https://orcid.org/0000-0003-3591-5449
Abstract
Human immunodeficiency virus (HIV) continues to present a public health problem, and pre-exposure prophylaxis (PrEP) offers a promising preventative intervention; however, its uptake remains low, so investigating determinants of use is essential. This article applies queer critical discourse analysis to a corpus of 121 TikToks sampled via the TikTok algorithm, coded and refined into three overarching content categories: ‘what makes a PrEP user?’, ‘what is PrEP as a drug?’, and ‘sexual health and HIV’. Examples from within these categories reveal four underlying discursive themes: (1) stigmatisation of HIV as a ‘gay disease’ with a poor prognosis; (2) stigmatisation of gay men as unsafe, high-risk and untrustworthy; (3) stigmatisation of PrEP as increasing ‘unsafe’ sexual practices; (4) poor healthcare and education gay men and other beneficiaries of PrEP. These themes are influenced by a broad spectrum of homophobic and heteronormative discourses available with specific examples reflecting parts of this spectrum from predominantly perpetuating to occasionally challenging. The findings report complementary evidence obtained from other media platforms yet offer a unique take while suggesting useful avenues for future public health messaging relating to PrEP which may be used to inform the next steps against HIV.
Keywords:
Introduction
Since its emergence, human immunodeficiency virus (HIV) and its sequelae have claimed 36.3 million lives (World Health Organization Citation2021). In 2020, the UK saw 2780 new HIV cases, with each case carrying an estimated average lifetime care cost of £400,000 (Ong et al. Citation2019; United Kingdom Health Security Agency Citation2021). Consequently, prevention remains salient, and pre-exposure prophylaxis (PrEP) is effective in doing this when taken orally using medications including Truvada and Descovy or more recently via an injection known as Apretude. PrEP is safe, has minimal side effects and is free of charge at the point of access in the UK. Despite the advantages PrEP offers, its uptake in countries such as the UK and USA remains low, an issue that demands consideration (Fitch et al. Citation2021; Terrence Higgins Trust Citation2020; United States Food and Drug Administration Citation2021).
Historically coined a ‘gay plague’, HIV’s emergence in 1981 was accompanied by institutional discrimination, shame, stigma and heteronormativity which worsened transmission, morbidity and mortality (Halkitis Citation2012). Heteronormativity, a force that dictates acceptable behaviours based on the assumption that heterosexuality is normal, has its roots in a patriarchal system that suppresses same-sex attraction and sexual desire (Ray and Parkhill Citation2021). In seminal work, Butler’s (Citation1989) idea of the heterosexual matrix advanced the view that sex and sexuality are presumed heterosexual unless proven otherwise, and those who deviate from this are viewed as abnormal or shameful. Sedgwick’s (Citation1990) work too pointed to a cultural system in which there is a strong binary between ‘normal’ (heterosexual monogamy) and more ‘deviant’ forms of sexuality (Warner Citation2011).
Despite only making up 2.5–3% of the UK’s male population, gay, bisexual and other men who have sex with men comprise up to 45% of all HIV diagnoses in the 2020s, with 56% of them aged between 15 and 34, making them at highest risk (AIDS Trust Citation2019; Office for National Statistics Citation2021; United Kingdom Health Security Agency Citation2021). Heteronormative ideologies are institutionalised throughout the UK, leaving queer individuals ashamed, stigmatised, uneducated, misinformed, improperly cared for by healthcare systems and vulnerable to ‘unsafe’ sexual practices (Epps, Markowski, and Cleaver Citation2023; Hafeez et al. Citation2017; van der Toorn, Pliskin, and Morgenroth Citation2020). The belief that HIV is a ‘gay disease’ stigmatises gay men while excluding others at risk (Jones and Collins Citation2020). Together, these institutionalised issues and their impact are important determinants of PrEP uptake.
Social media facilitates a large volume of today’s communication. With respect to public health, its greater anonymity and ‘rawness’ compared with other modes of communication, alongside a large userbase, make it attractive for investigating stigmatised topics relevant to gay and bisexual men (Birnholtz et al. Citation2020; Ramallo et al. Citation2015). Despite being launched in 2017, TikTok is a platform that now exceeds Twitter’s userbase (Statista Citation2023; Tomé and Cardita Citation2021). It allows the creation of ‘TikToks’ – in the form of short videos <120 s – which are shared to users’ ‘for you’ pages via its algorithm, which identifies TikToks that other users may find interesting. They can also be searched for using the ‘discover’ section (Klug et al. Citation2021; van Kampen et al. Citation2022). 38.9% of TikTok users are aged 18–25 and vary from healthcare professionals to members of the general public (Statista Citation2023). TikTok’s user base’s expanse, engagement and demographic make it especially pertinent for investigating and disseminating PrEP information to groups who may be at risk for HIV.
Conceptual framework
This work used critical discourse analysis (CDA) [in the form of Wodak and Meyer’s (Citation2009) discourse-historical method] and critical theory to highlight how language and communication create power asymmetries and inequalities (Fairclough Citation2013). We also used queer theory, including engagement with the work of Butler (Citation1989) and Sedgwick (Citation1990), to critique and challenge homophobic discourses and heteronormative ideologies. Our choice of CDA, informed by Ringer (Citation1994), facilitated exploration of how communication constructs ideas about sexuality and identity, and how these constructions are linked to the marginalisation of queer people. Our application of CDA to social media was informed by the work of Herring (Citation2004) and Yus (Citation2011), who highlight how communication via social media can perpetuate or counteract power asymmetries.
