“PrEP = Autonomy”: communication for HIV prevention among youth in the logic of neoliberal rationalityAbstract
This study examines the “biomedical turn” in Aids prevention in Brazil, focusing on the cultural and political dimensions of biomedicalization, particularly among young people. Special attention is given to how a “neoliberal rationality” permeates and shapes these processes. Thematic content analysis was used to explore the availability and use of pre-exposure prophylaxis (PrEP) for HIV prevention among this population, based on posts from a social media profile in dialogue with the bibliography on this issue. Cross-referencing these sources with an analysis of the macro-political process of neoliberalizing HIV prevention and Brazil’s Aids response revealed dynamics that affect young people in this context. Findings highlight the emergence of new stigmas and discrimination, as well as shifts in how sexuality and affectivity are perceived and experienced, particularly in a context where condoms are losing prominence. Furthermore, the study identifies an amplification of neoliberal subjectivity, characterized by the notion of the “self-entrepreneur,” which fosters individualistic behaviors and promotes a form of citizenship shaped by medication consumption.
Keywords:
HIV/Aids; PrEP; Prevention; Youth; Neoliberal Rationality.
Resumo
O objetivo deste artigo é analisar as dinâmicas da “virada biomédica” na prevenção da Aids no Brasil, destacando as interpelações culturais e políticas, geradas pelo processo de biomedicalização, particularmente no que diz respeito aos jovens. Atenta-se, em especial, para o modo pelo qual uma “racionalidade neoliberal” permeia e compõe tais processos. Utilizou-se a análise de conteúdo temática para explorar a disponibilização e os usos da profilaxia pré-exposição (PrEP) para prevenção ao HIV entre essa população, baseando-se nas publicações de um perfil de rede social em diálogo com a bibliografia acerca dessa questão. O cruzamento dessas fontes, aliado à análise do processo macropolítico de neoliberalização da prevenção ao HIV e da resposta brasileira à Aids, permitiu identificar dinâmicas complexas. Por um lado, essas dinâmicas revelam a produção de estigmas e discriminações. Por outro, apontam para a emergência de novos modos de pensar e viver a sexualidade e os afetos, especialmente em um cenário onde o preservativo perde centralidade. Além disso, observa-se a amplificação da noção de “indivíduo empreendedor de si”, característica marcante da subjetividade neoliberal, que reforça comportamentos individualistas e promove uma cidadania mediada pelo consumo de medicamentos.
Palavras-chave:
HIV/Aids; PrEP; Jovens; Prevenção; Racionalidade Neoliberal.
Introduction
Recent decades have witnessed a significant reduction in the number of new human immunodeficiency virus (HIV) infections and acquired immunodeficiency syndrome (AIDS) cases globally (UNAIDS - The Joint United Nations Programme on HIV/AIDS, 2024), despite structural inequalities that disproportionately impact poorer countries (Parker, 2002). One of the main contemporary challenges is the increase in infections among young people, especially those aged 15-24, compared to other age groups. It is estimated that in 2019, approximately 2 in 7 new HIV infections globally occurred in this age group, representing approximately 28% of total cases (UNAIDS - The Joint United Nations Programme on HIV/AIDS, 2021).
In Brazil, the 15- to 24-year-old group represented 23.4% of the 489,594 HIV cases reported from 2007 to 2023, with 25% among men and 19.6% among women. Between 2012 and 2022, 52,415 young people living with HIV developed AIDS, highlighting the relevance of the disease’s development in this age group and the urgent need for efforts to promote access to health services and adherence to antiretroviral therapy (Brasil, 2023). Within this group, men stand out as the most vulnerable, with the highest proportion of undiagnosed cases and high incidence growth rates. They experienced the most significant annual increase in HIV incidence, with a yearly growth rate of 3.7% from 2000 to 2018 (Szwarcwald et al., 2022).
Since the 1980s, adolescents’ greater vulnerability to HIV has been associated with the characteristics of this life phase, marked by the onset of sexual intercourse amid biological, social, and psychological transitions, in a context of job insecurity and difficulty in making future life plans. These young people often form diverse sexual partnership networks and face limited access to comprehensive health services. Factors such as gender identity, sexual orientation, social class, and ethnicity/skin color increase inequalities in infection risk, disproportionately impacting young lesbian, gay, bisexual, transgender, queer, intersex, asexual, pansexual, and nonbinary (LGBTQIAPN+), and Black people, who often face violence, stigma, and prejudice from childhood (Grangeiro et al., 2023).
The rising incidence of HIV among young people also reflects social and cultural changes since the 2000s, including the redefinition of gender identities, new affective-sexual arrangements, the use of technologies for sexual encounters, and the sexualized consumption of substances. These changes coincided with a period of strengthening social inclusion policies in Brazil and the recognition of the rights of the LGBTQIAPN+ population. Therefore, understanding these factors is essential to address the new challenges of the epidemic (Grangeiro et al., 2023).
This article is part of a context marked by the intersection of several dimensions: the long trajectory of national and global responses to the AIDS epidemic; the so-called “biomedical shift” in the field of prevention; the progressive implementation of Pre-Exposure Prophylaxis for HIV prevention (PrEP); the tense negotiations between AIDS prevention discourses and issues of gender and sexuality, especially regarding youth cultures; and the complex interconnections involving the enjoyment of sexual pleasures combined with the use of biomedical technologies, a particularly challenging setting for young people. Given this outlook, we analyzed the dynamics of the “biomedical shift” in Brazilian AIDS prevention, highlighting the cultural and political challenges generated by the biomedicalization process, emphasizing posts made on an Instagram profile managed by young people.
