The limits of promoting pleasure: Desiring-assemblages and HIV pre-exposure prophylaxis

HIV pre-exposure prophylaxis (PrEP) is said to have transformed pleasure and sexual practices in myriad ways. This article draws on interviews with PrEP users in Australia who had paused, stopped, or switched PrEP use in order to explore the varied affects and experiences of PrEP in relation to different dosing strategies. Drawing on the concept of ‘desiring-assemblages’, we considered ‘what can a body with PrEP do?’. Our analysis affirms PrEP as transformative, enabling freedom through reduced or removed fear of HIV transmission. However, participant accounts also suggested that PrEP has been normalised as an ordinary part of sexual cultures, with some indicating that PrEP use was felt as obligatory or ambivalent. Daily and nondaily dosing also potentiated different flows of desire and connections, remaking what PrEP is and can be in participants’ lives in ways that trouble the idea that PrEP consistently facilitates pleasure. PrEP dosing was framed by discussion of changes to one’s sense of self and future priorities, and through ideas about freedom, pleasure, shame, safety, obligation, fitting in, waste, and potential. While PrEP is increasingly promoted through messaging linked to ‘pleasure’, instead of earlier discourses of ‘risk’, a pleasure-centric focus may delimit understandings of how PrEP can produce multiple sexual lives and practices, including the mundane aspects of sex and pleasure. To appeal to a range of potential PrEP users, health promotion should emphasise the different possibilities for PrEP – it’s potential for pleasure, its critical role in preventing HIV, and its normative mundanity.