Barriers: A Critical Examination of Pre-Exposure Prophylaxis (PrEP) Non-Compliance

This thesis outlines how compliance with a therapeutic regime is achieved through the claim people face barriers. It refines our understanding of the undertheorised concept of barriers. Rather than ask what a barrier is, this thesis interrogates the effects of the claim individuals face barriers to a novel HIV-preventative intervention, pre-exposure prophylaxis (PrEP). Using a mixed methods approach of situational analysis complemented with interviews with nine men who have sex with men (MSM) who do not currently use PrEP, it illustrates how barriers have transformative effects on a person’s ability to justify making a good health decision. I compare extant discourses on PrEP to their claims to understand how on PrEP non-compliance is produced and becomes meaningful to HIV-negative MSM. Using a governmentality approach, the thesis illustrates how removing barriers fails to promote better health choices because barriers normalise patient conduct. Extending the concept of deresponsibilisation, the thesis illustrates how the claims-making activities of social and biomedical researchers and activists have transformative ontological and epistemic effects on politics, health, rationality, subjectivity and the ways people make decisions. I outline how a new biomedical rationality is realised through their claims.