Having an effect: Exploring understandings of effectiveness in demonstration projects of HIV pre-exposure prophylaxis

Stream: Critical Perspectives on Pre-Exposure Prophylaxis (PReP)
Date: Friday, 1 April 2016
Time: 2.00 pm – 3.45 pm

Abstract

This paper explores the concepts of efficacy and effectiveness by drawing in the accounts of men participating in an open-label demonstration project of the antiretroviral drug, Truvada, as HIV pre-exposure prophylaxis (PrEP) among gay men in Melbourne, Australia.

The accounts of these men suggest that (the effect of) PrEP is not fixed, but rather is enacted through two different sets of practices: adherence to the daily dosing regimen, and the (non)use of condoms and other HIV risk-reduction strategies while taking Truvada. Participants accepted a degree of responsibility for the study results. Adherence was not only about avoiding HIV acquisition but also about ensuring that PrEP ‘worked’. The concept of effectiveness was also drawn on in relation to engaging in sexual practices associated with risk of HIV acquisition. On the one hand, participant’s accounts indicated a concern that changing sexual practices too dramatically after starting Truvada could undermine protection provided by PrEP. On the other hand, the accounts also suggested an understanding of responsibility for producing data, which meant producing occasions of condomless sex, without which the effectiveness of PrEP could not be determined.

These findings provide evidence of how PrEP effectiveness is actively produced, notably through the efforts and accounts of study participants. Also, the study demonstrates the temporal aspects of effectiveness vis-a-vis efficacy. Whereas efficacy is both in the past (‘proven’) and also somewhat outside time, effectiveness—or the successful uptake of an intervention after it has been proven to be efficacious—is always in the future.

Author

Dean Murphy (Presenter), Centre for Social Research in Health
Dean is a Research Fellow at the Centre for Social Research in Health. He is interested in biomedical HIV prevention technologies, and he is an investigator on Australia's first study of HIV pre-exposure prophylaxis.