Pre-exposure prophylaxis (PrEP) is a game changer in HIV prevention and lays the foundation for potentially ending the AIDS epidemic. Despite its effectiveness it has met with controversy, which highlights the stigma and moralizing that still surrounds gay men and transgender bodies and sex lives. As providers we are faced with examining our own beliefs about sex and the need to be sex positive in our practice. Beyond HIV prevention, with successful widespread PrEP implementation, we have the opportunity to shape a cultural of effective healthcare for generations to come.