STI DoxyPEP, Antimicrobial Resistance and Queer Stewardship

The emergence of STI prophylaxis using doxycycline (aka DoxyPEP) amongst gay and bisexual men (GBMSM) has been positively received by healthcare professionals (Molina et al. 2018; Cornelisse et al. 2023; Leutkemeyer et al. 2023), community health organisations (Weil & Nutland 2023), and community members (Holt et al. 2024). Alongside high acceptability, integrating DoxyPEP into clinical medicine has raised clear issues about antimicrobial resistance (AMR) and complex disruption of the human microbiome (Bachmann et al. 2024). These issues present new challenges for community health research and practice, including refining existing HIV/STI prevention strategies and new methods for engaging communities in conversations about sustainable antibiotic use and antimicrobial stewardship (AMS) (Broder 2020; Weil 2023, 2024). This paper brings together interviews with UK clinicians with scholarship on STI/HIV health promotion to consider how emergent use of DoxyPEP plays into the making of queer AMS. I demonstrate how clinicians establish links between microbiome health and generalised antibiotic consumption to construct AMS principles. Based on these principles, I consider what a queer AMS might look like for GBMSM, including social and ethical procedures for assembling safer sexual practices and deterring onward transmission of bacterial STIs (Davis et al. 2022). Building upon Davis et al.’s (2022) work, I argue that the assemblage of normative and non-normative use of DoxyPEP constitutes queer AMS through the negotiation of what I call a ‘threshold of acceptable STI transmission’. Attending to this threshold might allow healthcare practitioners to stay with social complexity (Law 2004; Haraway 2016) and multiply engage with sexual communities (Epstein 2022) to cultivate queer AMS. Finally, when sufficiently contextualised and localised within larger debates about AMR, queer AMS can enable new understandings of how GBMSM actively understand and/or contest biomedical power through negotiated safer sex practices.