A Comparative Analysis of National and State-Level Pre-Exposure Prophylaxis (PrEP) Communications in the United States Open Access

Abstract

The United States is home to around 1.2 million people living with HIV. In July 2012,

the Food and Drug Administration (FDA) approved pre-exposure prophylaxis (PrEP), a daily

antiretroviral pill to reduce HIV risk among populations at high risk of becoming infected.

Despite its proven effectiveness in preventing HIV, PrEP is only taken by 23 percent of the

eligible population. To address this issue, PrEP communication campaigns have been created

both by local and national organizations to increase awareness and use of PrEP. This study was

conducted to better understand the characteristics of existing PrEP communication material as

well as the similarities and differences between national and state-level communications.

Five states – [Washington, California, Maine, Iowa, and Georgia] - were selected on

account of their geographic, cultural, and epidemiological diversity. A systematic internet search

identified one hundred posters and public service announcements. Using Microsoft Excel, the

materials were assessed in relation to 7 communication material characteristics: Tone of

Communication (formal, informal, positive, and neutral), Color Scheme (photo background,

video testimonial, monotone, brightly colored, and primary-colored), PrEP or Prevention

Mentioned, and Audience Demographics, i.e., Ethnicity, Gender, Sexual Identity, and Age.

These 100 communications were then analyzed comparatively using MAXQDA software,

focusing on the behavioral constructs implemented in the communication materials and

comparing similarities and differences based on their place of origin.

National communications were found to be more comprehensive than state-specific

communications in terms of the audience characteristics they targeted. The target audiences

reflected in national communications were more inclusive of minority populations. National

communication materials leveraged a greater number of constructs drawn from behavioral

theories compared to state-specific communications.

Overall, this study identified areas for improvement when creating tailored

communications for both national and state-specific levels. Increased PrEP communications that

target specific and particularly at-risk populations in addition to utilizing a greater number of

behavioral constructs could support improved PrEP-related awareness, knowledge, attitudes, and

behaviors. These findings will provide a starting point for future health communications research

to promote PrEP use.

Table of Contents

INTRODUCTION 1

Rationale: 1

Problem Statement: 4

Purpose Statement: 4

Significance Statement: 4

LITERATURE REVIEW 6

HIV and PrEP Prevalence: 6

History of PrEP: 6

Barriers to PrEP Use: 7

Access to PrEP 7

Knowledge of PrEP 8

Stigma 8

Evidence of Campaign Effectiveness: 9

Behavioral Constructs: 10

Audience Demographics: 11

Selection of States for this Study: 11

Summary of Current Problem and Study Relevance: 13

METHODS 15

Data Collection Methods: 15

Data Analysis Methods: 18

RESULTS 20

General PrEP Communication Composition and Design: 20

PrEP Communication Material Demographics: 26

Ethnicity 26

Gender 28

Sexual Identity 33

Age 34

PrEP Behavioral Constructs: 35

Temporality: 41

DISCUSSION 43

Summary: 43

HIV and PrEP Use Prevalence at the National and State Levels: 44

Demographics: 47

Ethnicity 47

Gender 48

Sexual Identity 49

Age 50

Behavioral Constructs: 51

Limitations: 52

RECOMMENDATIONS 54

REFERENCES 56

APPENDICES 64

Appendix A. Washington Campaign Poster Materials Collected 64

Appendix B. California Campaign Poster Materials Collected 66

Appendix C. Maine Campaign Poster Materials Collected 69

Appendix D. National Campaign Poster Materials Collected 70

Appendix E. List of YouTube Public Service Announcement Links 88

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Communications PrEP
Committee Chair / Thesis Advisor	Winskell, Kate, Emory University Sabben, Gaelle, Emory University

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