Pre-exposure prophylaxis (PrEP) information on Instagram: A content analytic study (Preprint)

BACKGROUND There is still an HIV epidemic in the U.S., which is a substantial issue for priority populations bearing a disproportionate burden of HIV infection. Daily oral pre-exposure prophylaxis (PrEP) has been shown to be safe and effective in reducing the risk of sexual HIV acquisition. However, large studies of young people, gay and bisexual men, transmasculine individuals, and Black people in the U.S. document that PrEP awareness and usage is low. There is limited understanding of social media as a source of information on PrEP. OBJECTIVE Given the paucity of research on PrEP-related Instagram posts and the popularity of the social media platform, the purpose of this research is to focus on PrEP-related messaging/communications on Instagram. METHODS Using Crowdtangle Search, we retrieved publicly accessible and English-language-only Instagram posts for the 12-month period preceding April 22, 2020, using the following search terms: Truvada or “pre-exposure prophylaxis” or #truvada or #truvadaprep or #truvadawhore or #truvadaforprep. We employed a qualitative coding methodology to manually extract information from this sample of Instagram posts. Using a pre-tested codebook, we performed a content analysis on N=250 posts, examining source and message characteristics, including specific information about PrEP and indicated users. Frequencies and percentages were calculated for all categorical variables. A chi-square analysis was conducted to determine statistical differences between source types on a variety of message characteristics. RESULTS More than three-quarters of all posts (n=193, 77.2%) were posted by organizations. Of the 250 Instagram posts reviewed, more than two-thirds (n=174, 69.6%) included some sort of photo, more than half (n=142, 56.8%) included an infographic (i.e., images containing factual information/data/charts), and approximately one in 10 (n=30, 12%) included a video. We observed that more than half of all reviewed Instagram posts defined PrEP (n=137, 54.8%), but fewer posts promoted PrEP use, explained how PrEP works, and included information on PrEP’s effectiveness or who can use PrEP. The most commonly hashtagged priority population among posts was men who have sex with men, but not necessarily bisexual men. Very few posts contained race- or ethnicity-related hashtags (n=11, 4.4%). Even fewer posts contained transgender-associated tags (e.g., #transgirl; n=5, 2.0%). No posts contained tags related to heterosexuals or injection drug users. We found statistical differences between source types (i.e., individual versus organization). CONCLUSIONS This study is among the first to review Instagram postings for content specifically related to PrEP. The National AIDS Strategy’s call to more clearly articulate the science surrounding HIV risk and prevention is more fully addressed by first understanding the current public information environment surrounding PrEP. The present study seeks to begin answering this call by offering a snapshot of how PrEP is being discussed (and by whom) on one of the most popular social media platforms.