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The paper asks what critical sociology might have to offer HIV prevention, a field dominated by biomedical and psychological interventions. Longstanding prevention messaging by AIDS service organizations and public health rely heavily on responsibilizing rhetoric to use condoms every time. More recent PrEP innovations have been conceived in terms of "roll out" and "adherence." This paper asks what institutional actors and structural constraints are left off the table by these paradigms and points to critical social research that identifies structural changes likely to be necessary for making headway in reducing HIV rates among gay and bisexual men.