Archives of Sexual Behavior

, Volume 48, Issue 4, pp 1041–1058 | Cite as

Making Meaning of the Impact of Pre-Exposure Prophylaxis (PrEP) on Public Health and Sexual Culture: Narratives of Three Generations of Gay and Bisexual Men

  • Phillip L. HammackEmail author
  • Erin E. Toolis
  • Bianca D. M. Wilson
  • Richard C. Clark
  • David M. Frost
Original Paper


Pre-exposure prophylaxis (PrEP) with Truvada has emerged as an increasingly common approach to HIV prevention among gay, bisexual, and other men who have sex with men. This study examined generational differences and similarities in narrative accounts of PrEP among a diverse sample of 89 gay and bisexual men in the U.S. Over 50% of men in the older (52–59 years) and younger (18–25 years) generations endorsed positive views, compared with 32% of men in the middle (34–41 years) generation. Men in the middle cohort expressed the most negative (21%) and ambivalent (47%) views of PrEP. Thematic analysis of men’s narratives revealed three central stories about the perceived impact of PrEP: (1) PrEP has a positive impact on public health by preventing HIV transmission (endorsed more frequently by men in the older and younger cohorts); (2) PrEP has a positive effect on gay and bisexual men’s sexual culture by decreasing anxiety and making sex more enjoyable (endorsed more frequently by men in the middle and younger cohorts); and (3) PrEP has a negative impact on public health and sexual culture by increasing condomless, multi-partner sex (endorsed more frequently by men in the middle and younger cohorts). Results are discussed in terms of the significance of generation cohort in meanings of sexual health and culture and implications for public health approaches to PrEP promotion among gay and bisexual men.


PrEP HIV/AIDS Gay men Public health Sexual culture Sexual orientation 



Research reported in this article is part of the Generations Study, supported by the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health under award number R01HD078526. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Generations investigators are: Ilan H. Meyer, Ph.D. (Principal Investigator), David M. Frost, Ph.D., Phillip L. Hammack, Ph.D., Marguerita Lightfoot, Ph.D., Stephen T. Russell, Ph.D., and Bianca D. M. Wilson, Ph.D. (Co-Investigators, listed alphabetically). We acknowledge the research assistance of Jessica Fish, Janae Hubbard, and Evan Krueger. This article was completed while the first author was supported by a fellowship from the Center for Advanced Study in the Behavioral Sciences at Stanford University.


This study was funded by Grant R01HD078526 from the National Institute of Child Health and Human Development of the National Institutes of Health.

Compliance with Ethical Standards

Conflicts of interest

All authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of California,Santa CruzSanta CruzUSA
  2. 2.Williams InstituteUCLA School of LawLos AngelesUSA
  3. 3.Department of PsychologyCity University of New York Graduate CenterNew YorkUSA
  4. 4.Department of Social ScienceUniversity CollegeLondonUK

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