All these processes occur within what is called the neoliberal order, which carries a specific rationality: neoliberal rationality (Dardot; Laval, 2016). A decisive hallmark of neoliberal rationality is that of individual entrepreneurship, or entrepreneurship of the self. Under entrepreneurial logic, everyone must become an entrepreneur of themselves, which can also be defined, conversely, as self-employed (Ortega; Zorzanelli, 2010). With this brand conceived within the context of PrEP policies, the medicine, as a public good made available to someone, can be consumed under this entrepreneurial rationale. Exploring the key elements that structure neoliberal rationality is necessary to understand how it shapes responses to AIDS in the current context.
Foucault (2008) pioneered the idea that neoliberalism cannot be construed as a simple economic system. He defines neoliberalism as a political rationality that seeks to reorganize society around market relations. This rationality implies considering the other as a competitor, a rival, and, ultimately, an enemy. Situated within capitalist logic, the individual is constantly pressured to cease being recognized as a citizen and become recognized as a consumer, gaining access to recognition through their consumption level. Within the orbit of neoliberal rationality, this shift is accentuated and seeks recognition through entry into the status of an entrepreneurial economic entity.
It is within this broader political framework, and using this grammar from which some essential conceptual categories are drawn, that the so-called “biomedical shift” in the field of AIDS prevention is produced. This biomedical upturn is understood as the shift in AIDS prevention strategies from an emphasis on procedures involving dialogue and negotiation - such as safer sex workshops, condom use strategies, the need to discuss gender equality, sex education campaigns, educational approaches to gender and sexuality and reproductive rights, and the connection of AIDS prevention with human rights - to an emphasis based on strategies for the intensive use of medicine.
The strategies that characterize this biomedicalized context are PrEP, Post-Exposure Prophylaxis (PEP), and Treatment as Prevention (TasP), all embedded within a model of risk management and biomedical control of HIV and AIDS. These interventions represent advances in confronting the epidemic and redefine the experience of prevention and the modes of subjectivation of the individuals who embrace them (Silva Junior, Brigeiro, and Monteiro, 2023). Our effort is to analyze the social, cultural, and symbolic impacts that arise after such encounters.
The concept of “biomedicalization”, as proposed by Adele Clarke et al. (2003), allows us to understand how AIDS prevention and treatment are not limited to medical practices but rather constitute processes that reconfigure subjectivities and social relations. These processes exceed the incorporation of new biomedical technologies, as they also involve the production of norms around health, risk, and self-care. Medicine, in this sense, must be understood as a cultural artifact, carrying with it cultural pedagogies - that is, teaching strategies and subjectivation modes (Rose, 2013). Medicine not only treats a biomedical condition but also guides practices and expectations regarding the body, sexuality, and prevention. These pedagogies operate as forms of governance for individuals and populations, inserting subjects into networks of surveillance, adherence, and continuous monitoring (Foucault, 2008).
Conceived in this way, public PrEP policies work to produce individuals capable of preventing HIV (Sierra & Meyer, 2020). More than simply expanded access to prophylaxis, these policies involve a set of discursive and institutional practices that shape behaviors, create risk profiles, and establish regulations for sexual health management. This creation of subjects who protect themselves from HIV occurs within this complex framework of power relations, symbolic materialities, production of identities, games of interpellations, desire to expand their human capital, dynamics of recognition, and redistribution. Furthermore, this production of subjectivities does not occur homogeneously, but instead crosses social markers such as class, race, gender, and sexual orientation (Oliveira et al., 2024), influencing how different groups access, internalize, and resignify these biomedical technologies. In other words, PrEP policies comprise the power-knowledge-subjectification architecture of the “AIDS apparatus” (Pelúcio; Miskolci, 2009).
PrEP is a paradigmatic example of the intersection between self-entrepreneurship and the pharmacologization of prevention, linking the individual to dynamics of risk management, self-care, and health improvement (Silva Junior; Brigeiro; Monteiro, 2023). Rose (2013) believes that contemporary biomedicine inaugurates a model of biological citizenship, in which individuals become responsible for managing their bodies’ health and performance. Thus, adherence to PrEP transcends the sphere of individual choice, constituting a social and political imperative that operates at the molecular level, shaped by the pharmaceutical market and public health policies.
In this sense, this is not just a transformation in prevention methods, but the emergence of a new form of subjectivation, in which HIV prevention aligns with neoliberal logic and the conception of health as a consumer good. This event is illustrated by Davis (2020), who, when analyzing protocols and methods for recruiting volunteers for PrEP studies and interviewing leaders and activists, coined the figure of Homo adhaerens, or the “subject who adheres”. This concept describes the ideal candidate for the pharmaceutical industry: an individual simultaneously exposed to high risk (in this case, the risk of HIV infection) and willing to undergo the discipline required for continuous prevention.
According to Davis (2020), Homo adhaerens is produced by disciplinary processes to keep bodily immunity while simultaneously maximizing the health of the general population, and is committed to long-term medication adherence. Thus, the individual is not asked to be a medicine consumer, but to reveal the disciplinary characteristics of a self-entrepreneur, aligned with the neoliberal order’s grammar. This figure is the ideal candidate for the pharmaceutical industry, due to the potential medicine consumption, and public policies, since he/she takes on the complete management of the situations to be faced, an analysis key adopted later in the examination of the Instagram profile.
