Normalizing pre-exposure prophylaxis: a thematic synthesis of self-talk and communication work

This article investigates the communicative mechanisms underlying the normalization of HIV pre-exposure prophylaxis (PrEP) as it evolves from a contentious innovation to a more widely accepted sexual health approach. By synthesizing qualitative research on the lived experiences of early users of the first PrEP medication (Truvada) among gay, bisexual, and other men who have sex with men (MSM), we examine how these men communicatively negotiate the novelty, stigma, and normative tensions surrounding PrEP, and how these practices contribute to its normalization. A thematic synthesis of 28 studies identifies 2 key modes of communication: (a) intrapersonal self-talk to establish coherence, negotiate propriety, and deconstruct stigma and (b) interpersonal communication work to counter stigma and manage PrEP use disclosure. Our findings advance a communication-centered perspective on normalization, illustrating MSM PrEP users’ communicative practices in integrating PrEP into their lives, reshaping personal, relational, and cultural scripts about HIV prevention and sexual relations.When HIV pre-exposure prophylaxis (PrEP) first became available, it sparked controversy and challenged long-held beliefs about sexual health. For early gay and bisexual male users, taking PrEP was more than starting a medication—it involved thoughtful communication to explain, justify, and integrate this new prevention method within their social and sexual circles. Our study examines how PrEP went from a debated innovation to a more accepted part of sexual health among these early users. Reviewing qualitative research on their real-life experiences revealed that communication was key in two ways: users had internal “self-talk” to make sense of PrEP, address doubts, and work through stigma, helping them feel confident and justified in using it; they also undertook external “communication work”—correcting misinformation, deciding when and how to disclose their PrEP use, and sometimes advocating for acceptance within their communities. These efforts helped shift attitudes and build understanding about PrEP, making it a normal part of everyday life and transforming how people view HIV prevention and sexual relationships.