Barriers: The discursive problematization and transformation of HIV-prevention service provision in England...

While the statement "patients face barriers" is prevalent in healthcare-related literature, barrier is seldom conceptualized. While reviews of the concept suggest the term is conceptually and methodologically weak, its utility is more nuanced. This article contributes to an emerging critical health literature conceptualizing barriers by outlining their discursive effects in healthcare discourses on HIV-PrEP in England between 2017 and 2020. A Situational Analysis of the alliances and positions taken by English stakeholders in debates over PrEP illustrates how designating something as a barrier facilitates a power struggle about how healthcare is provided and used. In addition to imparting significance on a problem to patient's uptake and use of a healthcare intervention, barriers align the patient's problems with groups of experts. Once integrated into an expert discourse, barriers facilitate the transformation of healthcare services by objectifying the values, preferences and abilities of a patient community and aligning them with their shared political and governmental aims. Barriers, therefore, play an indispensable and strategic role in evidence-based activism and in the broader domains of biological and sexual citizenship with implications for policy and systems management.