Today, social media plays a central role in self-construction, influencing how individuals think, relate, and act in/with the world. Besides functioning as spaces for interaction, they also operate as powerful tools for education and knowledge dissemination. However, critically reflecting on the discourses that circulate in these environments - especially those related to sex, diversity, inclusion, and pleasure - does not mean rejecting or disqualifying them, but rather understanding the contexts in which they were produced, the interests they mobilize, and the power dynamics that sustain them (Sales; Carvalho, 2024). No narrative about the body and sexuality is neutral; all are imbricated in knowledge and power relations, as Foucault (1999) pointed out, constituting perceptions, norms, and subjectivation modes.
In this setting, the role of social media in disseminating information about HIV/AIDS has become increasingly relevant. As analyzed by Sales and Carvalho (2024), digital spaces, such as the Instagram page of infectious disease specialist Vinícius Borges (@doutormaravilha), operate at an intersection between biomedical knowledge-power and resistance. While disseminating information about biomedical prevention, such as PrEP, these platforms also create alternative pedagogies that question sexual and medical norms, enabling new subjectivation forms for LGBTQIAPN+ youth. This dynamic highlights how social media has become not only channels of information but also territories of political and cultural dispute over health, desire, and prevention.
Given this article’s objectives, a thematic content analysis (Minayo, 2007) was conducted on a profile on the Instagram social network focused on PrEP communication among young people, in dialogue with the academic production on the topic available in the bibliographical base constructed in the PrEP South America research project (2025). Although research has examined PrEP posts on other social media platforms, to date, there is little PrEP-related research focusing on popular image-sharing sites such as Instagram (Walsh-Buhi et al., 2021). Finally, some considerations will be presented on the pedagogies and modes of understanding self-care and the exercise of sexual life.
Methods
The Instagram profile PrEPara Salvador (@preparasalvador) was highlighted. It is a virtual environment aimed at selecting and engaging adolescents aged 15-19, who identify as gay, bisexual, transgender, or non-binary people registered as male to participate in the PrEP1519 project. The PrEP1519 (2025) study is hosted at the Institute of Public Health at the Federal University of Bahia (UFBA) and aims to evaluate the effectiveness of PrEP among adolescents aged 15-19. The research is being conducted in three Brazilian capitals, namely, Salvador (BA), Belo Horizonte (MG), and São Paulo (SP), with funding from Unitaid, an international organization created in 2006 by Brazil, Chile, France, Norway, and the United Kingdom.
Each of these capitals has an active Instagram profile (@vcprepsp in São Paulo and @nodeumatch in Belo Horizonte), used as a tool for promoting the project, disseminating information about PrEP, and recruiting new participants. The @preparasalvador, the focus of this article, was analyzed as a space for discursive and practical production. The profile’s posts were examined based on the engagement strategies and “pedagogies of pleasure” (Euzébio, 2023) they manifest. These practices encompass the dissemination of information about sexual health and the construction of narratives and forms of subjectivation mediated by the digital environment.
Thematic health content analysis (Minayo, 2007) was employed as the primary technique for data analysis. This technique allowed for the systematic categorization of Instagram posts into recurring themes and an interpretative analysis. The posts on the Instagram page were examined to understand how health literacy is constructed and preventive practices developed. A summary table of the results of this process is shown below (Table 1).
This methodological procedure followed the three stages proposed in thematic content analysis (Minayo, 2007). The first stage consisted of pre-analysis, with an exploratory observation of social media profiles focused on communicating about PrEP as an HIV prevention strategy. From this stage, the PrEPara Salvador (2024) profile was selected because it presented communication aimed at young audiences, with original content and a high level of engagement. Subsequently, the posts were skimmed to familiarize oneself with the material and formulate preliminary questions, hypotheses, and analytical objectives.
In the second stage, corresponding to material exploration, 30 publications were selected that expressed four recurring thematic categories throughout the profile. One researcher performed the categorization in consultation with two other researchers involved in this article. Finally, in the third stage, regarding the treatment of results and interpretation, the publications were analyzed based on the prevention neoliberalization concept (Seffner; Parker, 2016a), seeking to understand how discourses and practices related to PrEP are mobilized and articulated with notions of individual responsibility, performance, and self-care.
The study was informed by the prevention neoliberalization concept, as proposed by Seffner and Parker (2016a), to investigate the macropolitical tensions underlying HIV prevention initiatives today. This perspective considers how neoliberal dynamics reconfigure care practices, shifting responsibility to individuals and encouraging solutions based on the consumption of biomedical technologies. This approach allows for the integration of multiple dimensions - microand macropolitics - and reveals how digital technologies empower the creation of new forms of care, interaction, and coordination between individuals, institutions, and practices in Health, expanding the horizons of prevention and public policy.
In short, all the actions analyzed here take place on a profile on Instagram, a social network and photo and video sharing platform, created in 2010, and acquired by the multinational technology company Meta in 2012. This digital space can be understood as an artifact with political (it operates with power relations), cultural (it carries and produces symbolic records specific to the fields of youth culture and health), and pedagogical dimensions (it operates with a clear intention of health education, drawing on pedagogies of gender and sexuality, in part because AIDS is a sexually transmitted infection). It is one of the countless artifacts that embody the technical-mediatized public sphere, as discussed in Miskolci (2021).
Therefore, the Instagram digital platform is not a politically neutral artifact. On the contrary, it is situated at the confluence of new technologies, mediatization, and the commodification of politics. The latter, in turn, was developed to operate in the production of self-entrepreneurial subjects, encouraging individualistic and moralizing interpretations of collective problems. It is an artifact that does not encourage dialogue between participants, operating with tools like “Like” or “Dislike”, reinforcing binaries and the pursuit of individual approval. It operates by creating or reinforcing “moral entrepreneurs” in the conservative field and “self-entrepreneurs” in the progressive field (Miskolci, 2021). It is clearly an artifact designed to reinforce the values of neoliberalism, which shape the fundamental contours of our political landscape.
