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Lissie Arndt Dissertation Proposal Defense
October 4, 2019 @ 10:30 am - 12:00 pm
“Risky Business”: The Cultural Construction of Risk in HIV Pre-Exposure Prophylaxis (PrEP) Administration in New York
In current medical understandings, patients’ wellbeing is constantly attenuated by a continuum of risk. Based upon their characteristics, they are “at risk” of having a heart attack, are “at risk” of developing a certain cancer, and are “at risk” of contracting certain infections, such as HIV. In particular, the epidemiologically-based categorization of a patient’s identity or behavior—like their race or sexual practices—as “risk factors” for contracting an infectious disease like HIV allows the sociocultural interpretation of that risk, stigmatizing individuals who are categorized into those groups. Nonetheless, with the advent of the HIV medication Pre- Exposure Prophylaxis (PrEP), such epidemiological categories of risk continue to be applied. PrEP, also known by its brand name Truvada, is a daily pill manufactured by the pharmaceutical giant Gilead that was first approved by the FDA in 2002 to treat HIV-positive patients and then again in 2012 to prevent HIV infection in HIV-negative individuals. Currently, the indications for PrEP prescription are impressively broad and vague, allowing much room for interpretation. Given how past identification of HIV risk factors negatively implicated entire groups of people, there is a significant need to better understand how HIV risk has been conceptualized, how these concepts may be influenced by the interests of public health organizations and pharmaceutical companies, and how they play out for health professionals and individual patients in the clinical setting.
This study will examine concepts of HIV risk in the administration of PrEP, considering how these representations of risk are taken up and internalized by individual health professionals and patients alike and how these concepts of risk may align with the goals of pharmaceutical companies’ and public health organizations. Using ethnographic research techniques, the proposed study will contrast the perspectives of HIV-negative patients identified as candidates for PrEP, HIV-positive patients, and health professionals administering PrEP to capture how they may differentially understand and apply pharmaceutical companies’ and public health organizations’ messages about HIV “risk” and PrEP’s role in treating it. The study will be conducted in a New York community health center network that provides PrEP and HIV services to diverse patient populations. The researcher will interview clinic administrators, social workers, public health workers, and pharmaceutical industry members; observe clinical interactions; review medical charts; and also analyze advertisements, publications, and protocols regarding HIV prevention. It is anticipated that patients and health professionals have different understandings of what it means to be “at risk” for HIV and the role PrEP may play in impacting that risk. By exploring these differences, the study will identify ways in which each group may internalize messages about HIV risk and the role of medications in treating it, which will further illuminate the greater impact such messages may have on our society as a whole.