Intimate Innovation: Subjectivity, political economy and a novel method to prevent HIV

In July 2012, the United States Food and Drug Administration (FDA) approved the commercial use of an antiretroviral pharmaceutical to prevent HIV. This method of preventing HIV is known as HIV pre-exposure prophylaxis (PrEP). The single pharmaceutical product approved for commercial use as PrEP is manufactured by Gilead Sciences, Inc (Foster City, CA) and sold under the brand name Truvada. This dissertation traces the development, commercialization, and implementation of Truvada as PrEP from an anthropological perspective, including by exploring several elements of the political economy of health, such as processes of innovation in drug development. The dissertation also displays how this novel method to prevent HIV emerges from a long history of HIV prevention in which the intimacy of ‘at risk’ individuals has been managed through techniques of discipline, including those that encourage individuals to engage only in ‘safe’ sex and to speak to physicians and investigators about their ‘risky’ practices. At the same time, this historical and ethnographic research marks an important shift in the value systems of antiretroviral markets, which once stitched together public interests (of the state and its citizen) and private interests (of the pharmaceutical industry) through the moral imperative to save life and are now strengthening public-private partnerships in order to secure health and manage sexual pleasure. By following the product life of Truvada from early moments in the antiretroviral market when Gilead obtained licenses for its pharmaceutical components into present day clinical care, where providers are prescribing Truvada as PrEP to augment sexual pleasure, this account brings together intimacy and innovation to show how they have become intertwined and inseparable. Thus, the dissertation argues PrEP is an intimate innovation