Rethinking the Bioethical Enactment of Medically Drugged Bodies: Paradoxes of Using Anti-HIV Drug Therapy as a Technology for Prevention

In this paper we examine the work of bioethics in the enactment of medically drugged bodies by focusing on the development of an oral pre-exposure chemo (drug) prophylaxis for preventing HIV, called PrEP. Our aim is to show how the operationalisation of bioethics to mediate drug development obscures a more complex and relational dynamic out of which emerges the qualities and, indeed, problematics of bodies incorporated into PrEP. Our analysis is drawn from a small body of literature from trial affected communities, advocacy groups, researchers and trial sponsors. In particular, we focus on bioethical questions about how best to protect the interests of participants in ‘offshore’ randomised clinical trials. We argue that the predominant bioethical frame insufficiently addresses the challenges posed by PrEP. By rendering PrEP a singular thing that differs across contexts, more fruitful alternative conceptions are obscured. Specifically, we argue that PrEP trials should be conceived as ‘ontologically multiple’—emerging out of divergent assemblages of heterogeneous entities, including material and cultural differences in and across context-specific bodies. On the basis of this alternative account of PrEP, we propose that the bioethical work of pharmaceutical development can become more inclusive.