Communicative appeals and messaging frames in visual media for HIV pre-exposure prophylaxis promotion to cisgender and transgender women

Abstract

Women in the USA represent 15% of new HIV diagnoses but only 5% of pre-exposure prophylaxis (PrEP) users. We sought to characterise communicative appeals and messaging frames used in US visual media to cultivate PrEP demand among cisgender and transgender women using content analysis methodology. We catalogued and coded media items (images and videos) from US PrEP marketing campaigns featuring women. Production and content characteristics were abstracted, and communicative appeals from media items were qualitatively coded in duplicate. We then descriptively summarised production and content characteristics and identified discrete subgroups of media items, clustering around specific messaging frames, through qualitative thematic analysis. Racial/ethnic minorities and sexual/gender minority women were heavily featured, and numerous media items leveraged cognitive and social communicative appeals to promote PrEP. We identified three unique messaging frames emerging from coded media items, portraying PrEP as: (1) necessary prevention (protection frame), (2) a desirable yet accessible commodity (aspiration frame), and (3) a conduit to sexual autonomy (empowerment frame). To effectively communicate PrEP information and promote PrEP to women, PrEP marketing should leverage alternative appeals (subjective norms, self-efficacy), address anticipated barriers to uptake (stigma, cost, medication interactions), and deconstruct misconceptions of PrEP use(rs).

Keywords: Content analysis; HIV prevention; PrEP; health communication; mixed methods research.

Figure 1.

Distribution of PrEP promotional media campaign items (N=181), by year (Panel A), persona types (Panel B), communicative appeals (Panel C), and U.S. census region (Panel D). Panel A: Number of media items over year, by production medium. Panel B: Number of personas featured across media items, by race/ethnicity and gender. Panel C: Proportion of media items leveraging different communicative appeals, by production medium. Panel D: Number of media items by scale of dissemination, aggregated to the U.S. census region. Notes: Non-binary/femme-presenting identity was ascertained only from media items where featured personas identified as such. The symbol ‘*’ in Panel C represents communicative appeals that were significantly different (at the p<0.05 level) between print and video media items.

Figure 2T.

Mixed methods sunburst diagram presenting the distribution of communicative appeals with exemplary quotes across PrEP campaign media items, clustered by ideation domain.