The ‘Informed Matter’ of Gay and Bisexual Men's (Potential) Use of HIV Antiretrovirals to Prevent COVID‐19

ABSTRACT

In 2020, there were reports that HIV antiretrovirals, specifically the combination tenofovir disoproxil fumarate and emtricitabine (TDF/FTC), had therapeutic potential for COVID‐19. In the context of scant empirical evidence at the time to confirm such an effect, we sought to understand the ways that gay and bisexual men (GBM) made sense of—and embodied—information about HIV antiretrovirals in relation to preventing and/or treating COVID‐19. We conducted interviews with 26 participants between August and November 2020. To understand how information about, and experiences of, consuming antiretrovirals might form part of assemblages of COVID‐19 prevention for GBM in Australia, we draw on Marsha Rosengarten's (2009) concept of ‘informed matter’. ‘Informed matter’ conceptualises the subject (of disease prevention) as involved in a co‐constitutive relationship with the contextual dynamics in which it is situated. Participants drew on their understandings of virology, immunology and pharmaceuticals and experiences with antiretrovirals to form perceptions about their function as therapeutics for COVID‐19. By looking beyond biotechnologies as causal of behaviour, we can avoid unintended moralism in contexts of potentially different use. We argue that using ‘informed matter’ is useful to interrogate, often neglected, complex changes in sex‐associated biotechnologies in complicated informational contexts, such as a global pandemic.

1. Introduction

As early as the end of March 2020, reports surfaced that HIV antiretrovirals may have been effective against the virus SARS‐CoV‐2, potentially preventing severe COVID‐19 disease (Johnson ^{2020a, 2020b}, 62–63). These reports speculated about the HIV combination drug, tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC), ¹ inhibiting replication of SARS‐CoV‐2 in a similar way to another antiviral, remdesivir (Johnson ^2020b). On 1 May 2020, remdesivir had been granted emergency use authorisation to treat COVID‐19 in the United States (Eastman et al. 2020). In June 2020, results from an observational study in Spain found rates of COVID‐19 acquisition (and hospitalisation) were lower among people living with HIV (PLHIV) who were taking an antiretroviral combination including TDF than their counterparts on other antiretroviral combinations (Del Amo et al. 2020). Other observational and case–control studies undertaken in this early pandemic period investigated the association between the severity of COVID‐19 symptoms and TDF/FTC among gay and bisexual men (GBM) (Ayerdi et al. 2020; Fernandes et al. ²⁰²⁰). Despite early promising signs, investigations of TDF/FTC's effectiveness as a prevention of COVID‐19 infection or disease progression produced varying results, with most observing no significant effects (Charre et al. 2020; Del Amo et al. ²⁰²⁰; Delaugerre et al. ²⁰²²; Ssentongo et al. ²⁰²¹; Verburgh et al. ²⁰²³). More recently, however, Del Amo et al. (2022) found that TDF/FTC significantly reduced the severity of COVID‐19 illness among PLHIV who were virally suppressed and aged over 50 years.

Given the emerging, yet inconclusive, evidence in 2020 about the potential for antiretrovirals to prevent COVID‐19 infection or reduce disease severity, some behavioural surveillance research included questions about the use of TDF/FTC to protect against COVID‐19 (de Sousa et al. ²⁰²¹). A survey conducted among gay men in Brazil and Portugal, commencing on 5 March 2020, found that almost half (46.1%) of participants taking Truvada (the brand name for TDF/FTC) reported they were using it to prevent COVID‐19 (de Sousa et al. ²⁰²¹).

Rather than adjudicate the evidence of TDF/FTC's effectiveness to prevent COVID‐19 or slow its disease progression, our aim in this paper is to interrogate how—in a contested informational context—GBM made sense of, interpreted and embodied information about antiretrovirals' potentials for COVID‐19. We first outline the evolution of antiretrovirals, specifically TDF/FTC, in relation to treating and preventing HIV.

1.1. TDF/FTC: A Brief History

TDF—brand name Viread—was approved by the U.S. Food and Drug Administration (FDA) in 2001 for the treatment of HIV in adults (U.S. Food and Drug Administration ²⁰⁰¹), with the approval of FTC—brand name Emtriva—in 2003 (U.S. Food and Drug Administration ²⁰⁰³). Both TDF and FTC form part of the reverse transcriptase inhibitor class of antiretrovirals, which work by blocking the production of enzymes that HIV uses to replicate and continue infection of cells (European Medicines Agency ²⁰²³). Gilead Sciences Inc. combined the two drugs into a single pill, and this formulation—under the brand name Truvada—was approved for HIV treatment in the United States in 2004. TDF/FTC has been widely used in treatment regimens (U.S. Food and Drug Administration ²⁰⁰⁶). However, since the approval of a new formulation of the tenofovir component in 2016, called tenofovir alafenamide fumarate (TAF)—known in its combination with FTC by the brand name Descovy—this formulation is largely used for treatment of HIV in combination therapies (U.S. Food and Drug Administration ²⁰¹⁶). This shift is mainly due to TDF/FTC's association with renal impairment and reduced bone mineral density (Di Perri ²⁰²¹). In 2008, TDF was also approved for the treatment of chronic hepatitis B in the United States (Gilead 2008) and Australia (PBS ²⁰⁰⁹).

