# Beyond the neoliberal label: A historical perspective on sexual actors and responsibility in HIV prevention in England (1986–2023)

## TL;DR

This paper explores how neoliberal ideas about personal responsibility have shaped and stigmatized HIV prevention efforts for gay men in England from 1986 to 2023.

## Contribution

The paper introduces 'biocommesuration' as a new theoretical framework to better understand pharmaceutical governance of sexual health beyond neoliberal subjectivities.

## Key findings

- Neoliberal ideologies have co-opted personal responsibility, stigmatizing gay men whose sexual behaviors deviate from public health norms.
- Theoretical frameworks emphasizing individual responsibility fail to capture the complexity of sexual behaviors and public health practices.
- Biocommesuration offers an alternative analysis that transcends limitations of neoliberal subjectivities in understanding sexual health governance.

## Abstract

Framed across three distinct periods of the history of neoliberalism and the HIV epidemic in England, this article conducts a detailed examination of the concept of personal responsibility and its contested uses within HIV prevention. The article questions the theoretical potential of neoliberal subjectivities to comprehend behaviours related to the pharmaceuticalised governance (or lack thereof) of gay men’s sexual health, exploring the gap between theories emphasising individual responsibility and the practical experiences of gay men. The analysis draws on testimonials from gay men in oral history interviews and archival sources. The article illustrates how the pervasive notion of personal responsibility in England has been co-opted by neoliberal ideologies, leading to the stigmatisation of gay men whose sexual behaviours diverge from public health mandates. The widespread stigmatisation resulting from this ideology underscores a significant limitation in the theoretical framework of neoliberal subjectivities. This constraint extends beyond merely failing to grasp the complexity of sexual behaviours; it also reflects a lack of understanding of any other behaviour related to public health. Therefore, the article concludes by advocating the necessity of employing and constructing alternative theoretical frameworks to comprehend the pharmaceutical governance or lack thereof of gay men’s sexual health. Through a concise autoethnography of the authors’ pharmaceutical sexual health governance, the article introduces the concept of biocommesuration as an illustrative analysis that transcends the limitations of neoliberal subjectivities.