Styles of thought in healthcare governance: A situational analysis of English PrEP discourse 2016–2020

Attending to competing styles of thought in healthcare controversies may be helpful to critical health scholarship. This article reexamines the debate over the introduction of a new HIV prevention technology in England as a tension between epidemiological and molecular style of thoughts. I argue English HIV services were organised according to an epidemiological style of thought. The introduction of biomedical pre-exposure prophylaxis (PrEP) to the health system brought this rationality into question in ways the English health system was ill-prepared to manage. A situational analysis of English PrEP discourse in the lead up and following NHS-England's 'U-turn' on PrEP illustrates a split along epidemiologically and biomedically informed styles of thought. These networks have their dedicated administrators, experts, activists and ways of thinking about their target population and preferred organisation of HIV services. Though they often collaborate, these two groups have distinct moral and political agendas that relate to their style of thinking. This analysis further nuances existing critical interpretations of the PrEP controversy in England. Beyond England, this debate suggests a potential departure from the conventional biopolitical subject and rationality of advanced liberalism.