Responsibilization and Sexual Stigma Under Austerity: Surveying Public Support for Government-Funded PrEP in England

Abstract

Introduction: Under austerity, governments shift responsibilities for social welfare to individuals. Such responsibilization can be intertwined with pre-existing social stigmas, with sexually stigmatized individuals blamed more for health problems due to “irresponsible” sexual behavior. To understand how sexual stigma affects attitudes on government healthcare expenditures, we examine public support for government-provisioned PrEP in England at a time when media narratives cast the drug as an expensive benefit for a small, irresponsible social group and the National Health Service’s long-term sustainability was in doubt. Methods: This paper uses data from an original survey (N = 738) conducted in September 2016, when public opinion should be most sensitive to sexual stigma. A survey experiment tests how the way beneficiaries of PrEP were described affected support for NHS provision of it. Contrary to expectations, we found that support was high (mean = 3.86 on a scale of 1 to 5) irrespective of language used or beneficiary group mentioned. Differences between conditions were negligible. Discussion: Sexual stigma does not diminish support for government-funded PrEP, which may be due to reverence for the NHS; resistance to responsibilization generally; or just to HIV, with the public influenced by sympathy and counter-messaging. Social policy implications: Having misjudged public attitudes, it may be difficult for the government to continue to justify not funding PrEP; the political rationale for contracting out its provision is unnecessary and flawed. With public opinion resilient to responsibilization narratives and sexual stigma even under austerity, welfare retrenchment may be more difficult than social policymakers presume.