Alvaro Martinez-Lacabe

Framed across three distinct periods of the history of neoliberalism and the HIV epidemic in England, this article conducts a detailed examination of the concept of personal responsibility and its contested uses within HIV prevention. The article questions the theoretical potential of neoliberal subjectivities to comprehend behaviours related to the pharmaceuticalised governance (or lack thereof) of gay men's sexual health, exploring the gap between theories emphasising individual responsibility and the practical experiences of gay men. The analysis draws on testimonials from gay men in oral history interviews and archival sources. The article illustrates how the pervasive notion of personal responsibility in England has been co-opted by neoliberal ideologies, leading to the stigmatisation of gay men whose sexual behaviours diverge from public health mandates. The widespread stigmatisation resulting from this ideology underscores a significant limitation in the theoretical framework of neoliberal subjectivities. This constraint extends beyond merely failing to grasp the complexity of sexual behaviours; it also reflects a lack of understanding of any other behaviour related to public health. Therefore, the article concludes by advocating the necessity of employing and constructing alternative theoretical frameworks to comprehend the pharmaceutical governance or lack thereof of gay men's sexual health. Through a concise autoethnography of the authors' pharmaceutical sexual health governance, the article introduces the concept of biocommesuration as an illustrative analysis that transcends the limitations of neoliberal subjectivities.

Drawing on testimonies from oral history interviews with HIV/AIDS community activists and PrEP users, this paper analyses new forms of collective action in relation to the efforts to implement PrEP in England. The analysis of this PrEP response, delivered by an assemblage of independent actors and public health-related agents exposes three important aspects in relation to the lived experiences of first-wave PrEP users and HIV activists: (i) the negotiation of PrEP as a medical commodity, (ii) the use of gay dating apps as enabling technologies in regard to peer support, and (iii) the fact that access to PrEP was not equally distributed and differed between gay communities. This paper concludes that although this response was effective in decreasing HIV infection, it was only partially transformative in terms of social/health justice. However, the response featured forms of collective action that contrasted with the individualistic paradigm of the biomedicalisation of HIV prevention, pointing to a shift in future HIV prevention interventions.

Drawing on testimonies from oral history interviews, this paper analyses the implications of pre-exposure prophylaxis (PrEP) practices for gay men in England. Through perspectives on biomedicalisation, the paper focuses on three aspects relevant to the construction of technoscientific identities in the realm of HIV prevention: (i) the question of agency of PrEP users in the context of what has been defined as a biomedical intervention, (ii) practices of freedom framed within neoliberal narratives of personal responsibility versus responsibilisation and (iii) the governance of risk in the era of biomedicalisation. The paper concludes that biomedical governmentalities, even those shaped by the rhetoric of personal responsibility, can be understood as rationalities linked more to solidarity and care of the other. Despite this, the use of PrEP in England is also giving way to the configuration of new sexual scenarios shaped by zero-risk mentalities. It will be important to remain alert to the implications of zero-risk scenarios for HIV-related stigma.
Résumé
En s'appuyant sur des témoignages provenant d'entretiens centrés sur des histoires orales, cet article analyse les implications des pratiques de la PrEP chez les hommes gays en Angleterre. À travers les points de vue sur la bio-médicalisation, il se concentre sur trois aspects de la construction des identités technoscientifiques dans le royaume de la prévention du VIH : i) la question de la capacité à agir des utilisateurs de la PrEP dans le contexte de ce qui a été défini comme une intervention biomédicale, ii) les pratiques de la liberté, encadrées par les récits néolibéraux sur la responsabilité personnelle, versus la responsabilisation, et iii) la gouvernance du risque à l'ère de la bio-médicalisation. En conclusion de leur article, les auteurs soutiennent que les << gouvernementalités >> biomédicales, y compris celles qui sont déterminées par la rhétorique de la responsabilité personnelle, peuvent être comprises comme des rationalités plus en rapport avec la solidarité et le souci des autres. Malgré cela, l'usage de la PrEP en Angleterre laisse la place à la configuration de nouveaux scénarios sexuels déterminés par les mentalités du risque zéro. Il est important de rester attentif aux implications des scénarios du risque zéro au regard du stigma lié au VIH.
Resumen
A partir de testimonios obtenidos a través de entrevistas de historia oral, el presente artículo analiza las repercusiones de la PrEP (profilaxis preexposición para el vih, por sus iniciales en inglés) en las prácticas de hombres gais en Inglaterra. Partiendo de perspectivas sobre la biomedicalización, el artículo se centra en tres aspectos pertinentes a la construcción de identidades tecnocientíficas en el ámbito de la prevención del vih: i) la cuestión de la gestión (agency) de los usuarios de la PrEP en un contexto identificado como de intervención biomédica; ii) las prácticas de libertad enmarcadas en narrativas neoliberales de responsabilidad personal versus responsabilización; iii) el manejo del riesgo en la era de la biomedicalización. El artículo concluye que los manejos biomédicos, incluso aquellos moldeados por la retórica de responsabilidad personal, pueden entenderse como racionalidades vinculadas más con la solidaridad y el cuidado de los demás. A pesar de esto, el uso de la PrEP en Inglaterra está cediendo espacio a la configuración de nuevos escenarios sexuales determinados por esquemas mentales de riesgo cero. Debemos permanecer atentos ante las implicaciones que conllevan los escenarios riesgo cero para el estigma vinculado con el vih

Pre-Exposure Prophylaxis (PrEP) is marking a milestone in contemporary HIV prevention technologies and strategies globally. This is being achieved by increasing national and international promotion of PrEP to specifically targeted HIV negative persons as a prophylactic means via which to prevail against viral transmissions in cases of unsafe sex between sero-discordant sexual partners. As such, PrEP is emerging as intrinsically bound to the production of new discourses on mutual care, pleasure, sexual risk and transgression. This is taking shape via new and on-going international and national policies aimed at achieving a post-AIDS future.

The promotion of PrEP, for example as newly advanced by agencies such as the World Health Organization, is largely centring on so-called ‘key populations’ who have long come to be defined as vital focal points of international HIV prevention policy and practice – in terms of sexual transmission most notably female, transgender and male sex workers and ‘men who have sex with men.’ PrEP promotion is reviving an interest in the targeting of such population groups in a manner that introduces new ethical questions concerning the connection between bio-politics and sexual subjectivity. Yet as PrEP opens a new emphasis for bio-medical/public health investment in HIV and AIDS work globally the relationship between communities, sexualities, bodies, markets and viral intervention is being radically re-narrated. Issues emerge concerning imaginaries of sexual difference as a ‘natural’ locus for rights and recognition, versus varied cultural, biomedical, and policy orientations toward sexually dissident subjects and practices.