This article does not aim to discuss the decision by the creators of @preparasalvador to use Instagram as a platform to publicize their health education initiative. However, platforms more focused on debate and reflection on the multiple determinants of health and disease would hardly have the same reach as an Instagram profile. We aim here to analyze existing publications. We understand that the choice of platform itself carries a political and pedagogical intention. However, within this article’s boundaries, it will not be possible to explore all these dimensions in depth.
Prevention in @preparasalvador
The PrEPara Salvador (2024) Instagram profile (@preparasalvador) had 5,402 followers and 471 posts on November 14, 2024, primarily aimed at people residing in the Salvador metropolitan area. The aim of offering PrEP in the project’s actions is to evaluate the effectiveness of this prevention method among young people. The profile invites gay men, bisexuals, trans people, and nonbinary people registered as male, aged 15 to 19, to participate in the research. The initial step is via an online questionnaire. Testing, counseling, and medical appointments are available at the project’s physical location. Although it primarily offers PrEP, the project also promotes condoms, lubricants, PEP, and information about other sexually transmitted infections (STIs), creating a sexual health care dashboard.
An examination of the profile’s posts reveals the importance of the axis we call “knowing the population”, which uses language that favors youth slang. It is common to see terms like “check it out”, “sister”, “girl”, “brother”, and “lady” (in an LGBT context). A second axis, which we call “disseminating quality information about PrEP”, features posts addressing questions about adherence to this prevention method. Investment in recruiting and training peer educators to conduct the project’s activities is evident in another axis we call “training”.
The question that guides the first post, in 2018, is striking, opening with an invitation to anyone interested: “Tá PrEParadx, novinhx?” (Are you PrEPared, youngster?) An analytical examination of the set of posts allowed us to organize the content into four thematic categories, whose names indicate the predominant conceptual vector, the one we wish to highlight in the analysis. However, the highlighted vectors always appear in the posts in conjunction with the others, never in isolation. Thus, entrepreneurship of the self, biomedical shift, pharmacologization of the self, activism, youth, pedagogies of pleasure, health education, care of the self and care of others, marks of neoliberal thought always appear articulated in the scene described, in the guidance given, in the episode reported, in the information prescribed or in any other narrative modality chosen to address PrEP in the Instagram profile mentioned above.
In particular, biomedicalization, promoted by the “biomedical shift” in HIV prevention and care, is coordinated transversally in the four thematic categories in the table 1 below. However, it appears with varying degrees of vigor in each analyzed material. A significant pedagogical effort made by the profile’s posts is the development of a youth lifestyle that combines intense enjoyment of opportunities for pleasure with the guarantee of HIV prevention. This lifestyle is produced in a way that is practically inseparable from biomedicalization, which provides it with content, form, and possibilities. It offers a strong indication of how the ways of being and living of contemporary youth are powerfully articulated with the field of pharmaceuticals and other health apparatuses.
Activism and adherence to PrEP in the relationship with Civil Society Organizations
The profile promotes participation in events such as the Salvador Trans Pride March. This content contextualizes HIV prevention as a community-based and politicized practice, associated with protection and care for LGBTQIAPN+ people. The rainbow flag is also coordinated and displayed, fostering a sense of acceptance for the movement. This symbolism of identity and visibility contributes to the project’s understanding as a collective support network, potentially reflecting engaged research (Grossi; Fernandes; Cardozo, 2017).
Along these lines, a large number of posts on the profile celebrate membership in the LGBTQIAPN+ movement and discuss its struggles, thus helping to build a collective identity. Several posts commemorate events such as Pride marches, demonstrations against homophobia, Trans Visibility Day, explanations about the red ribbon, the meaning of LGBTQIAPN+ movement flags, and March 8 (Figura 1). However, efforts to build a collective self are typically absent when posts address sexual life scenes. Here, the discourse of self-entrepreneurship prevails, showing some separation between “struggles” and “sex life”.
While showing creative ways to integrate study methods, contexts, and procedures, these points bring the discussion closer to the role of organizations and activism in creating a collective narrative about PrEP use. Young people are encouraged to view biomedical prevention as a practice that transcends individual health, emphasizing the intersection of health, identity, and citizenship.
Marks of the self-entrepreneurship concept
An analysis of the “biomedical shift” in Brazilian HIV prevention, especially in light of the neoliberalization concept, suggests a critique of the role of health policies as promoters of individualistic practices. We observe how these policies transfer responsibility for care and prevention to individuals, shaping them as self-entrepreneurs (Lermen; Mora; Neves, 2020). Thus, sentences like “Do it wherever you want. Do it whenever you want” and “PrEP = autonomy” suggest that HIV prevention is an individual choice and responsibility Figure 2. These messages promote the idea that adherence to PrEP and self-testing is an act of health self-management. They shift the preventive care responsibility to the individual. In this autonomy discourse, the idea seems to be that young people are encouraged to manage their health as a personal project, minimizing the role of collective and public support structures (Ortega; Zorzanelli, 2010).
