The Social and Political Dimensions of the Ethics of PrEP for HIV Prevention Among MSM

For many men who have sex with men (MSM), the risks, treatment, and prevention of HIV are central and unavoidable aspects of their experiences of sex and romance. This constant vigilance around HIV complicates their lives in medical as well as interpersonal and socio-political ways. Pre-exposure prophylaxis (PrEP) is a relatively new method of HIV prevention that is already revolutionizing the lives of MSM by lessening the need for this ongoing vigilance. However, the wide-ranging effects of PrEP on MSM are as of yet unclear. Therefore, the ethics of using PrEP among MSM is a timely issue that demands philosophical engagement. As MSM in North America face decisions of whether or not to use PrEP and the consequences of those decisions, philosophy has an important role to play in helping us think more clearly about the situation today by moving away from a strictly medical conception of the ethics of PrEP.

In my first chapter, I motivate my investigation into the social and political dimensions of the ethics of PrEP by providing a critical history of HIV and HIV prevention. In my second chapter, I challenge the prevalent risk assessment approach to the ethics of PrEP, arguing that it has a distorting effect, overblowing some risks while overlooking others. The second half of my dissertation demonstrates how a relational approach, focused on the conditions for trust and solidarity, better reveals the ethical terrain facing MSM with decisions about PrEP. In my third chapter, I examine the role of trust in sexual and romantic relationships between MSM as well as relationships between MSM and healthcare providers. In my final chapter, I argue that PrEP complicates relationships of solidarity within gay communities, focusing in particular on intergenerational differences in perspectives on HIV and HIV prevention.

Overall, my dissertation helps move us towards a more socially and politically informed conception of the ethics of PrEP, which helps us understand how MSM can live ethically within communities whose sexual and romantic lives continue to be medicalized, both internally by members of gay communities and externally by a broader culture and public health establishment.