Since the 1980s, antiretrovirals have also been used to prevent HIV infection after exposure to the virus (Beekmann and Henderson 2014). TDF/FTC has been listed as a preferred regimen for this purpose—referred to as HIV post‐exposure prophylaxis (PEP)—since 2005 by the U.S. Centers for Disease Control and Prevention (Panlilio et al. 2005) and is the recommended two‐drug regimen in Australian guidelines (ASHM ²⁰²³). The first evidence of TDF/FTC's effectiveness as HIV pre‐exposure prophylaxis (PrEP) among cisgender men who have sex with men (MSM) and trans women was published in 2010 (Grant et al. 2010). Even prior to publication of these findings, small numbers of gay men had been using antiretrovirals off‐label (for a purpose not indicated on the medications' registered approval) for HIV treatment or prevention after exposure (Kellerman et al. 2006; Krakower et al. ²⁰¹²; Zablotska et al. ²⁰¹³). TDF/FTC and TAF/FTC have been approved for use as PrEP by regulatory authorities in many countries. In Australia, TDF/FTC is still favoured for PrEP, as it is the only antiretroviral combination subsidised by the national health insurance scheme.

The use of PrEP by GBM in Australia is very high, having increased from an estimated 0.9% in 2014 to 66.8% in 2023 (Broady et al. 2024, 36). In addition, the proportion of HIV‐positive men on antiretroviral treatment increased from 85.3% in 2014 up to 96.0% in 2023 (Broady et al. 2024, 33). The high use of antiretrovirals for HIV treatment and prevention among GBM in Australia provides a concentrated context for investigating cultures of antiretroviral use (Murphy et al. 2024), including throughout the COVID‐19 pandemic.

1.2. Antiretroviral Assemblages

Assemblage approaches, following Deleuze and Guattari (1988), have been influential in helping scholars think about the nonlinear connections between bodies, HIV drugs and other entities and how they come together to produce effects (Gagnon and Holmes 2016). That is, rather than one thing affecting another, a multitude of ‘actors’ influence each other throughout their interactions.

In the field of HIV, assemblage thinking has been used to interrogate traditional understandings of the effects of drugs on bodies. Assemblage approaches to exploring antiretroviral effects have included studies on the following: the complexities of PrEP clinical trials (Rosengarten and Michael ^2009b); the expectations of PrEP among scientific stakeholders involved in PrEP trials (Rosengarten and Michael ^2009a); the configuration of potential users (Holt 2015) and the experience of side effects (Gagnon and Holmes 2016). Research after TDF/FTC became widely used for HIV prevention has paid similar attention to the relational processes between users and these biotechnologies (Brown and Di Feliciantonio ²⁰²²; Murphy et al. ²⁰²⁴; Smith et al. ^{2023, 2022}; Young and Boydell ²⁰²³). In this paper, we use assemblage thinking, specifically drawing on Rosengarten's (2009) conceptualisation of ‘informed matter’, to investigate the contexts and relationships of GBM's antiretroviral consumption during the first year of the COVID‐19 pandemic.

1.3. The ‘Informed Matter’ of HIV Prevention

By the early 2000s, highly active antiretroviral therapy (HAART) had become the standard of care for PLHIV, and ‘science gave promise that infection rates resulting from [condomless sex] could be reduced as a consequence of reduced individual viral loads’ (Rosengarten 2009, 59). However, concerns had emerged about how gay men were changing their sexual behaviour in light of this promise. These changes included reducing condom use based on information about the effectiveness of antiretrovirals in suppressing viral replication (attributed to ‘treatment optimism’, an explanation that did not grapple with shifts in possibilities for the prevention of HIV transmission). This positioned changes in HIV prevention behaviours as potentially ‘irresponsible’.

To break up this unidirectional (and potentially moralising) approach to how gay men were receiving and putting to use this new information about antiretrovirals, Rosengarten (2009) developed the concept of ‘informed matter’. Drawing on the work of Barry (2005), ‘informed matter’ reconceptualised the gay male subject of HIV prevention discourse. It replaced a subject who was understood as autonomous and agentic (and assumed, therefore, to use information about HIV risk responsibly) with a subject conceptualised as both embodied and involved in a co‐constitutive relationship with the ‘dynamic context’ (61–2) in which he was situated. This new subject of HIV prevention was one that was technologised through antiretroviral drugs and viral load testing technologies or, as Rosengarten argued, through the traffic between information and flesh. This ontological shift meant abandoning the conventional distinction between human and biotechnology (as described above). It also, as Rosengarten argued, questioned the distinction between human subject and material body that was customary in HIV prevention (2009, 61).