The response to AIDS needs to transcend the biomedical vision of so-called “magic bullets”, which relies on technical and quick solutions, often disconnected from the social and cultural contexts in which people live. It is, therefore, necessary to be willing to reinvent what prevention means, incorporating not only new pharmaceutical formulations and updated knowledge about the risks of HIV transmission, but also recovering ancient precepts that involve dialogue with different cultures and networks of collective solidarity. This fact implies considering that, in society, risk management strategies and life choices are profoundly affected by structural inequalities, which cannot be eclipsed by individualizing discourses centered on the “entrepreneur of the self” (Seffner; Parker, 2016a).
This is what we see in the post that shows the character SpongeBob, depicted in a clearly dazed awakening, with the words: “Me waking up drunk in the handsome’s room with no memory of anything. I WAS HIGH, RIGHT?? It happens... in this case, the recommended thing is to take PEP, but you can straightforwardly guarantee your protection against HIV. Using #PrEP!” Reports of violence due to excessive alcohol consumption, sometimes even provoked by the casual partner to obtain some benefit, such as robbery, or violent sexual practices due to the relative incapacity of the other person due to drunkenness, are not included in this setting. The approach focuses on protection against HIV infection, thus summarizing the sexual life scene, neglecting a set of concerns of the LGBTQIAPN+ collective subject, which address the violence perpetrated in the intimacy of the sexual scene.
The individualistic concept is reinforced in the post: “Steady relationships and trust are not prevention tools, love. Moreover, I’ll say more, prevention is individual! There is no such thing as couple prevention. #prep1519 #combinedprevention #gay #trans #transvestite #teenager.” Here, an entire history of pedagogical efforts in favor of negotiations around safe sex since the beginning of the fight against AIDS disappears, constituting a true waste of experience, as discussed in Seffner and Parker (2016b).
This history of efforts focused on the marital context in which two people keep a steady, emotional, and sexual relationship while also engaging in casual encounters with other partners. The need to establish agreements and rules within such a relationship, deepening the dialogue around desires, not just for AIDS prevention, is replaced by the assertion that “prevention is individual”. Building an effective response to AIDS does not result from a combination of individual efforts, however well-intentioned, but rather from the simultaneous construction of a collective subject and the establishment of a specific grammar of the common. The common cannot exist without a collective subject and without a set of daily agreed-upon and repeated practices that sustain it, as discussed in Dardot and Laval (2017).
The notion of a collective subject advocated here is closely related to Butler’s (2015) proposal regarding the notion of precariousness. Precariousness is linked to notions of interdependence and vulnerability, seen as inherent to the human condition. Human life is seen as intrinsically fragile and dependent on social and political structures. Such structures have the power to determine which lives are valued and protected and which are ignored or rendered abject. Vulnerability can be seen as an increase in precariousness, since certain groups, based on markers such as race, class, gender, sexual orientation, generation, regional origin, and even nationality, are more exposed to stigma and prejudice and, consequently, to violence, exclusion, and marginalization.
Such situations can occur in any context, including the intimacy of a sexual relationship. There will be no society of individuals prepared to prevent AIDS if it is not also an anti-racist society that seeks gender equality, respects and encourages the expression of sexual diversity, fights against economic inequality, and advocates for the notion of democracy as a system that fosters the right to have rights, whether individual, social, or collective, with some moderating the others (Chauí, 2018).
With slogans like “A gift for you, bee!!! Free HIV self-testing”, the profile promotes testing as accessible and available at any time. This approach positions healthcare within a consumer model, in which self-testing and PrEP are prevention products (Mora; Nelvo; Monteiro, 2022). The relaxed language and friendly tone help normalize testing and PrEP use. However, within the framework of neoliberal rationality, they can transform these practices into signs of “individual responsibility”, contributing to the narrative of self-surveillance, a shift from the state’s responsibility for healthcare procedures to the individual and the community, toward self-management of healthcare (Ortega; Zorzanelli, 2010).
By highlighting slogans such as “Successful mix! #protegidah” and “BB self-test!! Do it wherever you want, whenever you want”, the profile promotes PrEP and self-testing as the ideal form of self-care, potentially generating new stigmas for those who do not use these methods. In neoliberal logic, those who do not adhere to these practices can be seen as irresponsible or negligent, promoting a form of exclusion based on medical consumer practices (Ferreira, 2023).
Cultural and social dynamics of PrEP among young people from the perspective of the biomedical shift
Considering the cultural and social dynamics among young people, we can see how the use of memes and cultural references helps integrate PrEP and other prevention practices into this world, making sexual health a topic that becomes part of everyday life Figura 3. Memes that play on situations like a condom breaking, contrasting the “calmness” of those using PrEP with the “desperation” of those who do not, help normalize PrEP use and make it a practice embedded in routine, closer to everyday experiences and the uncertainties of sexual life. The “undetectable=untransmissible” meme reinforces important sexual health information with a lighthearted and welcoming tone. Humor and comedic timing around a serious topic help reduce stigma, encourage dialogue, and educate on important issues, such as the effectiveness of HIV treatment for undetectable individuals. This fact facilitates the dissemination of sexual health information and contributes to a broader, less moralistic understanding of PrEP and HIV.
The introduction of products, such as the “disposable anal hygiene device”, in educational messages shows an adaptation of the profile’s content to self-care and sexual hygiene practices relevant to the LGBTQIAPN+ youth community. By promoting these products in a natural and informative way, the profile legitimizes these practices as part of a self-care repertoire, expanding the concept of sexual health beyond biomedical prevention. While institutional, academic, business, and health-related content has gained relevance in this new phase of the internet, it is clear that content related to everyday intimacy is gaining visibility. In this setting, the former spectators now become the leading figures of their self-narrative, whether in videos, blogs, or live broadcasts, exhibiting themselves in a veritable spectacle of self, as is the case with the disposable anal hygiene device.
