Don’t let unfounded feelings of shame prevent you from taking a medication that could have enormous benefits for your health.

HIV treatment and prevention have evolved considerably over time, and HIV is now considered a manageable chronic disease. Medications such as pre-exposure prophylaxis (PrEP) have a very high success rate preventing people from contracting HIV. But many people who might benefit from PrEP are not taking it. There are several complex reasons for this.

The cost of PrEP and access to healthcare professionals and clinics for ongoing care can be challenges for many people. Others have trouble with side effects or with remembering to take their medications.

Another major barrier is that people may experience feelings of shame or stigma related to HIV and PrEP use. These feelings can make it harder for people to start and stay on PrEP.

Shame is a feeling rooted in the idea that you’ve done something wrong or that your behavior is somehow wrong. The reality is that PrEP can be an amazing tool to protect yourself and others. But of course, like so many things, it’s complicated.

PrEP is a safe and effective way to decrease your chances of contracting HIV. It has been an important tool to reduce new cases of HIV. When used consistently, it can reduce the risk of contracting HIV through sexual contact by 99%. Among people who inject drugs, PrEP can reduce the risk of contracting HIV by 74%.

You can take PrEP as a daily pill or receive an injection from a healthcare professional every few months.

Shame and stigma can prevent people from starting and staying on PrEP. These feelings may make it difficult for you to have open conversations about sex and HIV prevention with healthcare professionals.

Deanna Clatworthy (she/they) is a nurse and patient advocate specializing in HIV and gender-affirming care at a clinic in Ontario, Canada. “I hear feedback from folks in the 2SLGBTQ+ community that there is an assumption that if you’re on PrEP, you sleep around or are on Grindr and Scruff and have hookups,” they say.

These negative, inaccurate stereotypes can prevent people who would otherwise benefit from PrEP from being comfortable with it.

Several studies have explored beliefs about PrEP among people who may benefit from using it.

In a small 2018 study, researchers interviewed 43 men who were using PrEP. Some of the themes of the participants’ responses were:

  • worries about being judged by a healthcare professional if they request PrEP
  • harmful beliefs that PrEP users are less likely to use condoms and more likely to have sexually transmitted infections (STIs)
  • beliefs that someone who takes PrEP must have a lot of sexual partners
  • fear that someone might think they have HIV since people with HIV might take some of the same medications

It’s possible to internalize shame and stigma, which means you start to believe these harmful messages about yourself. Internalized shame can lead to isolation and make you feel like you’re not worthy of connection and support. And those feelings can contribute to worse emotional and physical health.

Changes within healthcare, communities, and individuals are helping to shift some of the lingering harmful ideas about HIV and PrEP use.

In a small 2019 study involving 29 men who had sex with men, researchers noted that PrEP had helped heal some of the participants’ deep fear, anxiety, and grief about HIV and AIDS. Some participants said that PrEP had allowed them to feel safe and enjoy sex again.

In another small study in 2023, many people said that taking PrEP had lessened the shame they felt about having sex. It allowed them to enjoy sex without the worry that they were putting themselves and others “at risk.”

It can be a powerful feeling to know you’re doing something to take charge of your health and well-being.

Shame thrives when things are kept secret. Talking about PrEP helps normalize it and reduce negative feelings. Opening the conversation about PrEP can be a powerful way to break down stigma.

If you feel you are not getting the best care from your current healthcare professional, consider finding another clinic. If your healthcare professional isn’t very knowledgeable about PrEP, try to find a clinic that specializes in PrEP. If you’re in the United States, you can search for a location near you with this tool.

A supportive healthcare team will normalize talking about PrEP and support you in all aspects of your health.

Research has found that some healthcare professionals view PrEP as a reason for an increase in STIs. These clinicians are less likely to prescribe PrEP if they think it will reduce condom use. The feeling of being judged by a healthcare professional can create an even bigger barrier to accessing any kind of care.

Healthcare professionals may also need to reframe how they talk about risk. Recommendations for who should use PrEP are often based on “risk.” But labeling someone’s life or behavior as “risky” creates more shame.

A big part of PrEP use is regular follow-up care, along with HIV testing. People do not want to maintain contact with healthcare professionals when they feel judged at every visit.

As a clinician, Clatworthy knows the important role that healthcare professionals play in supporting people who are taking PrEP.

“The number one way is for all prescribers to be educated on PrEP,” Clatworthy says. “They need to know how to prescribe it, how important HIV testing and follow-up are, and how to have safe and supportive conversations with your patients in an environment where talking about sex is normalized.”

Preexposure prophylaxis (PrEP) is a safe and effective way to prevent HIV. Shame and stigma about HIV and PrEP are huge barriers to starting and staying on PrEP and can prevent people from getting the care they deserve.

Talking openly about PrEP can help break down stigma. It’s also important that more healthcare professionals get comfortable talking about sex and HIV prevention.