Social Representation, Identity and HIV Prevention: The Case of PrEP among Gay Men

Abstract

HIV remains a major public health concern four decades after its first clinical observations. In Western, industrialised countries like the UK, gay men are disproportionately affected by HIV. According to Public Health England (2019), approximately 48% of the 103,800 individuals living with HIV in the UK are gay men. In London, it is estimated that one in 11 gay men is living with HIV. There is evidence of a higher HIV incidence in gay men of ethnic minority background, which has been attributed, in part, to socio-economic inequalities faced by ‘a minority within a minority’ (Jaspal and Bayley, 2019). Overall, these epidemiological data suggest that traditional HIV prevention methods, such as condom use, have not been entirely effective and that novel approaches are needed in the fight against HIV/AIDS. \nIn the last few years, pre-exposure prophylaxis (PrEP) has emerged as a significant tool for preventing HIV. At the end of 2016, a significant drop in HIV incidence was observed for the very first time since the beginning of the epidemic, which was attributed partly to PrEP (Brown et al., 2017). Although PrEP is clinically effective – having contributed to this dramatic fall in new diagnoses – it has not been met with consensual approval from all sections of society. Uptake has not been sufficiently high in the groups at highest risk of HIV – not least gay men of ethnic minority background (Huang et al., 2018). Both public and patient acceptability of PrEP are important factors in determining its effectiveness – after all, if people are unwilling to use PrEP, they will be unable to benefit from it. There are differences in levels of PrEP awareness, acceptability and uptake of PrEP among distinct groups in society. \nThere have been studies of PrEP in many different groups, such as African women, transgender people and sex workers (e.g. Celum et al., 2015; Restar et al., 2017; Sevelius et al., 2016). However, the focus of much research into PrEP has been on gay men who are especially affected in Western, industrialised societies. It is important to note that PrEP is a global issue, and that there are varying levels of PrEP awareness, availability and uptake in distinct countries and societal contexts (e.g. Grant et al., 2010; Huang et al., 2018). This chapter focuses principally on PrEP among gay men in the UK. In this chapter, it is argued that social representations and identity play an important role in gay men’s responses to PrEP. First, an overview of the HIV prevention tool is provided. Second, social representations theory and identity process theory from social psychology are described and their utility in PrEP research is outlined. Third, empirical research into public and patient understanding of PrEP is reviewed. Fourth, a broad set of principles for raising awareness among gay men at risk of HIV are presented.