American Sociological Association

ASA Footnotes

A publication of the American Sociological AssociationASA News & Events
May/June 2020

Isolating Intervention: Prevention as Citizenship (Sociology of Sexualities)

Jason Orne, Drexel University
James Gall, Drexel University

As the COVID-19 pandemic progresses, governments around the world search for virus prevention techniques to reduce the spread of the illness. Researchers and scientists are reporting, perhaps because of the use of antiretrovirals in HIV treatment, “[w]e are seeing few cases of HIV-positive people with severe COVID-19.” Other countries, like Spain, are currently testing drugs like Truvada (emtricitabine/tenofovir), an HIV prevention medication commonly referred to as PrEP, to prevent the transmission of the novel coronavirus. Currently, the American CDC does not recommend any medications for prophylactic use to prevent coronavirus. 

The CDC does, however, recommend a variety of social strategies to reduce the spread of the infection. Social distancing constrains every aspect of peoples’ lives, from making money to being active community members to having sex. Restraint comes at a cost. We argue that these strategies are on a continuum with biomedical responses. Research into “biosexual citizenship” reveals that prophylactic measures intended to reduce viral transmission have historically used symbolic and material resource distribution to define individuals’ rights and responsibilities. Our recent work on “PrEP citizenship” can helpfully inform our understanding of this emerging “COVID Citizenship,” whether we are talking about taking pills or standing six feet away from each other. Since no one can be “against health,” when prevention is citizenship, we argue it represents a general “prophylactic citizenship.” 

Prophylactic citizenship refers to the individual and structural co-production of the social experiences of the preventative biomedical intervention. Our work explores these considerations through interviews with cis-gendered queer men who had been taking PrEP for over 3 months. Interviews included a range of questions, from where they get their PrEP prescriptions, to the nature of their conversations about sexual negotiation and safety practices. Our research reveals that the PrEP protocol “prescribes responsible sexual citizenship” by utilizing tactics of surveillance. The moral status of the ‘good’ PrEP user is created by prescribing responsible practices, monitoring PrEP users for compliance, and distributing symbolic and material resources accordingly. While surveillance typically brings top-down techniques employed by formal institutions, PrEP users also experience lateral surveillance, monitoring each other to enforce norms and encourage proper medication compliance. These techniques establish connections between community members, turning them into a unified category, creating a PrEP Citizenship. 

During this pandemic, our existence has come to hinge on similar determinations. We determine what it means to be a ‘good’ citizen through our ability to maintain distance, stay home, and reduce contact with others. Wearing a mask and protective gear physically represents our intention to reduce the transmission of the virus, as a tangible signifier of prescribed ‘good’ behavior. The onus of protecting our own health is put on ourselves, but we are responsible for others as well since we can potentially act as transmission vectors. Symbolic resources present through public health ads with Hollywood actors praising you as a ‘fighter from home’ in the ‘war on COVID’. Material resources get distributed as stimulus checks by the government. 

As responsible citizens during the stay-at-home order, we are asked to question, pass judgement, and determine which risks are worth taking. We surveil others to recognize when an individual has maintained isolation. We compare individuals in similar situations to measure responsible behavior. This lateral surveillance is implemented through social media technology, by disciplining, shaming, and publicly denigrating the violator’s character. However, our lives before quarantine mediate whether we will engage with others during COVID-19, our ability to comply with social distancing recommendations, and whether we will wear protective gear. The grocery worker risks infection on the job even as their walk to work may be judged by others. While the production of overarching values is prescribed to us by institutions and agencies of the government, it also emerges between us, creating a co-production that subsumes us from either direction. Our vulnerability to potential infection at the individual level translates into a destabilized sense of safety at the population level; suddenly everything seems uncertain and risky. As new smartphone apps are deployed to monitor our contacts — a practice historically rooted in racist and homophobic tactics — and potentially centralize our movements in a government database, we wonder just how much we will sacrifice to feel safe again given the depth of loss this pandemic has wrought.