Pathopolitics: Pathologies and Biopolitics of PrEP

Abstract

This paper unveils the pathologies that are produced and sustained by the pharmaceutical industry, specifically by Gilead Sciences, Inc. Broadly defined, pathopolitics is the politics of treating and/or reproducing pathologies. This paper examines pathopolitics in the context of PrEP, or pre-exposure prophylaxis, an antiretroviral medicine that prevents HIV transmission. Although Gilead promises to prevent a pathology through PrEP, it reproduces social and biological pathologies by exposing certain people to higher risks of infections and diseases, thus epitomizing the operating logic of the pharmaceutical industry: that life is protected only insofar as it offers surplus economic and social value. This essay raises three fundamental sets of questions: (1) What are the techniques and mechanics of pathopolitics? (2) How does the pharmaceutical industry produce and exploit surplus value? (3) What is the nature of the relationship between the pharmaceutical citizenship and pathopolitics?

Discipline for pleasure: a new governmentality of HIV prevention

“…As such—and this is a key point in our article, its being tied to our focus on temporality— “pleasure is not the antithesis of self-regulation and safety, but the medium through which certain shared protocols of safety take shape” (Race 2008 , p. 421). PrEP campaigns can be said to be part of such protocols; that is, they are included in a discourse of consumer-directed commercials as well as entangled with what Tankut Atuk has called “pathopolitics” (Atuk 2020 ). However, the above PrEP imagery does not project pleasure as an obstacle to self-regulation and safety, but rather sets up PrEP as a protocol, so to speak, which defers self-regulation to the previously addressed ‘cold moments’ of calculation.…”

“…Although Foucault stated that bodies and pleasure are the only sites wherein resistance to biopower is possible (Foucault et al 2003 ), we might highlight a point raised by Tankut Atuk. Atuk states that if biopower appears to overdetermine pleasure, it is because “I do not believe that pleasure stands outside the realm of biopower: that is, pleasure can resist biopower precisely because it operates within not outside” (Atuk 2020 , p. 8). However, Atuk also raises the important potential of PrEP to provide radical queer alternatives to normative sexual practices when it is not purely framed as a biomedical HIV-preventive tool to be consumed in the name of public and individual health (Atuk 2020 , p. 8).…”

“…Atuk states that if biopower appears to overdetermine pleasure, it is because “I do not believe that pleasure stands outside the realm of biopower: that is, pleasure can resist biopower precisely because it operates within not outside” (Atuk 2020 , p. 8). However, Atuk also raises the important potential of PrEP to provide radical queer alternatives to normative sexual practices when it is not purely framed as a biomedical HIV-preventive tool to be consumed in the name of public and individual health (Atuk 2020 , p. 8). The transgressive potential of PrEP to reconfigure sexual practices, Atuk suggests, lies in its usage outside the domain of health rather than within the domain of pleasure.…”

A New Era of Queer Politics? PrEP, Foucauldian Sexual Liberation, and the Overcoming of Homonormativity

“…In the U.S., Gilead's vicious biocapitalist practices around PrEP have become a large-scale political scandal, including a congress hearing about the company's making 3 billion dollars profit from PrEP, which was developed with state-financed research (House Committee on Oversight and Reform 2019). Since Gilead's biocapitalism is solely directed at maximizing revenue and actively exposing those who are not profitable to the company to risks of illness and death, it can be called "pathopolitics" (Atuk 2020). Another product of these biocapitalist pathopolitics is the practice of offshoring; conducting risky trials in poor countries of the global south to develop drugs for the treatment of patients in the global north.…”

Revealing Truth through Diagnostics: From Disclosure Laws to Clinical Research for Novel Drug Development

“…They have examined the role of HIV-prevention practices in the discipline of the neoliberal subject (Race 2007) and the ways in which sexual subjectivity has been remade since the implementation of new biomedical HIV-prevention technologies (Martinez-Lacabe 2019;Thomann 2018;Sandset 2019). While exploring the ways in which biomedical prevention invites the possibility to reconstitute approaches to sex and risk (Nicholls and Rosengarten 2020), they have identified critical ways PrEP has opened opportunities to generate value in pharmaceutical markets (Atuk 2020). Building upon these important contributions, this article demonstrates how diagnostic practices have been integral to the reconstitution of both sexual subjectivity and mechanisms for producing projects in this emerging biomedical market.…”