Prep

PrEP (Pre-Exposure Prophylaxis) is a relatively new drug-based HIV prevention technique and an important means to lower the HIV risk of gay men who are especially vulnerable to HIV. From the perspective of biopolitics, PrEP inscribes itself in a larger trend of medicalization and the rise of pharmapower. This article reconstructs and evaluates contemporary literature on biopolitical theory as it applies to PrEP, by bringing it in a dialogue with a mapping of the political debate on PrEP. As PrEP changes sexual norms and subjectification, for example condom use and its meaning for gay subjectivity, it is highly contested. The article shows that the debate on PrEP can be best described with the concepts ‘sexual-somatic ethics’ and ‘democratic biopolitics’, which I develop based on the biopolitical approach of Nikolas Rose and Paul Rabinow. In contrast, interpretations of PrEP which are following governmentality studies or Italian Theory amount to either farfetched or trivial positions on PrEP, when seen in light of the political debate. Furthermore, the article is a contribution to the scholarship on gay subjectivity, highlighting how homophobia and homonormativity haunts gay sex even in liberal environments, and how PrEP can serve as an entry point for the destigmatization of gay sexuality and transformation of gay subjectivity. ‘Biopolitical democratization’ entails making explicit how medical technology and health care relates to sexual subjectification and ethics, to strengthen the voice of (potential) PrEP users in health politics, and to renegotiate the profit and power of Big Pharma.

Resumo Palavras-chave: PrEP; sexualidade; risco; prazer; HIV Este artigo objetiva refletir sobre determinados aspectos da subjetividade de alguns participantes do projeto PrEP Brasil, pesquisa conduzida a partir de 2014 por três centros participantes: a Fiocruz, por meio do Laboratório de Pesquisas Clínicas (LaPClin), o Centro de Referência e Treinamento de AIDS da Secretaria Estadual de Saúde de São Paulo (CRT-AIDS/SP) e a Universidade de São Paulo (USP). O projeto PrEP Brasil envolveu a administração do medicamento antirretroviral Truvada, droga – comercializada nos EUA desde 2012 – que é majoritariamente utilizada por homens que fazem sexo com homens (HSH), e que promete diminuir o risco de infecção pelo vírus HIV 3 em até 96%. Perscrutando alguns dos depoimentos extraídos de um fórum de discussão online sobre a PrEP e entrevistas na mídia, foi possível compreender como a equação " corpo, risco e prazer " se estrutura no cotidiano de alguns usuários desta nova tecnologia para prevenção contra o HIV. Abstract Key words: PrEP; sexuality; risk; pleasure; HIV This article aims to reflect on aspects of the subjectivity of some participants of the PrEP Brazil project, a research conducted since 2014 by three participating centers: Fiocruz, through LaPClin, Centro de Referência e Treinamento de AIDS da Secretaria Estadual de Saúde de São Paulo (CRT-AIDS/SP) and The University of São Paulo (USP), funded by the Ministry of Health of Brazil. The project PrEP Brasil involved the administration of the antiretroviral drug Truvada, a drug marketed in the US since 2012 – mostly used by men who have sex with men (MSM) – that promises to reduce the risk of HIV infection by up to 96%. Looking at some of the testimonies extracted from an online discussion forum and media interviews about PrEP, it was possible to understand how the equation " body, risk and pleasure " is structured in the daily life of some users of this new technology for HIV prevention.

Objective: This study aimed to identify situational and behavioral factors associated with condomless anal sex without on-demand PrEP in the open-label extension (OLE) study of the ANRS-IPERGAY trial. Methods: Univariable and multivariable modified Poisson regressions with a generalized estimating equation (GEE) were used. The attributable risk percentage for each explanatory variable and for condomless anal sex without PrEP was calculated. Results: In the OLE, 19% of anal intercourses were unprotected (i.e., no PrEP or condom). Of these, 85% were attributable to sexual intercourse with main partners and 47% with HIV-negative partners. The following factors were positively associated with condomless anal sex without PrEP: a depressive episode in the previous 12 months (aR [95% CI], p-value: 1.49 [1.02;2.17], 0.039), a higher number of sexual intercourses during the previous 4 weeks (1.01 [1.002;1.02], 0.014), and sexual intercourses under the influence of alcohol (1.45 [1.10;1.92], ...

Sob o referencial teórico-metodológico da análise de discurso, analisam-se todos os 22 textos sobre PrEP (profilaxia pré-exposição ao HIV) veiculados até 31/12/2017 no jornal O Globo. Objetiva-se identificar os sentidos presentes neste impresso acerca dos grupos populacionais alvos deste mais novo método preventivo recentemente incorporado ao sistema público de saúde do Brasil. Dentre os principais achados, ressalta-se que a indicação da PrEP para certas populações foi apenas citada pelo jornal, sem trazer vozes que o debatessem ou questionassem. A exceção foi quanto à comunidade de homens gays, com confrontamento de sentidos acerca da indicação do método para este grupo.

