Exploring the HIV pre-exposure prophylaxis (PrEP) risk rituals: individualisation, uncertainty and social iatrogenesis

AbstractHIV Pre-Exposure Prophylaxis (PrEP) consists of a daily antiretroviral regimen that prevents HIV acquisition. In this article, we discuss ways in which individuals on PrEP deal with risks and uncertainties through their life experiences amid PrEP risk rituals and rational and non-rational individualisation processes. We analysed data from a web-based group of mostly gays, bisexuals and other men who have sex with men on PrEP through a thematic-content approach. We found that individuals, influenced by medical and health institutions, were involved in ‘risk rituals’ with profound effects on their subjective embodiment, emotions and feelings. These processes became amalgamated into conflicting objective consequences to themselves and their social networks, which included the acquisition of new diseases amid increasing ambivalences of being on PrEP. Our theoretical argument is that risk rituals were symptomatic of social iatrogenesis amid the contemporary risk and individualised society. By developing an analytical dialogue between our empirical data and modernisation theories of risk and individualisation, we sought to understand risk rituals through conflict, relational, group and institutional domains, as these layers of analysis help us grasp the core characterisation of social iatrogenesis. Drawing on these insights, we also pay attention to potential futures of injectable PrEP, considering the role of hope, the collective production of the unknown and medical action as a type of intensification of risk rituals and social iatrogenesis.Keywords: HIV pre-exposure prophylaxisrisk ritualsindividualisationuncertaintyiatrogenesis Disclosure statementNo potential conflict of interest was reported by the author(s).AcknowledgmentsWe want to thank the Editor, Patrick Brown, and all anonymous peer-reviewers for a critical editing and review of this article. Special thanks to Emma Lumsden and Sandi Oliveira (University of Copenhagen) for providing suggestions and corrections at different stages of the manuscript.Additional informationFundingThe work was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior [ProexUSP]; Fundação de Amparo à Pesquisa do Estado de São Paulo [15/16218-0].