‘Informed matter’ moves beyond considering changes in gay men's approaches to sex without condoms as ‘bad’ and in need of intervention. Rather, it focuses on how more than biotechnologies are involved when gay men practise HIV prevention, including how they interpret and implement new information:

Rather than simply accept the general presumption of the HIV prevention education field that human practices are informed by knowledge and, therefore, one simply needs more effective knowledge, draw[ing] attention to an historico‐material process that […] can be seen as embodied in the target. This recasting of the target of prevention provides a subtle but strategic alternative to the more usual viewing of persons as merely acting in response to, and subsequent to the event of, an intervention. (Rosengarten 2009, 14 original emphasis)

The aim of Rosengarten's intervention was to interrupt the potential moralisation of emerging HIV prevention strategies as the product of ‘flawed’ engagements with new biotechnologies. Rosengarten challenged this linear explanation with an understanding of decision‐making about HIV prevention as intertwined with these biotechnologies, different sources of knowledge and the context in which these are brought together. That is, decision‐making about HIV prevention is intertwined with these biotechnologies, different sources of information and knowledge, and the context in which they come together, that is, antiretrovirals and histories of HIV prevention and treatment. Other researchers have worked to intervene in the potentially moralising ways of thinking about how GBM develop behaviours around new HIV prevention technologies (Race 2015; Spieldenner ²⁰¹⁶), including throughout the COVID‐19 pandemic (Hakim et al. 2022). However, using ‘informed matter’ situates the practices and perceptions of GBM within the historical context in which they are occurring. Paying attention to this historicity involves examining how context contributes to the relations between actors (human and nonhuman) in the assemblage. By interrogating how biotechnologies are used, how knowledge is mobilised in these uses and where and how they influence sexual practice, we may resist conventional, linear or causal claims about the relationships between these technologies, behaviours and risk reduction strategies.

Although Rosengarten was writing in a time when HIV treatments and technologies were altering gay men's cultures of prevention, our analysis considers how antiretrovirals that are already in use—and in bodies—to treat and prevent HIV are informing the potential for prevention in the context of a different virus. This new context involves processes where GBM and antiretrovirals come together with new information and produce something different, a COVID‐19 prevention assemblage that is informed by a history of HIV treatment and prevention. As we will demonstrate, similar modes of framing responsible/correct or irresponsible/incorrect behaviour and antiretroviral use were also at play in 2020. Using ‘informed matter’ has the potential to uncover how information about TDF/FTC and its potential for COVID‐19 contributed to the process of making GBM through discourses of COVID‐19 prevention.

2. Methods

Our study was designed at a time when certain HIV antiretrovirals (the protease inhibitors lopinavir and ritonavir (Cao et al. 2020) and other broad‐spectrum antivirals, such as remdesivir (Eastman et al. 2020)) were being investigated as potential treatments for COVID‐19. An early study indicated that TDF/FTC might be effective (Del Amo et al. 2020). Our decision to ask about knowledge and use of antiretrovirals for COVID‐19 was also influenced by other research among GBM that included questions about this use (see de Sousa et al. ²⁰²¹; Sousa et al. ²⁰²⁰; Reyniers et al. ²⁰²¹; Torres et al. ²⁰²¹).

We conducted qualitative semi‐structured interviews with GBM. Participants were recruited from a larger study on the impacts of the COVID‐19 pandemic, where they were asked to indicate if they were willing to participate in an interview. Some sociodemographic characteristics were prioritised during participant selection (i.e., aged 25 years or under, HIV serostatus, country of birth and visa/resident status) to ensure strong representation. Others were monitored but not actively prioritised (i.e., sexual activity, PrEP use, composition of household, relationship status, ethnic background, education level, residential location and employment status) (see Table 1). Eligibility for the larger study is discussed elsewhere (Hammoud et al. 2020). All participants provided written consent prior to the interview. Ethical approval was granted by the Human Research Ethics Committee of UNSW Sydney.

TABLE 1.

Participant characteristics at initial interview.

	N = 26
Age in years
Range	23–77
Mean	43.7
Gender
Male (cis)	26
Sexuality
Gay	24
Bisexual/pansexual	2
Country of birth
Australia	18
Other country	8
Education level
High school	5
Trade certificate	3
University degree	18
HIV status
HIV positive (on antiretrovirals)	7
HIV negative (using PrEP)	8
HIV negative (not currently using PrEP) a	6
HIV negative (never used PrEP)	5

^a This includes participants who had a history of using PrEP but were not using it at the time of interview.

DS conducted interviews between August 2020 and November 2020 by telephone or videoconference. Interviews focused on how the pandemic impacted participants' mental health and wellbeing, relationships and sex lives. For the latter, we asked about sexual practices and drug use since the start of the pandemic (including during stay‐at‐home orders), HIV care and prevention, and prevention of sexually transmitted infections (STIs). Given the information about antiretrovirals circulating at the time (described above) and that most participants were already taking antiretrovirals for HIV treatment or prevention, participants were also asked about their perspectives on TDF/FTC's potential uses for COVID‐19. Participants were asked, ‘What do you think about using the drug used for PrEP to reduce your risk of getting COVID?’. Interviews lasted ∼79 min, ranging from 49 to 123 min, were audio‐recorded, professionally transcribed, de‐identified and checked for accuracy. To ensure participants' confidentiality, each participant chose a pseudonym for research outputs.

Overall, we conducted interviews with 26 participants. All participants identified as cis men, most were gay and seven were living with HIV (see Table 1). Most HIV‐negative participants were using—or had previously used—PrEP, and all participants with HIV were on treatment (see Table 1). The majority (three‐quarters) of participants had an awareness of the possibility of TDF/FTC being used to prevent COVID‐19. The level of interest in or entertainment of the idea differed across participants who had an awareness. Two participants had no prior awareness, and for the remaining four, it was unclear whether they had prior awareness from their answers.

