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The Prep Recommendation: the Inscribed Disease in a Healthy Body

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The Prep Recommendation: the Inscribed Disease in a Healthy Body THEMES AND DEBATES The PrEP recommendation: the inscribed disease in a healthy body Simone Wolfgang, PhD; Denise Portinari PhD In July 2014, the World Health Organization This measure also exposes a delicate aspect of (WHO) recommended that all gay men join the the social conduction of the HIV/Aids epidemics: “pre exposal medication Truvada” as a valid the stigmatization related to the gay community as resource to prevent HIV. The PrEP, prophylaxis the ultimate risk group. Affirming that every consists in taking a combination of antiretroviral homosexual should take the PrEP pill, may have medication once a day, in order to prevent HIV the effect of perpetuating the idea that gay men are infection. The WHO promotion of a policy that the main vector of this disease. Among the recommends all HIV negative gay men to join the misconceptions that this may involve are the PrEP, may be seen, in the context of contemporary perpetuation of prejudice related to Aids and gay biopolitical techniques and strategies, as a form of men, leading heterosexual populations to believe control and medicalization of homosexual bodies that they are not connected in the epidemic chain. and practices. It´s important to explicit the life- Keywords: HIV/Aids, Pre exposure prophylaxis, related effects linked to a measure like the PrEP homosexuality, biocontrol, male body, biopower program, considering this as a paradigm shift in HIV/Aids strategies. The shift involves the gradual 1- Introduction substitution of the “condom use” The main goal of this article is to explore the recommendations for the use of permanent possibilities and consequences of the PrEP1 prophylactic medications, and may be understood recommendation, (pre-exposure prophylaxis for as a move away from the abstinence paradigm – HIV) through the analysis of media discourse, sexual behavior control – to a more contemporary literature and scientific articles related to this form of individual medicalized body biocontrol, subject, that have been published in the last couple as outlined by Foucault in his later texts. of years. The PrEP prophylaxis is a therapeutic hypothesis, concerning the prevention/treatment of Simone Wolfang HIV, that consists in taking one pill of a specific Title: PhD. in Design. antiretroviral as an alternative prevention form for Affiliation: Professor-researcher, Institute of Studies in Public Health, Federal University of Rio de Janeiro, HIV/Aids. Some double blind studies are being Brazil, and Pontifical Catholic University of Rio, conducted in countries of South America and Brazil. Africa, with serodiscordant couples. Gilead, the E-mail: [email protected] pharmaceutical industry that manufactures this medicine, actually sponsors most of these studies, Denise Portinari. in partnership with some research institutes like Title: PhD. in Clinical Psychology. US NIH and the Bill and Melinda Gates Affiliation: Professor-researcher, Institute of Studies Foundation. The PrEP protocol has been used as in Public Health, Federal University of Rio de Janeiro, an official public health policy in the United States Brazil, and Pontifical Catholic University of Rio, 2 Brazil. since 2014 supported by the government and the E-mail: [email protected] Received: May 25, 2019. Accepted: June 12, 2019. 1 Short for Pre exposal prophylaxis Conflict of interests : none. 2 CDC means Center for Disease Control, it´s the US govern agency that establishes the rules for the control Social Medicine (www.socialmedicine.info) - 272 - Volume 12, Number 3, September-December 2019. CDC. In 2014 there were about 3253 people using volunteers, or as researchers. The other significant PrEP therapy in different parts of the United source is a collection of textual data gathered from States. a variety of sources such as PrEP manuals and In the course of our argument we will seek to study protocols, institutional online sites, mass examine some aspects connected to the usage of media vehicles and scientific journals, the PrEP as a public health policy, exposing some commenting on different aspects of the of the possible reasons that led to the emergence prophylaxis. From these sources of information we of this method of prevention, and discuss some of have gathered observations on several important the issues that can be related to this prophylaxis. In aspects of the PrEP usage, such as the different the middle of July 2014 the World Health regimen choices in the multiple studies that are Organization (WHO) recommended that all HIV- conducted and their consequences, the point of negative, sexually active "men who have sex with view of those who support the prophylaxis and of men" or "MSM" and transgender women should those who look at it more cautiously, and some of consider joining in a permanent basis the pre- the most common issues related to this form of exposure prophylaxis (PrEP), which consists in profilaxy, such as