Risk, Relationships, and Refusal: How Relational Concerns Shape Personal Assessments of Risk and Mitigation

Mon, Mar 1, 2021, 12:00 pm

Photo of Anthony Urena

Anthony Ureña 
Presidential Postdoctoral Research Fellow
Princeton University

Why would a person forgo a safe, affordable medication proven to prevent a disease that he is worried he might contract? Pre-exposure prophylaxis (PrEP), a once-a-day HIV prevention pill, has proven to be highly effective at reducing infection, but the medication has not been widely adopted within disproportionately impacted communities. This article examines resistance to uptake by detailing how people assess their personal risk and the viability of mitigation options. Drawing on semi-structured in-depth interviews with 40 Black and Latino men who have sex with men, I argue that taking PrEP is not a matter of individual rational action, but rather a socially contextualized decision driven by relational concerns. As individuals consider the medication’s protection benefits, they are equally contemplating the social costs of a pill that may dissolve the protective social ties of their personal relationships. It may also shape how they see themselves as belonging in their respective ethno-racial communities. Overall, I develop testable propositions about how respondents’ HIV risk assessments and associated PrEP use are enmeshed in a broader societal context of surveillance, in ongoing relational work with romantic partners and socially significant others, and in their presentations of a racialized self in these contexts of risk.