Reconceiving Risk: Relational Understandings of Pre-Exposure Prophylaxis and the Down-Low

Abstract

This research advances sociological theorizing of risk through examinations of a sexual technology and a sexual practice. The sexual technology is the preventative HIV medication, Truvada for PrEP. The sexual practice is the “down-low” - the behavior of men who secretly engage in male-male sex but do not identify as gay. Previous studies of sexual risk examine categories of “at risk” people and rational calculations of risk. My analysis situates risk fully within sexual relationships and the temporal, unfolding process of sex. This perspective illuminates meanings related to risk that emerge from interaction as well as the emotions and uncertainty involved in the experience of risk-taking. Content-analysis of online media articles about Truvada for PrEP (N=214) shows how PrEP is individualized and desexualized with reference to categories of people portrayed as “risky.” Subsequent interview analyses with White and Black men who engage in sexual relations with men (N=60) reveal disjunctures between categorical representations of PrEP and understandings derived from sexual relations. Respondents’ evaluations of risk are contingent on social comparison to others and perceptions of intimacy in their relationships. Finally, drawing from a subset of interviews (N=36), this relational understanding of risk is applied to the case of the down-low. I argue that, due to their boundary work against an out-gay lifestyle, PrEP may not be viewed as relevant by this population. However, understanding the relational contexts of more intimate partnerships can help reframe PrEP as compatible with down-low sexual practices.