Shared embarrassment: (not) talking about sex in HIV-related doctor-patient encounters

The incorporation of HIV prevention into medical care is a central element of the redefinition of HIV prevention policies currently underway. In this article, I explore how safer sexual practices are promoted in doctor-patient encounters in the context of treatment of HIV infection in Madrid, Spain. Issues pertaining to the sexuality of people with HIV were usually absent after the initial visit, despite national and international recommendations that these be addressed. This absence is analyzed not as a mere lack or inefficiency but as a feature of prevention as a technology, that is, as a concrete array of relations of power, knowledge, and legitimacy. Silence surrounding sexual matters legitimates the power relationship established between doctors and patients around a biomedical narrative of (safer) sexual practices and shapes a field of knowledge and visibility with regard to the sexuality of people with HIV.