Promoting Pre-Exposure Prophylaxis to Gay, Bisexual, and Other Men who Have Sex with Men in the US Deep South: A Qualitative Exploration of Promotion Perceptions and Preferences.

Background: Effective HIV pre-exposure prophylaxis (PrEP) promotion is critical to mitigate PrEP disparities, yet there are gaps in understanding how gay, bisexual, and other men who have sex with men (GBM) respond to and prefer PrEP promotion. The Deep South of the United States, a region with high HIV rates and low PrEP uptake, has unique contextual factors that stifle effective PrEP provision and uptake, which could be overcome with effective PrEP promotional messaging.

Methods: We conducted an exploratory qualitative study grounded in Andersen's Behavioral Model for Healthcare Utilization. We recruited HIV-negative GBM, aged 18-39 years, from social media, dating apps, and community outreach to complete semi-structured interviews to explore perceptions of and preferences for PrEP promotion. Interview transcripts were inductively and deductively coded for thematic analysis.

Results: 40 participants completed interviews (median age 28 years, 68% Black, 48% current PrEP users). Three themes emerged: 1) the role of different identities with sub-themes emphasizing diversity to reduce stigma and improve relatability, 2) interpersonal relationships, i.e., friends, partners, and family, affect PrEP promotion, and 3) reduced emphasis on HIV risk in promotions.

Conclusion: To see behavior change for seeking PrEP knowledge and PrEP uptake, PrEP promotions must evolve to improve diversity to foster relatability and reduce stigma, harness social networks to efficiently transmit messaging, and tactfully discuss risk behaviors without compounding stigma.