Follow 23-year-old Chris King on his morning routine. He wakes up, goes into his bathroom and puts in his contacts. He also swallows a pill.

But it's not just any pill. It's one that a gay man like himself in the 1980s wished into existence – and could have died while waiting for it.

King, like hundreds of thousands of other Americans, takes PrEP – preexposure prophylaxis – daily and by doing so, reduces his risk of contracting HIV through sex by 99%. The club DJ and event producer from New York considers it "kind of like a medical miracle."

But the Supreme Court may soon stop requiring insurers to cover PrEP and other preventive medical care services for free, pending the results of a case regarding the Affordable Care Act it's set to hear; it stems from a group of Texas small businesses that don't want to "encourage homosexual behavior, prostitution, sexual promiscuity and intravenous drug use." The case could render it cost-prohibitive for many who rely on it.

"It's really scary that there's going to be a whole new generation of people who think that their sexuality, them wanting to engage in that is a moral failure," King says.

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The news ignited a maelstrom of opinions on social media, ultimately revealing that people within and outside of the gay community hold all kinds of views on sex, and what constitutes it as risky or dangerous. These arguments aren't new, but they highlight that the stigma around gay sex and HIV is still very real.

The discourse illustrates that we "still live in a cycle of stigma around sex behaviors, period," says Benjamin Goldman, licensed mental health counselor. For many people, there's a hesitation when it comes to "talking about sex, having sex, having good sex, exploring and figuring out what we want sexually."

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The stigma against PrEP

PrEP became available in 2012, and so with it the freedom to have sex without fear of contracting HIV. But that doesn't mean everyone's on board.

"Although most insurances cover PrEP under the Affordable Care Act, research has found that many gay men are not aware that PrEP is often covered by insurance or where to receive PrEP," says Daniel Jacobson López, an assistant professor in Boston University's School of Social Work. "Additionally, studies have indicated that associated health care costs, lack of information on PrEP, lack of willingness of medical providers to prescribe PreP, and stigma have resulted in the majority of gay men who are eligible for PrEP not being prescribed PrEP." Still, new HIV diagnoses ticked down 12% from 2018 to 2022, per Centers for Disease Control and Prevention estimates, likely in part due to PrEP prescriptions.

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Those who are against PrEP believe that it promotes promiscuity. In Matt Antar's experience, "if somebody tells me that they are on it, I'm going to make assumptions, and whether that's true of that specific person or not, I don't know," the 34-year-old New Yorker says, adding "it seems to me that there's a pattern that people who tell me that they're on it, they are typically engaging in risky behavior."

Some in the community lead lives where sex with strangers is common. Others opt to live more chastely, and many reside somewhere in between.

"The argument, will (PreP) increase promiscuity? It just seems to me to be completely faulty on a number of levels," explains Michael Bronski, a Harvard University professor and author of "A Queer History of the United States for Young People." "I always go back to the old joke that the definition of promiscuity is that person who slept with one more person than you have." Those judging people's choices are coming at it from a moral lens, not a scientific one, he says.

"So much of this stigma against PrEP is shaped by homophobia, racism and transphobia, and a moral argument about who deserves to have sex and who does not," says Alithia Zamantakis, research assistant professor at Northwestern Medicine's Institute for Sexual and Gender Minority Health and Wellbeing. Plus, "regardless of individuals' person religious sensibilities, we know that the cost of PrEP is far cheaper for health insurance companies than the cost of HIV treatment over a lifetime."

Some in the community worry about gay men's reputation for having a lot of sex, that it makes them less palatable to a straighter, stricter society shy to discuss anything sexual. It's the same type of judgment, often stemming from religion, that's discouraged some women from taking birth control pills.

The truth is that, though, "if someone is promiscuous, they will engage in those behaviors regardless of whether they take medication like PrEP or not," says Calvin Bartelle, licensed clinical social worker. "The purpose of PrEP is not to encourage risky behavior but to provide protection against HIV for individuals who are at higher risk of exposure."

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Exploring the psychological consequences

Generally, people should think about where they get their information about sex. Is it the friends you talk to? The media you consume? Where does the stigma you hold for sex or certain sexual behaviors come from?

When broaching discussions about sex, PrEP and HIV, take it one step at a time: "It’s all about starting a conversation with empathy and understanding," Bartelle says. "People are more likely to listen when you approach it from a place of care, not judgment."

Lacking a safe space to talk about sex, whether with partners, friends and/or a professional therapist could breed discomfort. "When people are living in sexual shame, there are deep psychological consequences," Goldman says. "Anxiety, depression, internalized stigma that materialize as a result of that shame."

When you take control of the narrative, Goldman says, you're free to have whatever sex life works for you.