Framing HIV pre-exposure prophylaxis use as a public or private matter

Abstract

PrEP campaigns often promote a medicalized ‘private’ frame that emphasizes personal HIV risk management. We explore how a ‘public’ frame emphasizing community maintenance of sexual health is increasingly relevant in men who have sex with men (MSM) and offers new intervention points for biomedical HIV prevention. In a cross-cultural examination of early adoption of PrEP frames, we sampled MSM from The United States (N=311 in 2015) and The Netherlands (N=222 in 2020) soon after each country’s official introduction of PrEP. Using linear regressions and machine learning, we calculated the prevalence of support for different PrEP frames, their person-level correlates, and their relevance for community-oriented actions like comfort disclosing one’s own PrEP use. The samples were mostly neutral about PrEP framing (US:44%, Netherlands:48%), yet many held a private (US:23%, Netherlands:28%) or public (US:33%, Netherlands:24%) PrEP frame. PrEP users in both countries were more likely to hold a public or neutral frame, non-users were more heterogeneous in their PrEP frames. Comfort with PrEP disclosure was more associated with a public than private frame. PrEP messaging and uptake could improve by understanding how MSM frame their PrEP use as a public or private matter and through context-informed interventions on views about PrEP disclosure.