This series has two aims. The first is to deepen anthropological engagement with a novel biomedical technology to prevent HIV. The second is to help bridge the divide between ‘critical’ and ‘applied’ approaches in our discipline. Over the following months we will publish a series of articles that work toward these joint goals. To introduce this series I begin with a brief background note about the biomedical prevention of HIV then offer a conceptual framework to understand what a ‘critically applied’ approach might be.

Trans women are at high risk of HIV infection. We conducted a review to determine the extent to which trans women were eligible for inclusion in and enrolled into pre-exposure prophylaxis (PrEP) efficacy trials. Out of seven trials analyzing PrEP efficacy, we found that trans women comprised only 1.2% of one trial and 0.2% of total trial enrollments. Although an additional PrEP trial to determine efficacy among trans women may not be warranted, further research is needed to determine the effectiveness of PrEP in this marginalized population, through observational and feasibility studies. These studies should focus on unique barriers that trans women may experience while obtaining access to PrEP, such as gender discrimination, transphobia, and violence.

The lack of a primate model that utilizes HIV-1 as the challenge virus is an impediment to AIDS research; existing models generally employ simian viruses that are divergent from HIV-1, reducing their usefulness in preclinical investigations. Based on an ...

This study revised the search strategy and conducted an updated search of MEDLINE, the Cochrane Central Register of Controlled Trials and EMBASE in April 2017. The study also searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing trials. Data concerning outcomes, details of the interventions, and other study characteristics were extracted by two independent authors using a standardized data extraction form. Relative risk with a 95% confidence interval (CI) was used as the measure of effect. 12 randomized controlled trials that meet the criteria for the review were identified. Six were ongoing trials, four had been completed and two had been terminated early. Six studies with a total of 9849 participants provided data for this review. The trials evaluated the following: daily oral tenofovir disoproxil fumarate (TDF) plus emtricitabine (FTC) versus placebo; TDF versus placebo and daily TDF- FTC versus intermittent TDF-FTC. One of the trials had three study arms: TDF, TDF-FTC and placebo arm. The studies were carried out amongst different risk groups, including HIV-uninfected men who have sex with men, serodiscordant couples and other high-risk men and women

Neste artigo pretendo apresentar alguns dos resultados de uma pesquisa de pós- -doutoramento, na qual acompanhei grupos virtuais e encontros presenciais de interlocutores adeptos de práticas sexuais tidas como “de risco”, tais como o sexo bareback, em eventos exclusivos para homens cisgêneros. O objetivo aqui é analisar um certo regime de regulação ético-moral percebido em campo relativo à preocupação de se afirmar que essas práticas se- xuais partem de valores como a “responsabilidade”, o “consentimento” e o “cuidado”. Nas dinâmicas observadas, esses valores se (re)constroem e fissuram a partir do atravessamento de elementos diversos como drogas e medicamentos, além de diversos tensores libidinais. É sobre a produção contextual desses conceitos e a sua relação frente às atuais políticas pública de prevenção que pretendo me debruçar no artigo.

This study revised the search strategy and conducted an updated search of MEDLINE, the Cochrane Central Register of Controlled Trials and EMBASE in April 2017. The study also searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing trials. Data concerning outcomes, details of the interventions, and other study characteristics were extracted by two independent authors using a standardized data extraction form. Relative risk with a 95% confidence interval (CI) was used as the measure of effect. 12 randomized controlled trials that meet the criteria for the review were identified. Six were ongoing trials, four had been completed and two had been terminated early. Six studies with a total of 9849 participants provided data for this review. The trials evaluated the following: daily oral tenofovir disoproxil fumarate (TDF) plus emtricitabine (FTC) versus placebo; TDF versus placebo and daily TDF-FTC versus intermittent TDF-FTC. One of the trials had three study arms: TDF, TDF-FTC and placebo arm. The studies were carried out amongst different risk groups, including HIV-uninfected men who have sex with men, serodiscordant couples and other high-risk men and women.

Die Einführung der HIV-Prophylaxe PrEP ist ein Beispiel für demokratische Biopolitik und macht Hoffnung auf eine Beendigung von Sexnegativität und Stigmatisierung, findet Dr. Karsten Schubert.
Gastbeitrag auf magazin.hiv
https://magazin.hiv/2020/01/24/hiv-prep-als-demokratische-biopolitik/