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Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy, but uptake remains low and more research examining its social dimensions is needed. Studies suggest a life course perspective is useful for understanding gay men’s PrEP perceptions. We extend this work by using interviews, focus groups, and key principles of the life course perspective, including those not used in the current research, to explore PrEP perceptions among 25 gay men of distinct generational cohorts who live in Seattle, Washington. Consistent with the life course perspective, participants gained PrEP knowledge, made sense of stigma, and developed perceptions through interactions with others in their social networks, including current and past friends, sexual and romantic partners, and community members of various ages and serostatuses. Additionally, participants comprehended PrEP by considering their own age-based HIV experiences and the experiences of gay men in different generations, highlighting how PrEP is shaped by HIV history and the experiences of multiple generations. The findings also indicate that, to communicate PrEP efficacy and increase uptake, it is important to create nuanced, and effective, messages, which consider positive and negative feelings about HIV and prevention, and emotionally laden behavior, knowledge, and beliefs.

A life course perspective and the qualitative examination of gay men’s PrEP perceptions