1) How do pharmacologically driven HIV prevention strategies and the increasing medicalization of social issues converge with expanding neoliberal governance practices, that work to individualize and racialise practices of social well-being and disease prevention?
2) In what ways are these convergent logics structuring of HIV prevention campaigns?
3) What is the work of images in producing sentiments, ideas, anxieties and fantasies about (racialised) MSM's sexuality, socialities, sexual practices, and social-health needs?
Methods: We examined 5 HIV prevention visual campaigns--produced by the New York City Department of Health, The New York State Department of Health, and Aids Service Organisation, Harlem United (2013-2018)--marketed in virtual and urban landscapes of NYC (billboards, public transportation venues, sexual health clinics, print media, websites); conducted in-depth, semi-structured interviews with key informants involved in the production and marketing of the prevention campaigns (targeted n=10); and analyzed briefs and evaluation reports associated with the campaigns. Given the researchers' poststructuralist orientation, epistemologically compatible methodologies were deployed: (i) Critical Discourse Analysis of interviews and textual evidence; (ii) Social Semiotics Analysis of visual images.
Findings: Current HIV prevention campaigns visualize a fearless and fantastical social-sexual life, made HIV worry-free by the taking of PrEP - a once a day pharmaceutical regimen with proven efficacy in HIV prevention. This party-like fantasy belies the materialities of PrEP use - that is, its physical effects, and the realities of accessibility in a fractured, racialised, and profit-driven American health care system. The campaign images further work to exclude the socio-economic realities undergirding racialized MSM's sexual practices, instead seducing targeted viewers into webs of epidemiological surveillance and personal sexual-health discipline. Healthcare as a fundamental right guaranteed by the welfare state is eschewed in the visual worlds of these campaigns for a neoliberal understanding of healthcare practice. Although accessible health care provisioning is a central feature in state provided HIV prevention programing, it is nevertheless the at-risk individual’s investment in PrEP adherence that is positioned as the principle driver of HIV eradication.
Implications: Media campaigns play a crucial role in framing debates about social-sexual health problems, shaping community perceptions and understandings of what is at stake. A more critical reading of the socially and morally charged work that HIV prevention campaigns are expected to perform provides social workers in health fields insight into the social-cultural dynamics that inform the social and sexual self-understandings of their clients and their related healthcare needs. These empirically based insights may contribute to more effective therapeutic encounters and more equitable, social-justice oriented health programs and policies targeting racialised and poor MSM communities.