Homo economicus: young gay and bisexual men and the new public health

Neoliberal ideology champions privatization, personal responsibility, and entrepreneurship, and public health practice under neoliberalism channels this individualized focus. Though this ‘new public health’ may be seen as a liberalizing practice of governance, in which individuals are free to maximize health and autonomy, this privatization also embeds responsibility within the individual without regard to existing or resulting inequalities. This paper examines the presence of neoliberal ideology in the narratives and subjectivities as it relates to HIV prevention in the lives of young gay and bisexual men living in New York City. We also seek to further the critique of neoliberalism in HIV prevention. The men often saw themselves or others as rational, autonomous agents, yet there were also clear instances where social and structural factors were at play. These factors influenced a subjectivity existing outside the narrow, atomistic framework of neoliberalism. Implicit moral hierarchies arose from notions of personal responsibility and recklessness, pitting men against each other and potentially inhibiting social and community prevention efforts. Further, neoliberal ideology obscured the social and structural mechanisms at play, such as racial inequality, economic inequality, homophobia, and sexual shaming. In contrast to the ideology of neoliberal public health, we must explicitly consider the resources, opportunities, and social conditions that shape autonomy and subjectivity among young gay and bisexual men.