Public health morality, sex, and COVID-19: sexual minority men’s HIV pre-exposure prophylaxis (PrEP) decision-making during Ontario’s first COVID-19 lockdown
Date
2021
Authors
Gaspar, Mark
Grey, Cornel
Wells, Alex
Hull, Mark
Tan, Darrell H. S.
Lachowsky, Nathan J.
Grace, Daniel
Journal Title
Journal ISSN
Volume Title
Publisher
Critical Public Health
Abstract
Experts have warned that COVID-19 control measures may amplify health
inequities among gay, bisexual, queer, and other men who have sex with
men (GBM). For HIV-negative GBM, concerns have been raised as to how
COVID-19 will disrupt access to HIV pre-exposure prophylaxis (PrEP). Our
study offers empirical findings on these issues, drawing on in-depth interviews
conducted with 25 HIV-negative GBM living in Ontario, Canada
during the first wave of the COVID-19 pandemic. Our thematic analysis
draws from the sociology of risk to elucidate how a public health morality –
a contested ethical framework determining how to be a ‘responsible’
sexual citizen during the COVID-19 pandemic – informs GBM’s sexual
and PrEP decision-making. This public health morality was shaped by
several factors, including: self-concern versus risks posed to others; anxiety,
economic precarity, and becoming COVID-19 weary; shaming public
health non-compliance; and comparisons with HIV and shaming (queer)
sex. The participants significantly altered their sexual practices, with some
stopping, restarting, and others stockpiling their PrEP. While some men’s
sexual practices ran counter to public health messaging to avoid ‘nonessential’
contact with those outside of their households, their risk reduction
strategies, including avoiding new sexual partnerships and evaluating
people’s ‘common-sense’, mirrored the negotiated safety strategies earlier
developed to mitigate HIV risk. Public health advice must account for the
nuanced ways in which GBM are mitigating COVID-19 risks and are
responding to a complex public health morality, in order to avoid stigmatization
and potentially increasing COVID-19 transmission by neglecting
practical risk reduction measures.
Description
Keywords
COVID-19, PrEP (preexposure prophylaxis), gay, bisexual, queer, and other men who have sex with men, sociology of risk, public health morality
Citation
Gaspar, M., Grey, C., Wells, A., Hull, M., Tan, D. H. S., Lachowsky, N. J., & Grace, D. (2021). “Public health morality, sex, and COVID-19: sexual minority men’s HIV pre-exposure prophylaxis (PrEP) decision-making during Ontario’s first COVID-19 lockdown.” Critical Public Health, 32(1), 116-126. DOI: https://doi.org/10.1080/09581596.2021.1970720