Throughout this paper, we are guided by reflexive thematic analysis (Braun and Clarke 2019, 2021). This approach required us to develop themes that were not simply categories of broad topics or subject domains but to find recurring meanings across interview transcripts, ‘patterns of shared meaning, underpinned by a central meaning‐based concept’ (Braun and Clarke 2019, 593). However, the aim of this approach is not to be completely descriptive but to be able to adapt the process that makes sense for the project. To organise interview transcripts, DS developed a coding framework based on topics covered in the study's interviews. By organising the data in this way, it provided a subset of data by topic area. This allowed DS to work with a smaller section of data (in this case, sections of the data that discussed TDF/FTC and COVID‐19) to develop themes. Data were organised using QSR NVivo (12.6.1.970). We explore the historical relationship GBM have with antiretrovirals and how this relationship informs speculation about the possible effectiveness of these same drugs for COVID‐19 using ‘informed matter’.

3. Findings

We established three themes about how participants made sense of TDF/FTC's use for preventing COVID‐19 infection or reducing the severity of illness. First, participants used their knowledge of viral transmission and replication (of HIV and SARS‐CoV‐2) and understandings of how TDF/FTC (and other antiretrovirals) work within bodies. Second, participants drew on their experiences of using antiretrovirals for HIV prevention and treatment, including dosing practices. Finally, participants speculated on the potential for knowledge about TDF/FTC and COVID‐19 to influence behaviour, particularly among gay men using PrEP.

3.1. Using Virological, Immunological and Pharmaceutical Knowledge

By analysing how participants engaged with virological and pharmaceutical information, we see how they positioned TDF/FTC's potential role against COVID‐19. This positioning provides a way of identifying where knowledge about HIV and COVID‐19 dis/connects for participants. Bryan, an HIV‐negative bisexual man in his 70s, had used PrEP prior to the COVID‐19 pandemic and saw TDF/FTC's antiviral abilities as indiscriminate:

I mean how it [TDF/FTC] operates would make me think that it would make me less likely to get COVID. Or for COVID to go anywhere. You know, I don’t see that it would necessarily discriminate between an HIV virus [sic] and a COVID virus [sic], […] I wouldn’t be surprised if it did confer some prophylaxis there.

As noted earlier, Bryan—as with all participants—was recruited from a wider project that included questions about the use of TDF/FTC for COVID‐19. As with Holt's (2013) account of how surveillance activities, like survey participation, mediate the imaginaries of gay men, here the activities within the survey from which participants were recruited and the questions they were asked in their interview for this study may mediate their imaginaries of what TDF/FTC can be. These kinds of research questions prompt participants to reflect on their own relationships with biotechnologies, including knowledge and embodied practices. A history of personal use of TDF/FTC and engagement in research shaped Bryan's conclusion that TDF/FTC may have a role in preventing COVID‐19 infection, much as this antiretroviral combination has done to prevent the acquisition of HIV. Bryan's account highlights how relationships with antiretrovirals and understandings of the relationship between the body and substances—referred to as pharmacokinetics and pharmacodynamics—allow for the possibility that TDF/FTC could be a prophylaxis for both HIV and COVID‐19.

Other participants compared their understandings of SARS‐CoV‐2 and HIV in their accounts, including the structure and transmission routes of the two viruses. Charlie, a gay man living with HIV in his 50s who, prior to being interviewed, had not heard about the potential use of TDF/FTC for COVID‐19, drew on his knowledge of viral transmission to question TDF/FTC's likely effectiveness against SARS‐CoV‐2:

I don’t see any connection between Truvada [TDF/FTC] and preventing a COVID infection. Considered we’re talking droplets ² rather than blood, semen, whatever, as well, yeah. I don’t see the connection.

Notably, information about HIV transmission routes has been emphasised through health promotion interventions targeting gay men over several decades, highlighting the specific sexual practices required for transmission. Although SARS‐CoV‐2 can also be transmitted through direct physical contact between people, transmission occurs in indirect ways as well via contaminated objects (fomites), droplets sprayed onto mucous membranes and inhalation of aerosols (although airborne transmission was much discussed and disputed early in the pandemic). With Charlie's understanding of TDF/FTC as a biotechnology specifically for treating and for preventing the transmission of HIV to sexual partners, it was implausible that the same drug could have an effect against COVID‐19 (or SARS‐CoV‐2).

To provide another example of someone thinking about TDF/FTC as the wrong tool for COVID‐19, Joseph says, ‘[i]t's like trying to catch a frog with a fly swatter.’ Joseph clarifies his thoughts using an analogy:

If you have any understanding of what the HIV virus [sic] looks like and does, and binds to, and any understanding of what a coronavirus looks like and binds to, it’s pretty obvious that, unless you have some weird thing going on, it’s [TDF/FTC] probably not going to help. […] People think that, you know, if it’s antiviral, it’s antiviral. […] It’s like saying all flour is the same. […] It’s a bit like you know, I want to make a flat bread. Let me use self‐raising flour. And then you’re disappointed when you don’t have flat bread.

