HIV Discourse after PrEP

By Wunna

Since its inception, PrEP (Pre-Exposure Prophylaxis) has been widely regarded as a public health breakthrough, offering the LGBTQ+ community a way to prevent HIV transmission and curb HIV progression to AIDS, culminating in the U=U that Undectable = Untransmittable. Yet, I’d like to stress that health or access to healthcare is not simply a discussion of medicine. With PrEP, HIV is still present in our day-to-day lives but now we’ve changed how it is seen.

Emil Edenborg’s “Queer Theories of Peace and Security” reminds us to “queer” research is to destabilize and interrogate normative understandings, practices, and institutions related to sexuality, sex, and gender. And three suggestions of queering a discourse include rethinking problems related to invisibility and hypervisibility, space and geopolitics, and finally, time and temporality. I incorporate these three modes of questioning in reframing the discourse on HIV, especially after PrEP.

Invisibility and Hypervisibility of the Seropositive Body

PrEP has changed what HIV looks like and who looks seropositive (living with HIV). Jan Huebenthal argues, in “Un/Detectability in Times of ‘Equality’: HIV, Queer Health, and Homonormativity,” that the current discourse on HIV centers around responsibility. If you are HIV-positive, being virally suppressed (U=U) makes you a safe subject, and if you are HIV-negative, taking PrEP protects yourself from risk. This means the seropositive body, once marked by stigma, becomes folded into a logic of management, rendering itself invisible in much of public life unless it fails to stay compliant. Therefore, this logic of management and compliance has introduced a moralizing dynamic of invisibility and hypervisibility that counteracts the empowering narrative of U=U.

PrEP has created a new queer archetype, one that defines a PrEP user as one who does not pose a threat to the state and its citizens. Yet, access to PrEP is not equal across social and racial lines because normally PrEP is easier to access for white, male, cisgender people in urban settings. And therefore, these individuals are taken as exemplars and visibilized by the state as those exercising safety and responsibility. And for those without access to PrEP? Queer people of color, trans women, sex workers, undocumented migrants confront a double bind: not only are these communities hypervisibilized as at-risk subjects but they are also invisibilized in their lack of access to PrEP. And the consequence is devastating as their failure to either access or adhere to PrEP is often framed as an individual neglect, not a systematic abandonment.

Borders and the Biopolitical Apartheid

In urban centers such as New York City, San Francisco, and Berlin, PrEP is widely available and normalized as it is prescribed in clinics, advertized in subways and in dating and hookup apps. These are zones of biomedical privilege, where taking PrEP takes on a performative element as the action signals to the public the PrEP-taker as informed, health-literate and sexually progressive. That said, access drops off sharply in rural areas or in prisons, particularly in the Global South, especially since the freezing of funding for PEPFAR (President’s Emergency Plan For AIDS Relief). This means that geography can determine not just who gets access to PrEP, but also who is deserving of it, meaning queer bodies in the wrong place remain out of sight and out of policy. I want to highlight also that the freezing of PEPFAR also reflects neocolonial power since HIV prevention is as much a geopolitical project as a medical goal, where certain bodies are deemed worthy of investment and others too complicated, too risky or simply too far.

Queer Temporality: Who is Included in the Future?

 The advent of PrEP has shifted the temporal narrative of HIV, with the U=U campaign suggesting that the AIDS crisis is a tragedy of the past. The images of people weakening and dying of the past and the future is seen as clean and manageable. But this temporal arc erases those still in crisis, those who are not included in the future and ultimately, relegated to the past. HIV is a daily reality shaped by poverty, stigma, and neglect, not something that was. And this refusal to move on is a defiance to neoliberal temporality that is linear, progressive, and depoliticized. As HIV, as well as differential access to PrEP, still affects communities today, so should they have the time for stagnation, mourning, and rage. Queer time remembers and lingers and does not (want to) move on.

PrEP has shown that biomedical progress does not necessarily equate to social justice. The question is no longer just “who gets to stay negative?” but who gets to live well? Who gets to be part of the queer future? Who gets to be remembered, cared for, and protected, and who doesn’t? And we must insist that no queer body is disposable whether medicated or not, visible or not, in the clinic or at the margins.

Because the crisis never ended. It just changed shape.

Cover photograph: Anna Shvets