effectiveness of PrEP, strategies to monitor and support PrEP adherence, and how to best implement PrEP in real-world settings. He served as protocol chair of the PrEP Demo Project and is now leading a PrEP demonstration project among transgender populations in the San Francisco Bay Area.