COUNTER-NARRATIVES ON, AND SPECULATIVE FORAYS INTO ‘EFFECTIVE’ PREP USE: A QUALITATIVE STUDY ON THE EXPERIENCE OF CANADIAN MSM PREP (NON-) USERS

4th International The Association of the Social Sciences and Humanities in HIV (ASSHH) Conference, 20-23 July 2018,

Amsterdam, The Netherlands.

Pre-exposure prophylaxis (PrEP) is heralded as a ‘game changer’ in HIV prevention. Should PrEP ‘work’, it could significantly reduce the spread of HIV. But what does ‘work’ mean? How do possibilities for PrEP use relate to current narratives around its ‘effective’ usage and consequently, what is changed, lost and gained in these contexts? Drawing on research with men who have sex with men (MSM) PrEP (non-)users from Ontario, Canada, this paper aims to re(think) notions of ‘effective’ PrEP use. Current biomedical and public health approaches to PrEP often exclusively focus on reducing ‘risk’ and by extension, delimit PrEP to this task alone. However, as our results illustrate, PrEP (non-)use goes beyond notions of ‘risk’ and is intimately entangled with MSMs’ lifestyle, work habits, prophylactic preference and responsibilities as a “good, healthy gay man” - issues that remain hitherto under-examined by research on PrEP. We suggest therefore that research around PrEP must attend to (non-)use as a dynamic accomplishment that is constantly brought-into-being by the different practices and relations that it is bound up in. MSM use PrEP in a multiplicity of ways, to actualise various modes of living and our findings thus highlight the need to take seriously the notion that organic possibilities will necessarily and always exceed that which has been codified as knowledge. This paper will subsequently also explore how future approaches to understanding HIV in the ‘biomedical era’ can benefit from a (more) explicit awareness of the fact that, despite all that we do know, we still simply do not know all that bodies can do, with or without PrEP. Pursuing the idea that bodies have the limitless potential to be creative and to surprise, a foray into the speculative articulation of possibilities will be made with the hope of moving current conversations around PrEP into new directions that will allow for a different understanding of what the ‘effective PrEP user’ is, to emerge.