From stigmatized status to responsibilized health behavior: Gay, bisexual, and queer men's longitudinal narratives of shifts in PrEP-related stigma over time

Abstract

For many gay, bisexual, and queer men (GBQM), using HIV pre-exposure prophylaxis (PrEP) has been extremely stigmatizing. Our objective was to trace changes in PrEP stigma within the accounts of GBQM in Canada, many with experience using this highly effective form of biomedical HIV prevention. We conducted annual longitudinal qualitative interviews with 46 HIV-negative GBQM living in Ontario or British Columbia, Canada. A total of 128 in-depth interviews were conducted over three years (2020–2022), transcribed verbatim, and coded in NVivo using reflexive thematic analysis. Most participants described experiencing little or no PrEP stigma in the last few years, attributing this to PrEP normalization within queer communities. PrEP stigma was not only commonly described as a thing of the past; the (reclaimed) trope of the ‘Truvada whore’ had been remade anew into the mainstreamed ‘responsible’ gay citizen. However, some men said PrEP stigma was still anticipated or enacted in social, sexual, and healthcare contexts. Although a few participants expressed recent concerns about being perceived as ‘slutty’ due to PrEP use, no one reported increased PrEP stigma over time nor linked stigma to PrEP discontinuation. For some participants, a new PrEP-related stigmatized status had emerged—the non-PrEP using sexually active GBQM as deviant and irresponsible. Rather than being conceived as static and individual processes, PrEP stigma must be understood as a dynamic and frequently resisted social phenomenon. While PrEP stigma remains, many GBQM noted a significant discursive transformation, storying PrEP use not as a stigmatized status but a responsibilized health behavior.