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This chapter provides a reflexive account of the research process behind the book’s qualitative studies conducted in Zimbabwe and Denmark with individuals taking, interested in, or eligible for PrEP. Both studies were designed with the applied goal of increasing PrEP uptake and generating insights for HIV prevention service planners and practitioners. A key principle guiding both studies was stakeholder involvement, ensuring that the research was conducted ‘with’ and ‘by’ those using or considering PrEP, rather than merely ‘about’ or ‘for’ them. The chapter begins by reflecting on the author’s stance on and approach to the topic of PrEP. It then introduces the two case studies and potentials for comparisons. The chapter details the research methods and outlines how the data were analysed.
This chapter examines the paradox of PrEP eligibility, revealing how contradictory ideas about who qualifies for PrEP create complex negotiations for users. Participants from two case studies – young women in Zimbabwe and queer men in Denmark – navigated opposing definitions and understandings of eligibility. In Zimbabwe, cultural criteria, manifested through familial and societal stigmas, often contradicted official guidelines, leading young women to question or forgo their PrEP use despite meeting clinical criteria. In Denmark, queer men faced discrepancies between their perceived eligibility and the official criteria, sometimes resorting to deceit to access PrEP. This paradox highlights how formal eligibility guidelines are often challenged by social and cultural norms, necessitating everyday PrEP negotiations. The chapter underscores the need to consider potential conflicts between biomedical and socio-cultural eligibility criteria in understanding PrEP access.
This chapter explores the paradox of PrEP being both free and costly, revealing the conflicting experiences of queer men in Denmark and young women in Zimbabwe. While PrEP is available at no direct cost through national health services, users often face other significant expenses – both monetary and in terms of time and opportunity costs. For queer men, public debates about PrEP costs led to reflections on their privileged access, while young women in Zimbabwe struggled to balance the benefits of PrEP with financial and social limitations. These challenges prompt ‘everyday PrEP negotiations’, where users navigate the complexities of access, responsibility, and entitlement. This chapter highlights how these negotiations foster critical thinking about the broader implications of PrEP access, shaping users’ advocacy and engagement with HIV prevention efforts.
This chapter examines the fourth PrEP paradox of the book: the dual identity of PrEP users as both healthy individuals and patients. Despite being in good health and undergoing rigorous screening to demonstrate this, PrEP users must reconcile their self-perception and status as healthy with the need to adopt a patient-like role due to the treatment regimen. In Zimbabwe, where preventive medication is often met with scepticism, and in Denmark, where PrEP involves close medical supervision, users grapple with this paradox in different ways. Young women in Zimbabwe face cultural resistance and concerns about taking medication when healthy, while queer men in Denmark struggle with regular hospital visits and PrEP’s close ties to the formal medical system. This chapter explores how PrEP users negotiate these conflicting identities and reflect on the value of PrEP, emphasising the need for a shift in how PrEP is framed and delivered, highlighting its role in health maintenance rather than just treatment.
This chapter explores the sixth and final PrEP paradox of the book: PrEP’s dual nature as both liberating and constraining. Participants in both Denmark and Zimbabwe acknowledge PrEP’s empowering role in mitigating HIV risk, but also encounter various constraints linked to its use. For queer men in Denmark, PrEP offers significant sexual freedom, but it can also lead to feelings of dependency, complex negotiations around discontinuation, and challenges in balancing its integration into their lives. Meanwhile, young women in Zimbabwe face practical difficulties with daily pill-taking and social stigma, leading to secrecy and possible relationship tensions. The chapter illustrates that while PrEP fosters autonomy and control, it can also impose new constraints, revealing its complex role in the lives of its users.
Available open access digitally under CC-BY licence.
Pre-exposure prophylaxis (PrEP) is a drug taken by HIV-negative people that reduces the risk of getting HIV. Comparing two case studies in Denmark and Zimbabwe, this book demonstrates six paradoxes that users often encounter in navigating their PrEP journey. The paradoxes lead to contentions, uncertainties, dilemmas and ambiguities that need to be carefully and pensively responded to through what the author terms ‘everyday PrEP negotiations’.
The social nature and need for such everyday PrEP negotiations help explain why PrEP works for some people and not for others. This book argues that such insight is critical to make PrEP work for more people and to inform social public health responses.
This chapter outlines the key objectives and significance of the book in the context of HIV prevention and biomedical prevention strategies more broadly. It begins by situating the book within the global HIV response, emphasising the urgent need to intensify prevention efforts. The chapter then explores the role of PrEP within these efforts, focusing on its potential to reduce HIV transmission. A critical discussion follows on how to maximise the impact of PrEP, and a call is made for a fourth approach to HIV prevention, one that considers the social context of PrEP use. The chapter also introduces the notion and definition of ‘everyday PrEP negotiations’, as well as the social representations paradox model.
This concluding chapter synthesises findings from two case studies of PrEP use among queer men in Denmark and young women in Zimbabwe. Despite differences, participants across both contexts encountered conflicting and opposing ideas about PrEP, necessitating everyday PrEP negotiations. Reflecting on the research presented in the book, the chapter argues that PrEP paradoxes can be both problematic and productive. They can be problematic if they i) reinforce unhelpful ideas that make PrEP seem undesirable; ii) create uncertainty and demand extensive mental work, potentially leading to inaction and inequity in PrEP uptake; and iii) further reproduce the struggles faced by sexual minorities and women in the Global South. Despite these challenges, PrEP paradoxes can also be productive. They can drive resistance to counterproductive ideas, particularly in the context of supportive social networks, which make uncertainties and dilemmas more manageable. Paradoxes can also stimulate deeper engagement and reflection among users. The chapter concludes with five strategies for mobilising social networks to help make PrEP work for more people.
This chapter explores the third PrEP paradox of the book: the tension between responsibility and irresponsibility in sexual health. For queer men in Denmark, PrEP represents a proactive approach to preventing HIV, but it also triggers ideas about irresponsible sexual behaviour. This paradox arises from conflicting views: while PrEP is seen as a responsible choice given the difficulties of consistent condom use and the need to prevent HIV, it is also linked to increased promiscuity and condomless sex, which some believe could lead to higher rates of sexually transmitted infections. These ideas are encountered and amplified through social interactions, especially on dating apps like Grindr, where PrEP status and condom use are contentious topics of conversation. This chapter shows that social networks play a key role in determining how queer men navigate different understandings of what responsibility means in the context of PrEP.
This chapter explores the fifth PrEP paradox of the book: PrEP’s dual role as both a safeguard against HIV and a source of new risks. Participants in both study contexts recognised PrEP’s efficacy in preventing HIV, yet faced different safety concerns. Young women in Zimbabwe experienced fears of social repercussions, such as violence or abandonment by partners or family, if their PrEP use became known. In Denmark, queer men encountered different issues, including the potential amplification of risky sexual behaviours, like chemsex, and uncertainties about long-term health effects. Despite these concerns, PrEP’s perceived benefits generally outweighed the risks. The chapter highlights how these safety concerns prompt ongoing negotiations and reflections, influencing how users balance the protective and risky aspects of PrEP in their everyday lives.