Joseph's account draws on knowledge about the pharmacological activity of antiretrovirals against viruses, knowledge that goes beyond traditional prevention messaging for both HIV and COVID‐19. Joseph's comparison of the viruses by morphology may be influenced by Australian public health officials' and media's use of images of the SARS‐CoV‐2 particle to visualise transmission and replication and later to describe the function of vaccines. However, the comparison that Joseph made forecloses on the possibility that TDF/FTC may have broad‐acting capabilities and relies on knowledge that (antiretro)viral medications only work for a specific purpose, even as science was investigating broad‐based applications of a range of HIV antiretrovirals, including TDF/FTC (e.g., Ayerdi et al. ²⁰²⁰; Charre et al. ²⁰²⁰). Notably, this move to the molecular goes beyond making a distinction between sexual encounters and signals that the informational context in which participants are becoming requires us to look beyond, but not exclude, the role of sex.

The accounts above operate in what can be considered ‘part of the making of a heterogenous technologized field’ (Rosengarten 2009, 77). That is, different articulations of virological, immunological and pharmaceutical knowledge—whether this knowledge is correct or not—can be framed as ontological differences that are shaped by informational contexts pertaining to both HIV and COVID‐19. Participants were not asked to elaborate further on their understandings of how antiretrovirals act on/against HIV and the connections they make, or do not, with COVID‐19. However, they may have drawn on their understandings—as subjects of decades of HIV prevention, which includes messaging about shared responsibility, behaviour change (using condoms) and biomedical interventions (testing, PEP, undetectable viral load and PrEP)—of how the immune system responds to a viral challenge and, specifically, the role of CD4 cells in this response. ³ This knowledge of the immune system response—particularly among PLHIV, who have the levels of these cells in their body tested to understand HIV progression—could contribute to perceptions of TDF/FTC's (in)ability to produce bodily effects for COVID‐19. This knowledge could be understood as what Rosengarten (2009) calls the ‘traffic’ between information and flesh. That is, rather than thinking about bodies and interventions as bifurcated and marking out their difference—bodies responding to interventions—‘traffic’ denotes the flow of information between bodies and interventions as mutual. Constituted as subjects of HIV prevention and treatment—where information was historically demanded and often resulted in dense exchanges between people affected by HIV and science—the accounts above provide ways of allowing ‘movement [in understandings of HIV and COVID‐19] that helps constitute their difference as much as dissolve it’ (Rosengarten 2009, 17). In other words, we can recognise that interventions, knowledge about them and relationality between actors can produce something more than cause and effect. Seen through this lens, Charlie and Joseph's accounts suggest that this ‘traffic’ between information and flesh is constitutive of divergent thinking about the role of TDF/FTC in COVID‐19 prevention.

3.2. Informed by Experience

Understandings of viral replication and its prevention, explored above, influenced how participants discussed the work of antiretrovirals within bodies. Additionally, embodied experiences and practices of using antiretrovirals provided participants with important contextual knowledge about TDF/FTC and COVID‐19. This included the bodily experiences of side effects, dosing practices, viral suppression and protection from HIV. For participants like Imran, a gay man in his 30s, making sense of questions about TDF/FTC's therapeutic potential for COVID‐19 entailed an assemblage of bodies, drugs, virus and knowledge that was different from but informed by HIV assemblages. Imran's account draws on his embodied knowledge of TDF/FTC use—in particular, dosing practices, (lack of) side effects and access—to allow for the possibilities of TDF/FTC for COVID‐19:

I don’t think there is enough science behind it, or data behind it, but, having said that, it’s like taking a vitamin tablet: you know, it doesn’t harm you, right? You might as well just take it. I don’t think the general population should take it, but I had it at home. Like it’s not like I had to go out of my way, go see a doctor or go to a pharmacy to get said medication, or I didn’t know what the side effects were. […] I would have been on it anyway. So, I just took it as an additional, precautionary thing.

Imran's declaration that there is not ‘enough’ empirical evidence to support the use of the antiretroviral for COVID‐19, the foregrounding in his account suggests some awareness of the available research. Armed with knowledge of TDF/FTC's effects within his own body and an understanding of limited evidence for the benefits of vitamins, TDF/FTC becomes harmless and mundane (Smith et al. 2023). Although there may not be any significant benefit, Imran knew TDF/FTC ‘doesn't harm you’; he had a supply on hand, and, if he had been having sex, the drug was already in his body. This openness would not be possible without the experience of using TDF/FTC. Although he does not specify why he suggested against the general population using TDF/FTC for COVID‐19, this emphasis could be due to the lack of evidence from clinical trials to support its use for COVID‐19 or the impact it may have on the availability for people who use TDF/FTC to prevent HIV, as occurred with hydroxychloroquine.

Similarly, Tristan, a man living with HIV in his 50s who was aware of TDF/FTC as a possible preventative for COVID‐19, stated, ‘I was really interested in that and I started reading a lot about it’, and he also drew on his experience with antiretrovirals for HIV treatment:

When I first looked at the virus [SARS‐CoV‐2] and realised that it was an RNA and DNA virus, I thought, ‘Hang on. I bet some of the HIV antiretrovirals would be of assistance’. I did look into some of the use of Truvada [brand name TDF/FTC] and also, I think, Biktarvy [brand name for the antiretroviral combination containing the integrase inhibitor, bictegravir, as well as FTC TAF], was also mentioned. […] I don’t know whether it would have any prophylactic effect on me. […] I have had Truvada; I’m not [using it] at the moment but I think the ingredients in Truvada are in my current medication anyway.

