PrEP Advertisements That Only Feature Certain Populations May Inadvertently Perpetuate Stigma

Images that link Black sexual minority men (SMM) to HIV and use of pre-exposure prophylaxis (PrEP) may reinforce stigma and prevent Black SMM from taking PrEP, according to a study published in PLOS ONE that assessed targeted PrEP social marketing campaigns.

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PrEP advertisements that exclusively feature Black SMM were considered more stigmatizing than advertisements with no couples; however, visual advertisements featuring diverse couples were favored the most.

“Pervasive disparities in both HIV incidence and PrEP access suggest a need to prioritize Black SMM in PrEP social marketing initiatives,” the study authors wrote in the article. “[But] stigma surrounding the health product (PrEP), the health issue it is intended to address (HIV), and the target audience (Black SMM) merits special consideration.”

Social marketing applies commercial marketing principles to promote socially beneficial behavioral change. Many PrEP social marketing campaigns feature Black SMM and other minority groups who are disproportionately affected by HIV to appeal to members of these groups—they become the “target audience” of the content, according to the study.

Visual advertisements of PrEP with Black SMM can lead to the stigmatization—or social devaluation—of PrEP (includeing stereotypes associated with sexual promiscuity), Black SMM (sexual stereotypes, promiscuity, disease risk), and HIV (inaccurate fear of transmission), which can discourage Black SMM from using PrEP.

Investigators conducted a mixed methods study to understand how PrEP visual advertisements that feature Black SMM affect their perception of targeted social marketing initiatives and preferences related to PrEP visual advertising. The study also explores the impact of advertisements for PrEP that feature Black SMM on PrEP stigma, motivation, and behavior among Black SMM.

The study compared targeted and non-targeted PrEP visual advertisements from 3 social marketing campaigns. Investigators evaluated Black SMM responses to advertisements that feature a Black SMM couple, a Black heterosexual couple, diverse couples, or no couples.

The majority of Black SMM participants favored PrEP advertisements that featured a greater diversity of couples—including couples of other races, Black SMM with different skin tones, and varying sexual orientations. Advertisements with diverse couples were described as more eye-catching, motivating, relatable, and memorable compared to advertisements with no couples.

Generally, SMM of color desired non-targeted social marketing with inclusivity across multiple US geographical locations (New York City, Washington D.C., other East Coast cities).

Sexualized imagery may be a culprit that perpetuates Black SMM stigma by reinforcing sexual stereotypes—especially because Black SMM are still not represented in many other forms of media—so it was not widely supported by participants. In addition, Black SMM did not highly favor “sex-positive” aspects of PrEP commercials, considering them better suited for the dating space.

An inclusive approach to PrEP marketing includes a diverse array of Black SMM with other races, sexual orientations, and genders. Participants themselves suggested that inclusive advertisements could also discuss PrEP as relevant to people who do not have but are at risk of HIV, are not a part of a target population, and are part of a broader audience.

There is no one-size-fits-all solution to optimize the social marketing of PrEP to Black SMM,” the study authors wrote. “Black SMM are a heterogeneous group, and their perspectives and preferences related to PrEP social marketing are not monolithic. Nonetheless, a significant proportion of our participants regarded PrEP advertisements that targeted Black SMM to be potentially stigmatizing.”

Reference

Calabrese S, Kalwicz D, Dovidio J, et al. Targeted social marketing of PrEP and the stigmatization of black sexual minority men. PLOS ONE. May 2023. DOI: 10.1371/journal.pone.0285329