Ambivalence and the biopolitics of HIV pre-exposure prophylaxis (PrEP) implementation

Mark Gaspar,Daniel Grace,Travis Salway

doi:10.1057/s41285-020-00154-w

Abstract

Ambivalence, the vacillation between conflicting feelings and thoughts, is a key characteristic of scientific knowledge production and emergent biomedical technology. Drawing from sociological theory on ambivalence, we have examined three areas of debate surrounding the early implementation of HIV pre-exposure prophylaxis, or PrEP, for gay, bisexual, queer, and other men who have sex with men in Canada, including epistemology and praxis, clinical and epidemiological implications, and sexual politics. These debates are not focused on the science or efficacy of PrEP to prevent HIV, but rather represent contradictory feelings and opinions about the biopolitics of PrEP and health inequities. Emphasizing how scientists and health practitioners may feel conflicted about the biopolitics of novel biomedical technologies opens up opportunities to consider how a scientific field is or is not adequately advancing issues of equity. Scientists ignoring their ambivalence over the state of their research field may be deemed necessary to achieve a specific implementation goal, but this emotion management work can lead to alienation. We argue that recognizing the emotional dimensions of doing HIV research is not a distraction from “real” science, but can instead be a reflexive site to develop pertinent lines of inquiry better suited at addressing health inequities.

Highlights

We begin by drawing on an anecdote as a non-representative “research device” with the capacity to prompt reflexivity on the current state of knowledge (Race 2016)
We demonstrate how critical attention to this ambivalence can foster productive dialogue on the biopolitics of prophylaxis therapy (PrEP) and health inequities
We focus on how these debates reveal ambivalent tensions regarding the biopolitics of PrEP

Summary

Introduction

We begin by drawing on an anecdote as a non-representative “research device” with the capacity to prompt reflexivity on the current state of knowledge (Race 2016). Critical attention to ambivalence connects to a sociological literature on emotions that conceives of social actors as embodied, emotional subjects and understands that all decision-making is shaped by emotional experience as much as “rational” abstraction or cognitive processes (Freund 1990). Persson (2004) has drawn on Derrida’s conceptualization of the pharmakon (the Greek term for drug) as simultaneously both cure and poison, to investigate the dual capacities of early antiretroviral regimes to improve the health and longevity of people living with HIV and cause significant bodily disfigurement This conflicting duality leads Persson to contend that antiretrovirals are inherently saturated with ambiguity and ambivalence. We conclude by addressing how this ambivalence can affect HIV social scientists and health practitioners as embodied, emotional subjects

Epistemology and Praxis

Clinical and epidemiological consequences

Findings

Sexual politics