Tristan's knowledge base has been built up through his engagement with HIV prevention prior to, and 11 years since, seroconversion. However, his perception was that if TDF/FTC, or other antiretrovirals, did have prophylactic capacity against COVID‐19, he was sceptical of the effectiveness for him personally. Tristan remarked further on the extensiveness of HIV research and the benefits it may have for SARS‐CoV‐2 and other infectious diseases, ‘I started to think that the 30‐plus years of investigations into virology and HIV studies will be of benefit in the treatment and vaccines for this coronavirus.’ This hopefulness for HIV science and COVID‐19 is incongruous with Tristan's pessimism for the benefit of antiretrovirals to himself.

A lack of scientific evidence to suggest a preventative effect of TDF/FTC against COVID‐19 ruled out any meaningful reason to consider the medication for many participants (although, paradoxically, there was evidence to suggest a reduction in severity of COVID‐19 infection among PLHIV aged over 50 (Del Amo et al. 2022)). In contrast to Tristan, because of this lack of evidence to suggest a broader association, Brandon, another man aged in his 50s living with HIV, suggested that something intrinsic to an individual might assist with any protective quality that antiretrovirals could have for COVID‐19:

I mean I read a lot about what’s going on with the HIV treatment situation and I ask a lot of questions [of my healthcare providers]. And it’s just, there’s no studies that say that HIV medication has any real association with COVID at all. It might have an association with an individual who’s taking it, but it has got nothing to do with COVID. And, if you think you’re going to take it to stop COVID, forget it.

Like Tristan, Brandon's engagement with HIV treatment fostered a curiosity about the advancement of the field and, in particular, how this was unfolding throughout the COVID‐19 pandemic. Although Brandon was firm that there was no ‘real association’ between antiretrovirals providing protection against COVID‐19 based on his investigations, his account left open the possibility of protective associations between antiretrovirals and COVID‐19 for individuals.

Taken together, Imran's, Tristan's and Brandon's accounts blur the lines of how drug effectiveness is conceived when accounting for embodied experiences and practice. The dynamism of knowledge processes in these accounts highlights the ‘coextensive relation between information and flesh’ (Rosengarten 2009, 5). Information and flesh (the body and the processes that occur within, on and in relation to it) become intertwined with understandings of antiretrovirals within the body, on viruses and knowledge that contribute to perceptions and decisions. Understanding the nuanced ‘traffic’ of informational effects mends the bifurcation of information and flesh and opens up what is possible to know about how biotechnologies become material within, and in relation to, experience.

3.3. Misinforming (Potential) Behaviour

Conventional framings of knowledge can be used to instil a sense of authority, particularly when it concerns the potential to contribute to changes in behaviour that are viewed as responsible/correct or irresponsible/incorrect. For some participants, their accounts emphasised the impact that the potential use of TDF/FTC for COVID‐19 might have on the behaviour of GBM in general. At times, sources of knowledge and/or advice were contrasted against each other to highlight what was deemed (un)trustworthy and influential:

If it was said and driven by the chief health officer, and published in a peer‐reviewed article, I’d listen to it. But, if it’s just some gay people trying to find an excuse, I would not listen to it. […] Like, if the [state] government said, ‘PrEP reduces risk of getting COVID‐19,’ I’d be like, ‘Oh okay, sure. Let’s do it’. But, if it’s just a gay wives' tale like, come on. (Harry, 20s, HIV negative, had never used PrEP)

Harry had an awareness of the potential of TDF/FTC for COVID‐19, and in his account, he made clear that the chief health officer ⁴ or evidence ‘published in a peer‐reviewed article’ would have more salience for behaviour change concerning PrEP than ‘if it's just gay people trying to find an excuse’. Harry's framing conjures notions of ‘gay men as selfishly, sometimes murderously, hedonistic, reckless and irresponsible’ (Hakim et al. 2022, 290), creating ‘gay wives’ tales’—a kind of misinformation—to justify behaviour. Through Harry's account, we gain insights into how gay men themselves—alongside policymakers and public health authorities—participated in discourses that relied on normative framings of biotechnologies—framings critiqued by Rosengarten—in which biotechnologies are preformed objects that are taken up in either responsible/correct or irresponsible/incorrect ways.

Discussion of TDF/FTC for COVID‐19 as misinformation was articulated through several participant accounts and was usually framed as circulating through GBM social circles to fit narratives for its effectiveness (‘gay wives’ tales' a la Harry). The circulation of this ‘misinformation’ was something Marcus, a gay man living with HIV in his 30s, recounted trying to dispel in his role as a community health worker:

When China did treat people with that particular kind of [antiretroviral], the [HIV negative] gays were [thinking], ‘Oh my God! We’re PrEPs’, you know. […] But no, I think people in the community are very clear about that. Occasionally, I do get asked questions about, around, that. I’m just like, ‘Oh, no, no. That’s just a meme. That’s not real’.