The meme about the “brain thinking about Salvador Carnival” with PrEP highlights the connection between sexual health and popular cultural events. This association suggests that PrEP is essential preparation for participating in events with high social interaction levels, aligning preventive care with festive moments. This type of post helps reinforce the importance of being careful without losing the lighthearted tone and fun. It also situates sex life in the realm of pleasure, avoiding being captured by discourses that turn it into a moralizing agenda. These elements reveal how PrEP is situated in a social fabric in which prevention, culture, and humor intertwine. By incorporating cultural references and memes, the profile makes PrEP and other sexual health practices part of the language and daily experiences of young people who access Instagram.
Pedagogical strategies for Health Education and care pathways aligned with biomedicalization
The content comprises a cultural curriculum, similar to a school curriculum. The Instagram page presents itself as a classroom landscape Figure 4, with plenty of games. Posts like “Tips for remembering to take your PrEP” and the distinction between “HIV and AIDS: they’re not the same thing” show the profile’s strong educational emphasis. However, the content is almost unidirectional between the teacher and the person being taught. The space for dialogue, represented by the comments section, often does not allow for more substantial debates, never going much beyond isolated expressions. The traditional power relationship between healthcare professionals and users is experiencing a break in its monopoly, and other voices are gaining prominence, especially in peer education. Thus, the digital environment acts as a mediator of daily life.
A project is being developed to make PrEP a digital social tool. The chat about LGBTQIAPN+ and friendship networks highlights social support in care journeys. With posts like “I took a break from sex: Why PrEP?”, the profile contextualizes PrEP use in specific moments, such as social isolation. In this context, sociability involves mechanisms of everyday life that escape the constraints of Western sociability, generally centered on principles such as individualism and the moral norms that regulate associations between individuals, and allow for a breach in neoliberal rationality. In contrast, it presents a sociality valued by affective and intersubjective arrangements (Deslandes; Coutinho, 2020).
Using avatars to answer common questions, such as “Is PrEP recommended for any specific group?”, helps make information more accessible and user-friendly. This strategy brings young people closer to prevention and care practices, allowing them to feel comfortable asking questions and learning in an accepting virtual environment. These elements reveal how the profile builds a “self-care curriculum”, in which informative and interactive practices shape PrEP use and sexual health. This curricular strategy focuses on fostering young people’s autonomy, encouraging a continuous care pathway that adapts to different contexts and personal situations.
Final considerations
This article aimed to analyze the dynamics of the biomedical shift in AIDS prevention in Brazil, taking as a case study the digital communication surrounding PrEP use among young people. The analysis of the dynamics of biomedical HIV prevention among young people evidenced how health technologies are mediated by social, cultural, and subjective markers that escape the biomedical dimension. Through a socioanthropological analysis of the activities of a social media profile focused on PrEP among young people, in dialogue with the literature on the topic, we observed the centrality of neoliberal rationality in organizing responses to the HIV/AIDS epidemic. This setting promotes an individualized view of prevention, shaping individuals as self-entrepreneurs and shifting collective responsibility to individual self-care strategies.
The analysis of the publications also highlights the potential for digital media and community practices on social media to be spaces for the redefinition and pedagogy of pleasure. These initiatives create narratives that integrate sexual health, identity, and citizenship, especially when engaging with young people affected by structural inequalities based on gender, race, and class. In this context, opportunities emerge for concepts of collectivity and commonality to clash with approaches marked by an emphasis on individual autonomy. We observed a persistent tension between the strengthening of community networks and the valorization of individualistic practices, highlighting the need for a balance between biomedical interventions and approaches that prioritize the social dimensions and health policies.
Along these lines, biomedical technologies for HIV and AIDS, such as PrEP and testing, are recognized by Ayres (2023) as valuable tools that significantly enhance the promotion and protection of sexual and reproductive rights, also reducing vulnerability to HIV/AIDS. However, it is illusory to believe that the mere availability of these resources will resolve an epidemic. This vision ignores essential factors such as access, acceptability, and effectiveness in the diverse and unequal daily lives of populations. Under the neoliberal logic, these technologies seek to reframe self-care, transforming it into an individual responsibility, encouraging young people to adopt preventive practices in pursuit of citizenship associated with medication use and entrepreneurship.
Adherence to PrEP should not be reduced to a simple act of medication consumption, but rather as part of care trajectories that situate the subject within pedagogies of gender and sexuality, care, power plays, and dynamics of recognition. Public policies, research in the humanities and social sciences, and community initiatives should continue to explore ways to expand access to and the acceptability of new prevention technologies, promoting critical and inclusive dialogue that addresses social markers of difference.
-
Financing
Fernando Seffner, Productivity Grant PQ-2 (National Council for Scientific and Technological Development - CNPq, process nº 309670/2021-7, 2022 to 2025). Research project “Pre-Exposure Prophylaxis (PrEP) for HIV prevention in South America: ethnography of experiences of access, use, and management” (CNPq and Decit/SECTICS/MS, process nº 445070/2023-4). For more information, visit: https://prepamericadosul.uea.edu.br/.
Data Availability Statement
The research data are available within the main text of the article.
