Accessibility,Utilization And Governmentality:A Qualitative Research On PrEP In MSM Community

The use of HIV PrEP(Pre-Exposure Prophylaxis)began to expand globally after2020,and China has also embarked on this train of globalization.This study examined the use of PrEP by MSM(Men Who Have Sex with Men)communities in China through qualitative research.Firstly,the concept of PrEP emerged because of the randomized,double-blind trials of HIV medicines.The meaning of HIV medicines has shifted from treatment to prevention.Secondly,transnational mobility,local market,and generic market are the main channels of access to medicine.International residents access PrEP through(1)foreign medical systems,(2)international NGOs,(3)family physicians,and(4)international Internet pharmacies,and they would switch between multiple access approaches.While international residents benefited from preferential PrEP services in Global North,they also faced restrictions based on local medical insurance,nationality,and permanent residency.Local sources of access to PrEP include(1)Internet pharmacies,(2)medical trials,(3)medical clinics,and(4)NGOs.The formation of the generic drug market is shaped by multiple structural forces,and its operation needs to be maintained by "drug dealers",platforms,and buyers.The differences in access approaches reproduce health inequalities.Vulnerable groups such as the youth MSM are facing greater risks and more demands but having difficulty accessing HIV prevention services,resulting in the "resource paradox".Economic capital,information capital,social capital,mobility,types of insurance,stigma,and knowledge all contribute to the persistence of health inequalities.Thirdly,for the MSM communities,(1)replacing condoms,(2)dual insurance,(3)addressing HIV stigma,and(4)being a cosmopolitan queer subject are the main meanings of using PrEP.There are two types of action logic interweaving in the use of PrEP in MSM communities:(1)the cost logic based on the calculation of medicines,and(2)the relationship/trust logic based on the degree of relationship closeness.PrEP reshaped the sexual risk,and the "self-management without condoms" became the new "technique" for actors.While PrEP has liberated the stigma of HIV in the MSM communities,it has also brought a new stigma to PrEP,resulting in the "stigma paradox".Lastly,"the management of prevention" has become the new target of AIDS governance in China.Based on the findings of this study,the policy recommendations were proposed:(1)Release of local guidelines on PrEP and supporting policies in China;(2)Establish inclusive PrEP services for the youth and promote the inclusion of PrEP into medical insurance;(3)Provide comprehensive PrEP advocacy and education training;(4)Establish the sexual infrastructure integrated of "Internet,community and hospital";(5)Address the social stigma and usage stigma of PrEP;(6)Provide sexual health services that integrate PrEP with STD.For Chinese social workers,I emphasize the importance of cultural competence and global vision.