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Agency, Pleasure and Justice: A Public Health Ethics Perspective on the Use of PrEP by Gay and Other Homosexually-Active Men

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Remaking HIV Prevention in the 21st Century

Part of the book series: Social Aspects of HIV ((SHIV,volume 5))

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Abstract

The introduction of pre-exposure prophylaxis (PrEP) for HIV has triggered critical analysis within the social sciences. For example, some have signalled how PrEP may lead to a renewed medicalisation of gay and other homosexually-active men’s sexuality. This chapter challenges some of those accounts. Adopting a public health ethics perspective, it argues that gay men should be understood as agentic in their use of PrEP, as opposed to being the passive victims of medicalisation, and that greater attention should be paid to questions of pleasure in PrEP use. Applying a reproductive justice framework, the chapter argues that the worldwide inaccessibility of PrEP constitutes a more serious ethical issue than the potential problem of the medicalisation of gay men’s sexuality.

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Notes

  1. 1.

    The main ethical principles within this safe sex ethics framework are respect for autonomy and justice (Brisson et al. 2019b, pp. 54–55): respect for autonomy by acknowledging the right to engage in sex and to choose preventive measures; and respect for justice by paying attention to social context, in this case how the HIV epidemic principally affects already socially marginalised communities, hence creating the need to address issues related to justice.

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Author information

Authors and Affiliations

  1. Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada

    Julien Brisson, Vardit Ravitsky & Bryn Williams-Jones

Authors
  1. Julien Brisson
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  2. Vardit Ravitsky
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  3. Bryn Williams-Jones
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Corresponding author

Correspondence to Julien Brisson .

Editor information

Editors and Affiliations

  1. School of Public Health, University of Sydney, Sydney, New South Wales, Australia

    Sarah Bernays

  2. Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia

    Adam Bourne

  3. Social Policy Research Centre, UNSW Sydney, Kensington, New South Wales, Australia

    Susan Kippax

  4. Centre for Social Research in Health, UNSW Sydney, Kensington, New South Wales, Australia

    Peter Aggleton

  5. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA

    Richard Parker

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This work was supported by a doctoral research award to Julien Brisson from the Canadian Institutes of Health Research [grant number 201610GSD-385545-283387] in honour of Nelson Mandela.

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Brisson, J., Ravitsky, V., Williams-Jones, B. (2021). Agency, Pleasure and Justice: A Public Health Ethics Perspective on the Use of PrEP by Gay and Other Homosexually-Active Men. In: Bernays, S., Bourne, A., Kippax, S., Aggleton, P., Parker, R. (eds) Remaking HIV Prevention in the 21st Century. Social Aspects of HIV, vol 5. Springer, Cham. https://doi.org/10.1007/978-3-030-69819-5_10

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  • DOI: https://doi.org/10.1007/978-3-030-69819-5_10

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