The Ambiguity Of Hiv Risk In Pre Exposure Prophylaxis Prep Administration In New York PDF Download

"Risk" has become a ubiquitous concept in American healthcare settings, drawing both on objective biostatistics and on subjective, morally-charged interpretations. In particular, past epidemiological categorizations of a patient's identity or behavior-like their race or sexual practices-as "risk factors" for contracting HIV has promoted the sociocultural interpretation of HIV risk and stigmatized individuals in those groups. Nonetheless, with the advent of the pharmacologic Pre-Exposure Prophylaxis (PrEP) to prevent HIV transmission, such epidemiological categories of HIV risk are being even more broadly applied. The first medication used for PrEP was Truvada (emtricitabine and tenofovir disoproxil fumarate), an antiretroviral manufactured by the pharmaceutical giant Gilead Sciences that was first approved by the FDA in 2004 to treat HIV-positive patients and then approved again in 2012 as PrEP to prevent HIV infection in HIV-negative patients. Currently, the indications for PrEP prescription are impressively broad and vague, allowing much room for interpretation. Given how past identifications of HIV risk factors negatively implicated entire groups of people, there is a significant need to better understand how HIV risk has been conceptualized, how these concepts may be influenced by the interests of public health agencies and healthcare corporations, and how they play out for health professionals and patients in the clinical setting.In this dissertation, I examine the concepts of HIV risk that come into play in the administration of PrEP, considering how these concepts are understood by individual health professionals and patients alike and how such representations may align with the goals of healthcare corporations and public health agencies. Using ethnographic research techniques, I contrast the perspectives of HIV-negative patients identified as candidates for PrEP, HIV- positive patients, and health professionals administering PrEP to capture how they may understand HIV "risk" and PrEP's role in treating it. I conducted the fieldwork for this dissertation in a New York community health center network that provides PrEP and HIV services to diverse patient populations. I interviewed patients, clinic administrators, social workers, public health workers, and pharmaceutical industry members; observed clinical interactions; reviewed medical charts; and analyzed HIV prevention advertisements, publications, and guidelines. Based upon these collected data, I found that the discourse surrounding HIV risk is ambiguous, PrEP distorts and crystallizes this ambiguity, and structural risk (embedded healthcare structures identifying certain people as "at risk") is a reflective "model of" and constructive "model for" this process in a top-down direction. In doing so, I draw attention to the social significance of the pharmaceuticalization of risk by showing how pharmaceutical marketing can impact how risk is conceptualized, communicated, and experienced.