How the right messaging can improve PrEP equity in the U.S.

How the right messaging can improve PrEP equity in the U.S.

Illustration credit: FHI 360 Design Lab

In the Southern United States, there is a disproportionately high rate of HIV diagnoses amongst Black and Latino men who have sex with men. However, these groups are also less likely than their white counterparts to take PrEP, or pre-exposure prophylaxis, which can safely decrease a person’s likelihood of getting HIV through sex by about 99% when taken as prescribed.

Increasing PrEP usage among groups with a higher likelihood of acquiring HIV is a critical part of the U.S.’s national strategy to end the HV epidemic. It’s clear from the data, though, that more needs to be done.

Increasing access to PrEP for HIV prevention 

The HIV epidemic in the U.S. features both geographic and racial disparities. Just over half of new HIV cases in the U.S. occurred in Southern states in 2021. That same year, the overwhelming majority of new HIV diagnoses (70%) were among gay, bisexual or other men who have sex with men.

Within the Southern U.S., the largest percentage of men who have sex with men who also had HIV diagnoses were Black men (47%) followed by Hispanic/Latino men (28%), as of 2019, the latest year for which there is available data.

Anyone can get HIV, regardless of race, region, gender identity or sexuality. But as we see in the Southern U.S., not everyone has equal access to the resources that allow them to live their healthiest lives, including biomedical interventions for HIV prevention.

An estimated 1.2 million people in the U.S. could benefit from PrEP for HIV prevention, and the majority are Black or Latino people. American men who have sex with men generally know about PrEP, but usage varies, especially among different racial and ethnic groups. Compared to white men who have sex with men, a lower percentage of Black and Latino men who have sex with men have used PrEP, or even discussed it with a health care provider, in the past year.

A 2021 study found that Black and Latino men don’t access HIV-prevention services, like PrEP, because of the stigma surrounding HIV; lack of information about PrEP coverage and access; and competing demands around financial security, housing stability and insurance coverage. Additionally, some men who have sex with men are unaware that their sexual networks and other behavioral factors can place them at higher likelihood of exposure to HIV.

Improving outcomes by addressing barriers 

Social marketers and public health experts must make the effort both to educate medical providers on these health disparities and to directly engage Black and Latino men who have sex with men, particularly in Southern U.S. states, through messages that address known barriers like those cited above.

Unlike traditional marketing campaigns that sell products, social marketing campaigns are designed to change or maintain behavior for the benefit of individuals and society as a whole and can be particularly effective in increasing PrEP usage. FHI 360 is developing such a campaign in conjunction with a U.S. public health agency. Our approach includes formative research activities, such as message testing to identify what resonates best with priority audiences.

Our recommendations for health communicators working on PrEP campaigns are to develop messages that reduce stigma and combat misconceptions, such as: 

  • Provide information on how to access PrEP at little or no cost; most insurance plans and state Medicaid programs cover PrEP. 
  • Provide clear calls to action that encourage community members to visit trusted, reputable online resources where they can find PrEP providers and HIV prevention services near them by simply entering their zip codes. 
  • Reframe PrEP as a useful HIV prevention tool for anyone — regardless of relationship status — and promote PrEP as a safe, effective option for sexually active individuals with multiple partners as well as for monogamous couples. 
  • Rely on storytelling to normalize conversations about PrEP by highlighting testimonials that feature individuals discussing their experiences being on PrEP. 

As racial disparities related to HIV prevention and acquisition continue to rise, sharing the kinds of compelling messages outlined above can help alleviate barriers that prevent people from accessing PrEP. By first understanding more about the barriers to PrEP equity, we can better help people understand that PrEP is safe, low-cost and effective, and normalize its use. 

Anyone working with communities that are disproportionately affected by HIV should consider sharing messages that are based on known barriers to PrEP uptake. When we do this together, we can help ensure that everyone, regardless of their racial or ethnic identity or where they live, has the resources they need to live their fullest and healthiest life.

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