Everyday PrEP negotiations - new book exposes the paradoxes of HIV prevention pills

Based on seven years of research among queer men in Denmark and adolescent girls and young women in Zimbabwe, the book identifies six paradoxes that people encounter when trying to access and use PrEP—such as being “healthy, yet a patient” or “safe, yet unsafe.” These paradoxes reveal tensions, social risks, and moral judgments that users must navigate in their daily lives, through what Skovdal terms everyday PrEP negotiations.

The book calls for a shift away from a narrow biomedical focus toward an analysis of the social and psychological "work" involved in engaging with preventive medicine. Skovdal demonstrates that even a highly effective disease prevention method, like PrEP, can falter if it does not align with people’s worldviews, values, or social circumstances.

I wanted to write a book that is both accessible and practically useful. My hope is that researchers, students, healthcare providers, policymakers—and PrEP users themselves—can find something in this book that resonates and informs their work or experiences.”

Endorsing the book, Judith D. Auerbach, Professor at the University of California, San Francisco, writes:“Skovdal reveals the intricate dynamics between people and the HIV prevention pill, focusing on the paradox of being both healthy and a patient. Essential reading for anyone in global health and HIV prevention.”

The book is also timely. Early 2025, the U.S. government abruptly terminated global PrEP programmes funded by PEPFAR, which provided access to over 2.5 million people in the Global South—more than 90% of all PrEP users. This crisis underscores the fragility of global health infrastructure and makes Skovdal’s insights into what makes preventive medicines stick—or slip—especially urgent.

The book challenges the assumption that making prevention tools technically effective and accessible is enough. Instead, it shows how people's engagement with preventive medicine is shaped by stigma, institutional norms, conflicting value systems, and the cultural meanings attached to health, illness, and risk. These dynamics are too often ignored in public health strategies, with serious consequences for disease prevention.