cumulative toxicity and the the daily use of Truvada, an antiretroviral drug possibilities of a widespread relaxation in safer sex combination, in order to prevent HIV infections. practices. “Clinical Study Data Sources. Clinical data are now available from several relevant 3- A little bit more about the PrEP human studies on ART PrEP for sexual PrEP, short for pre-exposure prophylaxis, are transmission of HIV-1. All studies of ART a series of studies to assess whether the use of a PrEP were conducted in the public health pill that combines two antiretroviral drugs, setting and sponsored by one or more non- industry organizations. All of the studies tenofovir (TDF) and emtricitabine (FTC) - evaluated ART PrEP concurrent with a marketed as Truvada - can significantly reduce the background of HIV-1 risk-reduction spread of HIV virus in seronegative people. The counseling and provision of conventional site of the French National Agency for Health HIV-1 prevention methods. For each of the describes several benefits of PrEP such as that it studies, Gilead provided study drug (ie, "may be effective in preventing HIV infection in Truvada or Viread) but did not participate in men who have sex with men and transvestites." In protocol design, study administration, or France, the study is conducted by ANRS (National data collection. (…) Study sites are located Agency for Research on AIDS and Viral in 6 countries: 3 in Peru, 1 in Ecuador, 3 in Hepatitis). In Brazil, the study is conducted by the Brazil, 2 in the United States, 1 in Thailand, and 1 in South Africa.” (Gilead 2012 p.8) National Institute of Infectious Diseases Evandro Chagas - Oswaldo Cruz Foundation. 2- Methodology The prophylaxis, in most sources, is usually This article is part of the initial and exploratory presented as a new form of HIV/Aids prevention, stage of a postdoctoral research in which the and often described as quite revolutionary, in a universe that for nearly three decades was activities are to be conducted bilaterally, in Brazil 3 and France. Its main goal is to investigate the populated mainly by messages of "safer sex" and similarities and differences of PrEP in these two condom usage. countries. The information that is used in this Emerging from a very restricted universe, article was obtained from two different sources: with quite limited prevention options regarding an one consists mainly in participant observation in incurable condition, PrEP´s popularity has grown Brazilian, north American and French online 3 groups for PrEP discussion, and informal Safer sex messages can be taken as “the status quo” of conversation with participants of both nationalities the prevention since de 1990´s and it consists in the in actions related to PrEP protocol, either as condom usage recommendation advertisements that are commonly displayed in HIV/Aids prevention and prevention for the infectious diseases in the United campaigns. States and all its territories. Social Medicine (www.socialmedicine.info) - 273 - Volume 12, Number 3, September-December 2019. widely, mostly for accomplishing good results in Today, in 2015, it´s been about a year since most researches, and due to the 2014th WHO´s the first research related to the pre-exposure recommendation. The prophylaxis reputation prophylaxis has been applied in Brazil. This seems impeccable, and lots of people are research is conducted by Fiocruz in Rio de interested in joining the therapy that is much Janeiro. Currently, there is more than one type of acclaimed among certain social groups; in fact it is PrEP protocol under development in Brazil and not uncommon to see news about the PrEP in the from what one may infer about the prevailing news and in discussion groups in social networks. attitude in user, media and scientific discourse, That said, it is also absolutely necessary to mostly related to the North American experience, put the PrEP in perspective: issues related to its it seems well on its way to being integrated into practice should be raised and a questioning of the Brazilian public health policies in the near future. all aspects of the therapy should be exposed and Currently, the main Brazilian research is the discussed. From the perspective of human and iPrEx4 Protocol, which has about 650 volunteers. social sciences, this can be done in different ways. What we have observed so far is that this increase In this research, we are combining the analysis of of PrEP studies is gradually changing the focus of the study protocols and manuals for the prevention. Since the beginning of the 1990´s most implementation of PrEP and its results, with of the HIV/Aids prevention actions were based information from program researchers and almost exclusively in the promotion of safe sex volunteers, as well as textual data derived from practices. Now, we seem to be facing a very various sources, and crossing these data with the significant shift from the safe sex paradigm to a current literature related to the issues of public new, almost entirely medicalized form of health, sociology of health and social medicine.
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