Converting, monitoring, and policing prep citizenship: Biosexual citizenship and the prep surveillance regime

Abstract

Pre-exposure prophylaxis (PrEP) is a revolutionary public health strategy to prevent HIV infection but comes with a significant personal and structural surveillance regime. Using interview data with gay, bi, and queer men on PrEP, field notes, and document analysis, we discuss the individual and institutional practices that produce what we call PrEP citizenship. Drawing on the concept of biosexual citizenship, we show how PrEP citizenship involves surveillance for compliance with use and behavioral guidelines, expanding the PrEP population, and allocating community resources to PrEP users over non-PrEP users. On the individual level, users surveil themselves and others for proper use and sexual behavior, identify nonusers and evangelize PrEP use to them, and stigmatize non-PrEP users as irresponsible, immoral, and potentially infectious. Similarly, on the institutional level, public health, medical authorities, and sexual community infrastructure work to ensure PrEP users remain adherent, increase the user base, and grant material and symbolic resources to PrEP users. PrEP citizenship has implications for the role of the co-production of surveillance in conceptions of biosexual citizenship.