Queering the Toolkit: Sexual Health in the Era of PrEP, DoxyPEP, and U=U

Abstract

Medications that prevent sexually transmitted infections (STIs) are changing how people manage risk, pleasure, and safety in sexual health decision-making. This dissertation asks how medical professionals and sexually active queer adults in the San Francisco Bay Area navigate this evolving landscape and what their navigation reveals about the state of medication-based prevention in sexual health care. To answer these questions, I conducted an 18-month ethnography in San Francisco, California, during which I visited sexual health clinics, attended LGBTQ+ community events, and embedded myself into the Queer nightlife scene. I interviewed 35 sexually active queer adults and 10 medical professionals about sexual health in the San Francisco Bay Area. I also analyzed 90 digital advertisements from online sexual health services. In Paper 1, I utilize cultural sociology to show how sexual health medications operate as cultural objects with distinct meanings that shape acceptance, access, and use. In Paper 2, I examine how telehealth advertisements position medication-based prevention tools within holistic, sex-positive, lifestyle-oriented frameworks that challenge traditional representations of medicine and complicate the processes of (bio)medicalization and de-medicalization. In Paper 3, I examine queer sexual health in San Francisco as a strategic action field in which patients and medical providers draw on formal knowledge, personal experience, and community norms to make sexual health decisions. Collectively, these papers show that medical professionals and sexually active queer adults navigate medication-based prevention by balancing hope and uncertainty. They collectively embrace the possibility of an era in which HIV is no longer feared, and bacterial STIs are increasingly manageable, while remaining attentive to unresolved questions regarding medication use and the evolving role of barrier methods (e.g., condoms). Rather than preventing change, contestation among patients and medical providers fuels innovation as cultural interpretations of medications and sexual health are incorporated into action, revealing the critical truth that sexual health care is not only shaped by medical institutions or public health, but by the communities navigating it.