Framing HIV Pre-exposure Prophylaxis Use as a Public or Private Matter

Area of Science:

• Public Health
• Social Science
• HIV Prevention

Background:

• PrEP campaigns often focus on individual HIV risk management.
• The relevance of a community-focused 'public' frame for PrEP among men who have sex with men (MSM) is under-explored.
• Understanding PrEP framing is crucial for optimizing HIV prevention strategies.

Purpose of the Study:

• To investigate the early adoption and relevance of 'private' versus 'public' frames of PrEP among MSM.
• To quantify support for different PrEP frames and identify associated factors.
• To explore the relationship between PrEP framing and personal disclosure.

Main Methods:

• Cross-sectional surveys of MSM in the United States (N=311, 2015) and the Netherlands (N=222, 2020) post-PrEP introduction.
• Regression analysis and machine learning were used to analyze frame support and correlates.
• Examined associations between PrEP frames, user status, and disclosure comfort.

Main Results:

• Respondents showed general neutrality towards PrEP framing (US: 44%, NL: 48%).
• Significant proportions endorsed private (US: 23%, NL: 28%) and public (US: 33%, NL: 24%) frames.
• Public and neutral frames correlated with being a PrEP user and comfort discussing PrEP use.

Conclusions:

• Both 'private' and 'public' frames of PrEP are present among MSM early in its adoption.
• A 'public' frame, emphasizing community sexual health, is relevant and associated with PrEP use and disclosure.
• PrEP messaging and uptake can be enhanced by considering how MSM perceive and communicate their PrEP use.