Marcus recounted challenging community members' speculation about PrEP (i.e., TDF/FTC) having some effect against COVID‐19 by trying to convince them it is ‘not real’ and is ‘just a meme’—referencing its slip into social media feeds—signalling that it is not to be taken seriously. Marcus's actions were aimed at preventing behaviour he characterised as ‘incorrect’. His strategy relied on providing information that would discourage ‘incorrect’ behaviour and shut down what Rosengarten calls ‘inventive approach[es]’ (2009, 73) to risk reduction. The discouragement of diverse approaches to risk reduction reinforces dominant ideals of prevention and behaviour while inhibiting creativity, irrespective of the success of strategies. Like Harry's positioning of gay men as providing misinformation, in Marcus's account biotechnologies are framed as causal of behaviours, a representation that contributes to conventional ways of thinking about GBM's relationships with biotechnologies (Rosengarten 2009, 13).

Understanding the relationship between interventions and the groups for whom they were intended involves investigating how knowledge becomes entangled in discourses of correct/incorrect social and sexual behaviour. While our goal throughout this paper has been to think beyond these binaries, to disregard them where they exist misses crucial understandings of how biotechnologies and knowledge become material through users' experiences in situations where sex is seen as causing disease (Rosengarten 2009, 64). The conflation implicit in Harry’s and Marcus’s accounts are spectres of when ‘HIV […] bore a prior investment in an already pathologized gay sexuality, an investment in a thinly guised claim of gay sexuality as not “right”’ (Rosengarten 2009, 8) in the COVID‐19 pandemic context. That is, men who imagined the possibilities of TDF/FTC for COVID‐19 and sex were cast as threatening perceptions of ‘homonormative respectability’ (Hakim et al. 2022, 294). This evokes representations of GBM imagined as engaging in wanton behaviour and as blameworthy for ongoing transmission and the extension of restrictions on movement.

4. Discussion

Our analysis has considered the contributors to how GBM in Australia made sense of antiretrovirals as a biotechnology for COVID‐19. We explored how virological, immunological and pharmaceutical knowledge was leveraged, how experiences of using antiretrovirals for HIV treatment and prevention were positioned and how knowledge was mobilised to judge and discourage ‘irresponsible/incorrect’ behaviour. The complex nature of participants' accounts suggests that ‘rather than see [the participants] as moving in a context and as an effect of a context […] we might recognize the informational context as embodied in [them]’ (Rosengarten 2009, 76). We suggest that participants were not only products of their engagement with HIV prevention and treatment, but this information was demonstrated through practices and knowledge that flowed through them and antiretrovirals to be harnessed in a new viral context. Our study offers insights into how GBM become ‘informed matter’ in the COVID‐19 context by articulating and working through prior and new knowledge about antiretrovirals, as well as—for most participants—their experience of consuming these drugs.

Findings on TDF/FTC's benefit as a therapy for COVID‐19 are mixed (Sousa et al. 2020; Del Amo et al. ²⁰²²; Reyniers et al. ²⁰²¹; Verburgh et al. ²⁰²³). Studies among people using antiretrovirals for HIV prevention or treatment investigated the effectiveness of TDF/FTC's ability to reduce transmission and prevent severe illness from COVID‐19 (Ayerdi et al. 2020; Charre et al. ²⁰²⁰; Del Amo et al. ²⁰²²; Fernandes et al. ²⁰²⁰). Findings continue to be published on the effects of TDF/FTC among PLHIV (Verburgh et al. 2023; Möller et al. ²⁰²³). Knowledge about the effectiveness of antiretrovirals, particularly TDF/FTC, was bound up in the ‘traffic’ of information in participants' accounts about their uses for COVID‐19. However, as we have argued, the separation of information and flesh that pervades conventional thought misses relational processes and risks simplifying biotechnologies and behaviour to relations of linear causality. Using ‘informed matter’, we can think beyond constructions of biotechnologies as creating ‘“good” or “bad” effects’ (Rosengarten 2009, 5) in behaviour and interrogate ‘the relational process that biomedical interventions partake in and for which their design—involving a traffic in subject/body—can be held at least partially responsible’ (81).

To our knowledge, this is the first study that investigates the responses of people who use antiretrovirals when considering their use for the novel coronavirus, COVID‐19. We know that GBM in Australia are largely willing to take up new prevention methods in response to viral outbreaks, as has been shown with COVID‐19 vaccines (Holt et al. 2022; Prestage et al. ²⁰²²). Yet, there is little investigation among this population, let alone others, into the relationships these populations have with biotechnologies beyond treatment or prevention. GBM have co‐produced TDF/FTC through their engagement with it in the context of HIV treatment and prevention, alongside pharmaceutical, virological and epidemiological information, over decades. As we have explored, some participants harnessed experiential and empirical knowledge about antiretrovirals to develop a viewpoint—and diverging viewpoints—about their appropriateness for COVID‐19 (e.g., transmission pathways, virus structure, TDF/FTC developed for a specific virus). Although mostly speculative in nature, due to the lack of evidence at the time of interviews, some participants noted that knowledge and experience with TDF/FTC was, mostly, not ‘evidence enough’ (Lancaster et al. 2020) to seriously influence changes in behaviour. Lancaster et al. (2020) use the concept ‘evidence enough’ to make sense of the rapid generation and translation of health evidence to inform decisions about what is not known throughout COVID‐19. For our purposes, the phrase highlights the role that both experiential and empirical information play in constructing how GBM approach new uses of an existing biotechnology.

