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Explaining the Efficacy of Pre-exposure Prophylaxis (PrEP) for HIV Prevention: A Qualitative Study of Message Framing and Messaging Preferences Among US Men Who have Sex with Men

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Abstract

We investigated message comprehension and message framing preferences for communicating about PrEP efficacy with US MSM. We conducted eight focus groups (n = 38) and n = 56 individual interviews with MSM in Providence, RI. Facilitators probed comprehension, credibility, and acceptability of efficacy messages, including percentages, non-numerical paraphrases, efficacy ranges versus point estimates, and success- versus failure-framed messages. Our findings indicated a range of comprehension and operational understandings of efficacy messages. Participants tended to prefer percentage-based and success-framed messages, although preferences varied for communicating about efficacy using a single percentage versus a range. Participants reported uncertainty about how to interpret numerical estimates, and many questioned whether trial results would predict personal effectiveness. These results suggest that providers and researchers implementing PrEP may face challenges in communicating with users about efficacy. Efforts to educate MSM about PrEP should incorporate percentage-based information, and message framing decisions may influence message credibility and overall PrEP acceptability.

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Acknowledgments

We are grateful to the study participants, Project Weber, Miriam Community Access, the Yale Center for Interdisciplinary Research on AIDS, the Lifespan/Tufts/Brown Center for AIDS Research, Melissa Guillen, Genevieve Ilg, Bobby Ducharme, and Dr. Caroline Kuo for help during the implementation of this study. This study was supported by the National Institute of Mental Health, #5K01MH093273 (PI: Underhill).

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Authors and Affiliations

  1. Yale Center for Interdisciplinary Research on AIDS, Yale University, 135 College St, Suite 200, New Haven, CT, 06510, USA

    Kristen Underhill & Sarah K. Calabrese

  2. Yale Law School, Yale University, P.O. Box 208215, New Haven, CT, 06520, USA

    Kristen Underhill

  3. Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA

    Kathleen M. Morrow & Christopher Colleran

  4. Yale School of Public Health, Yale University, New Haven, CT, USA

    Sarah K. Calabrese

  5. Program in Public Health, Brown University, Providence, RI, USA

    Don Operario

  6. Department of Psychology, Yale University, New Haven, CT, USA

    Peter Salovey

  7. The Fenway Institute, Fenway Health, Boston, MA, USA

    Kenneth H. Mayer

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  1. Kristen Underhill
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  2. Kathleen M. Morrow
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  3. Christopher Colleran
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Correspondence to Kristen Underhill.

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Underhill, K., Morrow, K.M., Colleran, C. et al. Explaining the Efficacy of Pre-exposure Prophylaxis (PrEP) for HIV Prevention: A Qualitative Study of Message Framing and Messaging Preferences Among US Men Who have Sex with Men. AIDS Behav 20, 1514–1526 (2016). https://doi.org/10.1007/s10461-015-1088-9

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