Beyond prevention : lived experiences of pre-exposure prophylaxis in Aotearoa New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Massey University, Albany, New Zealand
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Date
2021
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Massey University
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Abstract
The prevailing research perspectives surrounding the use of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) revolve around public health aspects, offering less insights into the lived experiences of those who use it. This project aimed to expand this perspective and examine the experiences of PrEP users in Aotearoa New Zealand by contextualising them in the local social and cultural backgrounds.
Ten individuals (nine men and one non-binary person) who identified as gay were interviewed individually, each on two separate occasions. A method of interviewing that followed the interpretive Gadamerian hermeneutical approach was used to elicit the deeper meanings of PrEP for its users. The theoretical lens of analysis included Bourdieu’s habitus theory and informed understanding of PrEP use and sexual behaviours as social practices.
During the interviews, participants shared how their connection with the gay community gave them an informed and empowered status as they actively sought PrEP access. Participants pointed to pervasive heteronormativity in healthcare as a source of difficulties, and they reflected on their methods to challenge it. Many participants demonstrated resilience and were active advocates for themselves and their communities. PrEP was not only seen as one of the methods of HIV prevention, but primarily as an agent of personal and sexual liberation. PrEP also served as an enabler of what was seen as safe condomless sex as a carrier of new or recovered symbolic meanings signifying intimacy, connection, and ecstasy, as contrasted with fear and contagion. Condomless sex constituted an important part of the gay habitus that entailed subversive notions of social resistance contradicting the homonormative ideas of mainstream social acceptability. The use of PrEP enabled interrogation of moralised HIV prevention discourses, where condom use served as proxy for homonormative judgments. Differences were noted in ways participants were reconstructing the notions surrounding sexual liberation depending on their generational experiences of HIV/AIDS history.
The new methods of HIV prevention may enable transformation of established discourses that can now allow agentic practices and offer safe ways of embodying desire. The changing notions of sexual risk and safety in previously forbidden practices need to be considered when analysing the impacts of HIV prevention methods and designing public health interventions.
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Keywords
Pre-exposure prophylaxis, HIV infections, Prevention, Social aspects, Gay men, Attitudes, New Zealand