The Gold Standard: The Complex Singularity of PrEP, RCT and Bioethics

Abstract

In this chapter we begin to explore the ‘singularization’ of the PrEP RCT. We pose the question: how are the pill, the RCTs and their bioethics each enacted as singular? As such, we mean to investigate how each is performed as a unitary object or event. Of course, we shall see that RCTs, the pill and bioethics are contested and we shall trace how they are interpreted in conflicting ways. However, ‘behind’ these interpretations there is a commonly accepted underlying ‘essence’ that appears to exist beyond ‘differences of opinion’. Put differently, in order for there to exist an ‘essence’ — here, for example, a PrEP pill that has at its core the primary quality of a pharmaceutical preparation condensed into a pill — a further set of ‘secondary’ qualities are necessary to explain variation in effect. In tracing out the process of singularization by drawing on a range of empirical material including interviews with HIV trial investigators we also point to the ways that other types of entities — most notably trial participant groups — both enter into the enactment of PrEP and themselves come to be enacted in particular and, importantly, problematic ‘singularized’ ways. Indeed, as we show later in the chapter, the bifurcation of trial participants in the form of a (recalcitrant) subject/ (experimental) body split participates in threatening the viability of PrEP as an ‘efficacious’ entity.