PrEP: controversy, agency and ownership

Area of Science:

• Public Health
• Social Science
• Medical Ethics

Background:

• Pre-exposure prophylaxis (PrEP) remains a controversial HIV prevention method.
• Debates surround PrEP provision, advocacy, and community acceptance.
• Controversies extend beyond access to complex social and ethical dimensions.

Purpose of the Study:

• To explore the roots of controversy surrounding PrEP.
• To compare historical and current debates in PrEP implementation.
• To identify mediating principles influencing PrEP arguments.

Main Methods:

• Commentary analyzing historical and contemporary PrEP controversies.
• Identification of five mediating principles or cultural norms.
• Analysis of three specific areas of concern: risk/benefit, healthcare distrust, and community impact.

Main Results:

• Similarities exist between early PrEP trials and current implementation controversies.
• Key concerns include medical risk-benefit balance, healthcare distrust, and fears for individual/community cohesion.
• A perceived loss of control over these domains underlies much of the dissent.

Conclusions:

• Addressing PrEP controversies requires understanding underlying fears.
• Recommendations include fostering community ownership of PrEP.
• Enhancing individual agency over sexual risk is crucial for successful PrEP implementation.