References
-
AYRES, J. R. Vulnerabilidade, cuidado e integralidade: reconstruções conceituais e desafios atuais para as políticas e práticas de cuidado em HIV/Aids. Saúde em Debate, Rio de Janeiro, v. 46, n. 7, p. 196-206, 2023. DOI: https://doi.org/10.1590/0103-11042022E714
» https://doi.org/10.1590/0103-11042022E714 -
BRASIL. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Boletim Epidemiológico HIV e Aids 2023 Brasília: Ministério da Saúde, 2023. Disponible en: https://www.gov.br/aids/pt-br/central-de-conteudo/boletins-epidemiologicos/2023/hiv-aids/boletim-epidemiologico-hiv-e-aids-2023.pdf/view Access in: 26 nov. 2024.
» https://www.gov.br/aids/pt-br/central-de-conteudo/boletins-epidemiologicos/2023/hiv-aids/boletim-epidemiologico-hiv-e-aids-2023.pdf/view - BUTLER, J. Quadros de guerra: quando a vida é passível de luto? Rio de Janeiro: Civilização Brasileira, 2015.
-
CHAUÍ, M. Democracia: criação de direitos. Síntese: Revista de Filosofia, Belo Horizonte, v. 45, n. 143, p. 409-422, 2018. DOI: https://doi.org/10.20911/21769389v45n143p409/2018
» https://doi.org/10.20911/21769389v45n143p409/2018 -
CLARKE, A. et al. Biomedicalization: Technoscientific transformations of health, illness, and US Biomedicine. American Sociological Review, New York, v. 68, n. 2, p. 161-194, 2003. DOI: https://doi.org/10.2307/1519765
» https://doi.org/10.2307/1519765 - DARDOT, P.; LAVAL, C. Comum: ensaio sobre a revolução no século XXI. São Paulo: Boitempo, 2017.
- DARDOT, P.; LAVAL, C. A nova razão do mundo: ensaio sobre a sociedade neoliberal. São Paulo: Boitempo, 2016.
-
DAVIS, C. Homo adhaerens: Risk and adherence in biomedical HIV prevention research. Social Studies of Science, [S. l.], v. 50, n. 6, p. 860-880, 2020. DOI: https://doi.org/10.1177/0306312720933943
» https://doi.org/10.1177/0306312720933943 -
DESLANDES, S.; COUTINHO, T. Pesquisa social em ambientes digitais em tempos de COVID-19: notas teórico-metodológicas. Cadernos de Saúde Pública, Rio de Janeiro, v. 36, n. 11, p. e00223120, 2020. DOI: https://doi.org/10.1590/0102-311X00223120
» https://doi.org/10.1590/0102-311X00223120 - EUZÉBIO, F. A. Pedagogia dos prazeres: apreendendo formas de compreender e modos de estar em PrEP no Brasil. 2023. Dissertação (Mestrado em Antropologia) - Programa de Pós-Graduação em Antropologia, Universidade Federal da Bahia, Salvador, 2023.
- FERREIRA, D. D. Entre o risco e o prazer: uma cartografia dos afetos de homens gays cisgêneros usuários da profilaxia pré-exposição ao HIV (PrEP). 2023. Tese (Doutorado em Saúde Coletiva) - Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina, Florianópolis, 2023.
- FOUCAULT, M. História da sexualidade: a vontade de saber. 13. ed. Rio de Janeiro: Graal, v. 1, 1999.
- FOUCAULT, M. O nascimento da biopolítica: Curso no Collège de France (1978-1979). São Paulo: Martins Fontes, 2008.
-
GRANGEIRO, A. et al. Epidemia de HIV, tecnologias de prevenção e as novas gerações: tendências e oportunidades para a resposta à epidemia. Cadernos de Saúde Pública, Rio de Janeiro, v. 39, p. 1-12, 2023. Supl. 1. DOI: https://doi.org/10.1590/0102-311XPT144223
» https://doi.org/10.1590/0102-311XPT144223 - GROSSI, M. P.; FERNANDES, F. B. M.; CARDOZO, F. (org.). Sexualidades, juventudes e práticas docentes: uma etnografia da educação básica em escolas públicas de Santa Catarina. Florianópolis: Tribo da Ilha; Tubarão: Copiart, 2017.
-
LERMEN, H. S.; MORA, C.; NEVES, A. L. M. das. Aids em cartazes: representações sobre sexualidade e prevenção da Aids nas campanhas de 1º de dezembro no Brasil (2013-2017). Interface - Comunicação, Saúde, Educação, Botucatu, v. 24, p. e180626, 2020. DOI: https://doi.org/10.1590/Interface.180626
» https://doi.org/10.1590/Interface.180626 - MINAYO, M C. O desafio do conhecimento Pesquisa qualitativa em saúde. 10. ed. São Paulo: Hucitec, 2007.
- MISKOLCI, R. Batalhas morais: política identitária na esfera pública técnico-midiatizada. Belo Horizonte: Autêntica, 2021.
-
MORA, C.; NELVO, R.; MONTEIRO, S. Peças de comunicação governamentais sobre as profilaxias pré (PrEP) e pós-exposição (PEP) ao HIV (2016-2019): análise de seus conteúdos e circulação entre gays, mulheres trans/travestis e trabalhadoras sexuais. Saúde e Sociedade, São Paulo, v. 31, n. 4, p. e210855pt, 2022. DOI: https://doi.org/10.1590/S0104-12902022210855pt
» https://doi.org/10.1590/S0104-12902022210855pt -
OLIVEIRA, E. A. et al. Adolescentes gays, bissexuais e outros homens que fazem sexo com homens: interseccionalidade e continuum de cuidado de PrEP. Revista de Saúde Pública, São Paulo, v. 58, p. 11s, 2024. DOI: https://doi.org/10.11606/s1518-8787.2024058005705
» https://doi.org/10.11606/s1518-8787.2024058005705 - ORTEGA, F.; ZORZANELLI, R. Corpo em evidência: a ciência e a redefinição do humano. Rio de Janeiro: Civilização Brasileira, 2010.
