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

PrEP campaigns often promote a "private" frame emphasizing personal HIV risk management. We explore how a "public" frame emphasizing community-managed sexual health is relevant among men who have sex with men (MSM) and can advance HIV prevention. We sampled MSM from the United States (N = 311 in 2015) and the Netherlands (N = 222 in 2020) soon after each country's official PrEP introduction to study the early adoption of PrEP frames. Using regressions and machine learning, we quantified support for different PrEP frames, person-level correlates, and relationships to personal PrEP disclosure. Respondents were generally neutral about PrEP framing (U.S.: 44%, Netherlands: 48%), yet many held private (U.S.: 23%, Netherlands: 28%) and public (U.S.: 33%, Netherlands: 24%) frames. Public and neutral frames were associated with PrEP users and disclosure comfort. PrEP messaging and uptake could improve by understanding how and when MSM frame their PrEP use as a public or private matter.