Much of this knowledge was used as a way of speculating about TDF/FTC and COVID‐19. Although there are parallels between our analysis of the recent COVID‐19 context and Rosengarten's analysis of HIV, there are some differences to note. As mentioned earlier, Rosengarten was writing at a time when knowledge was emerging about the effect of viral suppression on lowering the risk of transmission of HIV to sexual partners (especially between men). This preventative effect of viral suppression had already been discussed as a possibility for over a decade and was beginning to be accepted and adopted by authoritative bodies (see the Swiss Consensus Statement (Vernazza et al. 2008)). This knowledge was well covered in the media, particularly gay community media. Practices were, therefore, not an unexpected line of inquiry.

In contrast, the idea that HIV antiretrovirals could prevent transmission of a different virus (SARS‐CoV‐2) or reduce the severity of the disease it caused, COVID‐19, was a more speculative proposition, even for those who were aware of findings suggesting it as a possibility (Del Amo et al. 2020, 2022). Additionally, crucially, the direct link with sex is not present with COVID‐19 as it is with HIV, which may explain why there has been less attention to moralistic positions about the former. However, we still argue that ‘informed matter’ has been useful to explore how participants mobilised information about HIV antiretrovirals in the context of COVID‐19.

Certainly, there are potentially important dimensions of understanding GBM's sense‐making about antiretrovirals as ‘informed matter’ that this analysis has not thoroughly illuminated. Firstly, our data, largely collected during lockdowns, did not yield GBM's in‐depth reflections on relations between bodies in sexual contexts. Hence, compared with Rosengarten's analysis, the importance of these relations in shaping how antiretrovirals materialise in bodies is not foregrounded in our analysis. Secondly, participants' accounts were reflective of neoliberal framings of antiretrovirals for COVID‐19, based on decisions about the self and rarely discussed antiretrovirals for COVID‐19 in relation to other people, and this warrants further investigation. Further, because in drawing on the concept of ‘informed matter’, our analysis eschews rather than describes linear causal pathways, our findings may not easily align with conventional ways of thinking about interventions, making them challenging to adopt and use to inform interventions in crises, such as COVID‐19, which demand quick actions often targeting obvious solutions. Still, attempts to challenge convention and taking the necessary time to do so should not be the reasons that analyses like ours are disregarded or delayed. In fact, we argue that grappling with what becomes normative in these or other public health emergencies is necessary. As Rosengarten suggests, analyses of ‘informed matter’ are useful when sex‐associated biomedicine is understood to produce ‘good’ or ‘bad’ behaviours, ‘for instance, the morning after pill, the vaccine against cervical [and anal] cancer, or PEP’ (2009, 13). Similar analyses could be conducted with people using doxycycline as prophylaxis for STIs, for example. Although the use of antiretrovirals as an intervention for COVID‐19 has not eventuated beyond research, by being attentive to how knowledge can produce ontological heterogeneity (Rosengarten 2009, 77) in relation to other sex‐associated biotechnologies.

5. Conclusion

By using ‘informed matter’ to investigate how GBM in Australia were engaging with and employing knowledge to speculate on the potential of TDF/FTC and other antiretrovirals to prevent COVID‐19, we can look beyond binary understandings of GBM's sense‐making as simply ‘good’ or ‘bad’. Our analysis highlights the importance of investigating how heterogeneous embodied experiences with biotechnologies influence how users of these technologies make decisions about use in a new and contested informational context. Emphasising a focus on how users of biotechnologies become ‘informed matter’, we can get to relations that impact the processes between antiretrovirals (or other therapeutics) and the people who use them. In particular, when there is the potential for moralism and the oversimplification of their impact on behaviours that go on to inform responses to use. In other words, ‘informed matter’ is useful to interrogate, often neglected, complex changes in sex‐associated biotechnologies in complicated informational contexts, such as a global pandemic.

Author Contributions

Daniel Storer: conceptualization (lead), data curation (lead), formal analysis (lead), investigation (lead), methodology (equal), project administration (lead), writing – original draft (lead), writing – review and editing (equal). Dean Murphy: conceptualization (supporting), formal analysis (supporting), methodology (equal), supervision (equal), writing – review and editing (equal). Niamh Stephenson: conceptualization (supporting), formal analysis (supporting), supervision (equal), writing – review and editing (equal). Garrett Prestage: conceptualization (supporting), formal analysis (supporting), funding acquisition (lead), methodology (equal), supervision (equal), writing – review and editing (equal). Mohamed A. Hammoud: funding acquisition (equal), methodology (supporting), writing – review and editing (supporting).

Ethics Statement

Ethical approval was provided by the UNSW Human Research Ethics Committee.

Consent

All participants provided written consent prior to being interviewed.

Conflicts of Interest

The authors declare no conflicts of interest.

Storer, Daniel , Murphy Dean, Stephenson Niamh, Prestage Garrett, and Hammoud Mohamed A.. 2025. “The ‘Informed Matter’ of Gay and Bisexual Men's (Potential) Use of HIV Antiretrovirals to Prevent COVID‐19.” Sociology of Health & Illness: e70078. 10.1111/1467-9566.70078.

Data Availability Statement

Research data are not shared.