-
PARKER, R. The Global HIV/Aids pandemic, structural inequalities, and the politics of international health. American Journal of Public Health, Washington, v. 92, n. 3, p. 343-346, 2002. DOI: https://doi.org/10.2105/ajph.92.3.343
» https://doi.org/10.2105/ajph.92.3.343 - PELÚCIO, L.; MISKOLCI, R. A prevenção do desvio: o dispositivo da aids e a repatologização das sexualidades dissidentes. Sexualidad, Salud y Sociedad, Rio de Janeiro, n. 1, p. 125-157, 2009.
-
PREP AMÉRICA DO SUL. PrEP América do Sul - Início 2025. Disponible en: https://prepamericadosul.uea.edu.br/ Access in: 13 mar. 2025.
» https://prepamericadosul.uea.edu.br/ -
PREPARA SALVADOR. Instagram: @preparasalvador Available from: https://www.instagram.com/preparasalvador/ Access in: 14 nov. 2024.
» https://www.instagram.com/preparasalvador/ -
PREP1519. PrEP1519: escolhas. 2025. Disponible en: https://prep1519.org/ Access in: 13 mar. 2025.
» https://prep1519.org/ - ROSE, N. A política da própria vida: biomedicina, poder e subjetividade no século XXI. São Paulo: Paulus, 2013.
-
SALES, T. A.; CARVALHO, D. F. Sexualidades entre saber-poder, resistências e linhas de fuga em “Doutor Maravilha”. Revista Estudos Feministas, Florianópolis, v. 32, n. 2, p. e88358, 2024. DOI: https://doi.org/10.1590/1806-9584-2024v32n288358
» https://doi.org/10.1590/1806-9584-2024v32n288358 -
SEFFNER, F.; PARKER, R. A neoliberalização da prevenção do HIV e a resposta brasileira à Aids. In: Associação Brasileira Interdisciplinar de Aids (Org.). Mito vs realidade: sobre a resposta brasileira à epidemia de HIV e Aids em 2016. Rio de Janeiro: ABIA, 2016a. p. 24-32. Disponible en: http://abiAids.org.br/wp-content/uploads/2016/07/Mito-vs-Realidade_HIV-e-Aids_BRASIL2016.pdf Access in: 26 nov. 2024.
» http://abiAids.org.br/wp-content/uploads/2016/07/Mito-vs-Realidade_HIV-e-Aids_BRASIL2016.pdf -
SEFFNER, F.; PARKER, R. Desperdício da experiência e precarização da vida: momento político contemporâneo da resposta brasileira à aids. Interface, Botucatu, v. 20, p. 293-304, 2016b. DOI: https://doi.org/10.1590/1807-57622015.0459
» https://doi.org/10.1590/1807-57622015.0459 -
SIERRA, J. C.; MEYER, D. E. Entre capturas biopolíticas e estratégias de resistência LGBT: um ensaio sobre a lógica fármaco-moralizante na profilaxia pré-exposição - PrEP. Revista Interinstitucional Artes de Educar, Rio de Janeiro, v. 6, n. 3, p. 1018-1037, 2020. DOI: 10.12957/riae.2020.54592.
» https://doi.org/10.12957/riae.2020.54592. -
SILVA JUNIOR, A. L.; BRIGEIRO, M.; MONTEIRO, S. Saúde, aprimoramento e estilo de vida: o uso da profilaxia pré-exposição ao HIV (PrEP) entre homens gays, mulheres trans e travestis. Physis: Revista de Saúde Coletiva, Rio e Janeiro, v. 33, p. e33082, 2023. DOI: https://doi.org/10.1590/S0103-7331202333082
» https://doi.org/10.1590/S0103-7331202333082 -
SZWARCWALD, C. L. et al. HIV incidence estimates by sex and age group in the population aged 15 years or over, Brazil, 1986-2018. Revista da Sociedade Brasileira de Medicina Tropical, Brasília, v. 55, p. 1-11, 2022. DOI: https://doi.org/10.1590/0037-8682-0231-2021
» https://doi.org/10.1590/0037-8682-0231-2021 -
UNAIDS. The urgency of now: Aids at a crossroads (2024 Global Aids Update). Geneva: UNAids, 2024. Available from: https://www.unaids.org/en/resources/documents/2024/global-aids-update-2024 Access in: 26 nov. 2024.
» https://www.unaids.org/en/resources/documents/2024/global-aids-update-2024 -
UNAIDS. Young people and HIV Geneva: UNAids, 2021. Disponible en: https://www.unAids.org/sites/default/files/media_asset/young-people-and-hiv_en.pdf Access in: 26 nov. 2024.
» https://www.unAids.org/sites/default/files/media_asset/young-people-and-hiv_en.pdf -
WALSH-BUHI, E. et al. Pre-exposure Prophylaxis (PrEP) information on Instagram: Content analysis. JMIR Public Health and Surveillance, v. 7, n. 7, p. e23876, 2021. DOI: https://doi.org/10.2196/23876
» https://doi.org/10.2196/23876
-
Editors: Ivia Maksud, Simone Monteiro
Source: Instagram @preparasalvador screenshot. Available from: 
Source: Instagram @preparasalvador screenshot. Available from: 
Source: Instagram @preparasalvador screenshot. Available from: 
Source: Instagram @preparasalvador screenshot. Available from: