Table 2.

PrEP-related stigma documented in scoping review sample by socioecological levels and thematic findings

Stigma expression	Frequency	Examples
Individual level
Internalized homophobia	4	“You’ve got to accept within yourself that you love and enjoy sex with a man every single day, and you may like it raw 90 percent of the time. But then that’s like accepting, ‘Oh, I’m going to get HIV. Oh, I’m just another fag.’”
PrEP efficacy distrust	4	“I don’t believe that PrEP works, because if it did, then they’d be handing out the pill like they do condoms. I’m gonna need some facts before I try it. I need to see someone do it and get their results.”
Internalized promiscuity	2	”I feel like it would lead me to be more promiscuous.”
Positive health impact	11	“it’s [PrEP] a great method just to prevent the disease. Like it’s the only way HIV and AIDS will actually stop, if people start becoming more conscious about it. And if there’s medicine out there that is allowing us to help us, that’s a great step forward.”
Interpersonal level
Promiscuity	12	“I’ve heard that it’s only for gay men… I had a conversation with someone today and he told me if he was on PrEP he’d be a whore, like that is his get out of jail free card. Um, so I think that kind of stuff. It’s only for gay men, it’s only for whores.”
Risk promotion
Anticipating	10	“A majority of Latino MSM reported that taking PrEP would cause people to stigmatize them as… promiscuous.”
Enacting	10	“Oh I don’t trust that at all. I think it’s just an excuse to sleep around and not use condoms.”
Experiencing	6	”I mentioned to my mom that I was doing a PrEP study to combat HIV. She asked me if I was a sex worker. I’ve been shamed by the guys I used to date, being told that I’m going to die of Hep C and that I’m transmitting HIV to everyone because I’m not using condoms (which was an assumption; I still do).”
HIV-related stigma
Anticipating	10	”I keep my medication in my room and not in the bathroom where I used to keep it because either my little brother or my mom might see it and they’d be like, ‘Hmm, why is this person taking this?’ Maybe they’ll assume that I have HIV.”
Experiencing	4	”I think one of my friends I had to tell exactly what it was because they saw the bottle and I think they looked up what it was for and they thought I had HIV because it was an HIV med.”
Enacting	2	“Several salient themes emerged from the discussion starter question: what comes to mind when somebody tells you they are on PrEP?… Outlier responses to this opening question included the view… that the PrEP user was HIV-positive
Negative relationship impact	8	“When I was having sex, I would take the pills and my partners would be like, ‘Why are you taking those pills?’… Sometimes it would never get to the intercourse part. It would just stop the night. They would be mad and leave.”
Homophobia/other ing	6	“In expressing their concerns about PrEP, participants, including many who identified as gay, bisexual, or MSM, frequently drew on stereotypes that link promiscuity and condomless sex with a ‘gay lifestyle’ and used those prejudices to underpin their negative opinions about PrEP.”
General	6	“Some men discussed experiences of PrEP-related judgment, stigma, or rejection when trying to connect online with prospective sexual partners.”
Community level
Anticipated homophobia	4	“One said that stigma related to gay sex might be a barrier to people seeking PrEP for HIV prevention.”
Responsibility to educate peers	7	“Men who were currently on PrEP shared the obstacles they overcame and used the experience as an opportunity to educate others. Disclosure to peers and other men on social network applications allowed for linking men seeking PrEP to known providers who were prescribing it for HIV prevention.”
Institutional level
Provider distrust	10	“Historically, African Americans have an aversion to any kind of healthcare, or any kind of medicine. So we, as African Americans, historically prefer natural healing or prayer. And we kind of, we avoid doctors.”
Provider discrimination	7	“She [his provider] said that I should take PrEP and I was like, ‘Uh, I’m ok.’ And she was like, basically, you’re gay and you’re having sex, surely, and active so you should do it… She went on about it and was saying, ‘You’re gay and you’re young, you have a lot of sex you should take PrEP.’ And I’m like, ‘You know, you don’t know me lady.’
Governmental/pharmaceutical distrust	7	“Some men explicitly referred to historical abuses by pharmaceuticals and research (e.g., Tuskegee Syphilis Study), and how they profit from [black men who have sex with men]”
Healthcare distrust	5	“Mistrust of both the pharmaceutical industry and healthcare providers was widespread.”