Abstract
The global implementation of pre-exposure prophylaxis (PrEP)—a HIV prevention medicine—has evoked new hopes of ending AIDS. In 2016, a group of Taiwanese and Thai doctors and AIDS advocates initiated a PrEP delivery online platform to assist gay Taiwanese men to access the less expensive, generic versions of PrEP in Thailand. Drawing on science and technology studies, this article investigates how gay men’s bodies and sexualities and PrEP’s promise of ending AIDS become intertwined with the political and cultural economy of governmental regulation, pharmaceutical innovation, and personal mobility and pleasure. Building on the ethnographic fieldwork conducted in Taiwan and Thailand, it scrutinizes changing definitions of sexual health and surplus values of PrEP in two intertwined social settings: One is that of Taiwan’s online PrEP delivery system, which mediated between the top-down biomedical regulation of the pharmaceutical industry and Taiwanese state, and the other one is the transnational commercial transitions, which mediated through commercial ventures and individual recreational and consumer activities. By moving across various social landscapes, the article not only acknowledges the constraints put upon the individual by processes of commodification but also recognizes the possibilities and potentialities that are enacted by laypersons’ desires and migratory practices.
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Notes
Between the PrEP online pharmacy’s launch in 2016 and the middle of 2018, 256 individuals used the delivery system to obtain generic PrEP. At least 20% of these users had been formally registered in the CDC’s demonstration projects (Chu et al. 2018). The Taiwanese government-led PrEP program had recruited a mere 302 participants.
Unique to Taiwan and some other countries (such as Japan, Germany, Sweden, Denmark, Finland, and Norway), the Drug Hazard Relief system consists of a set of legal procedures for promptly assisting people who suffer from ADRs (On et al. 2012). Specifically, Taiwan’s drug injury hazard scheme adopts a no-fault, compensation-based system in which ADR victims receive immediate compensation without having to endure litigation that can be time- and labor-consuming. In addition to civil law, the drug hazard relief system serves as an extra layer of legal protection that reflects a strong consumer-protection spirit. Access to the system is limited to those who follow government-approved medical guidelines. Notably, the drug injury relief system exists not so much to hold pharmaceutical companies legally accountable as to be an expression of humanitarian charity (On et al. 2012).
In medicine, off-label drug use is defined as using medicine for a purpose other than that established by the FDA’s approved guidance (Miller, 2009). It is important to note that the off-label use of drugs is not entirely without merits. For example, off-label drug use can be an alternative treatment option when current treatment methods are exhausted. Additionally, off-label drug use can help reduce prescription costs when a non-approved medicine with similar treatment effects is used in the place of an approved medicine. From the Taiwanese medical community’s perspective, the provider-assisted PrEP access model amounted to off-label drug use.
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Acknowledgements
The author would like to thank David Serlin and Lisa Cartwright for their guidance. At the Fairbank Center for Chinese Studies, Harvard University, the China STS research group—Susan Greenhalgh, Victor Seow, Ya-Wen Lei, Arunabh Ghosh, and Peter Braden—offered valuable feedbacks on the early version of this article. Finally, the author want to thank two anonymous reviewers for their useful suggestions.
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Huang, P. Sexual health as surplus: the marketization of PrEP in Taiwan. BioSocieties 18, 410–428 (2023). https://doi.org/10.1057/s41292-022-00273-9
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DOI: https://doi.org/10.1057/s41292-022-00273-9