Literature review
Systematic reviews on the uptake of PrEP (Hillis et al. Citation2020; Matacotta, Rosales-Perez, and Carrillo Citation2020; Peng et al. Citation2018; Yi et al. Citation2017) have demonstrated poor knowledge, direct stigma and homophobia as barriers to PrEP uptake. This is reflected in qualitative analysis about PrEP use in social media. Content analyses of YouTube (Kecojevic et al. Citation2021), Twitter (Schwartz and Grimm Citation2017) and Instagram (Walsh-Buhi et al. Citation2021) messaging, as well as of mixed social media platforms (Hannaford et al. Citation2018), have identified self-reported HIV- and PrEP-related stigma and homophobia as barriers to uptake and use alongside poor knowledge among healthcare professionals and the general public. In contrast, other qualitative studies of Twitter (McGregor and Gomes Citation2019) and Reddit (Loosier et al. Citation2022) found issues of cost and access to healthcare of greater salience than stigma. Some similar studies have used CDA in British newspaper accounts to focus on homophobia and PrEP-related discourse (Jones and Collins Citation2020; Mowlabocus Citation2020), but the approach has never been used on TikTok.
Aims
This work applies CDA to reveal the underlying discursive themes of a corpus of TikToks regarding PrEP and how specific examples of TikToks perpetuate or challenge these themes. More generally, the work aims to expand understanding of institutionalised heteronormative and homophobic ideas and practices surrounding PrEP and strengthen HIV prevention on a platform that informs many of those most at risk of HIV.
Methods
Corpus production
We configured a new TikTok account as a 22-year-old male (a decision influenced by the average age of TikTok users and an age of high HIV risk [National AIDS Trust Citation2019]). On 20 May 2022, we generated TikToks via three sequential searches using the terms ‘HIV PrEP’, ‘Truvada’ and ‘Pre-Exposure Prophylaxis’ in turn in the ‘discover’ section of the app. The display order generated was determined by the platform’s search algorithm, which is based on factors including other users’ interactions (Klug et al. Citation2021). The first 50 TikToks in English from each of the three searches formed our sample of 150.
We withdrew TikToks that were duplicated, irrelevant, incomprehensible or deleted during analysis (see ), resulting in a final corpus of 121. This sample size is comparable to that in previous studies of a similar nature (Basch, Yalamanchili, and Fera Citation2022; Fowler et al. Citation2022; Purushothaman et al. Citation2022; van Kampen et al. Citation2022), and sampling would have continued if ‘thematic saturation’ had not been reached.
Figure 1. Corpus selection.
Next, using the approach suggested by Saldaña (Citation2021), we inductively developed an NVivo codebook. Relevant content codes were created and attached to each TikTok sequentially in a non-mutually exclusive way. We refined codes into categories, subjects and sub-subjects (). We then collected quantitative data regarding each TikTok’s popularity and creator characteristics ().
Table 1. Content subjects.
Table 2. Most liked subjects.
Table 3. Subjects by identity.
Table 4. Identity engagement.
Corpus analysis
Initially, the codes, categories, subjects and sub-subjects were examined to develop an overall picture of the discourse used. Specific examples under each code were then examined to identify underlying discursive themes. As analysis progressed, four main themes were identified in the corpus at which point thematic saturation (Braun and Clarke Citation2021) was reached. Quantitative data regarding popularity and creator characteristics were blended with code-based CDA to examine who and what shape this discourse. To ensure reliability, corpus analysis was undertaken by the first author, then checked and agreed upon by the second author. In-text example quotations of TikToks were extracted and transcribed verbatim in line with .
Table 5. Transcription.
Ethics
The work of Townsend and Wallace (Citation2016) guided our research ethics, and approval for the study was granted by the University of Exeter (ref: 126/22/03/005). TikTok content is shared with anyone, and so users can reasonably expect it to be shared with strangers. That being said, we excluded TikToks from anyone who was identifiably under 18 and anonymised identifying features throughout.
Findings
The content of 121 TikToks was coded 1020 times and sorted under 57 sub-subjects, 23 subjects and three overarching content categories: ‘what makes a PrEP user?’; ‘what is PrEP as a drug?’; ‘sexual health and HIV’. shows the frequency of referrals to each subject and sub-subject category. Analysis of the content within these three categories revealed four main underlying discursive themes across the corpus: (1) stigmatisation of HIV as a ‘gay disease’ with a poor prognosis; (2) stigmatisation of gay men as unsafe, high-risk and untrustworthy; (3) stigmatisation of PrEP as increasing ‘unsafe’ sexual practices; (4) poor healthcare and education for gay men and other beneficiaries of PrEP. Analysis of each category revealed a spectrum of discourses from reproduction and perpetuation to efforts to challenge the validity of each of the four themes as discussed below.
What makes a PrEP user?
‘Who is PrEP for?’ was discussed in 47% of TikToks, with just under half of these implying that PrEP was purely for gay men. ‘This is for the girls and the gays, actually just the gays’. ‘This gay medicine’. ‘What is one thing that every gay needs in their life? *Action: rattles Truvada pills*’. ‘Tell me you’re gay without actually telling me you’re gay. Ok, I take Truvada’. These quotes suggest that PrEP is purely for gay men, linking to a discursive theme labelling HIV as a ‘gay disease’, with the implication that PrEP is only relevant to members of this group.
However, the corpus suggested that Black heterosexual cisgender women were also at high risk of HIV and would benefit from PrEP but were often unaware of it, or did not believe it is for them. ‘People who should consider PrEP: people who live in a community with a high prevalence of HIV […] this includes the Black community’. ‘You all need to educate yourselves, Black women can get on PrEP’.
The content of 18 TikToks suggested that gay men were promiscuous and ‘unsafe’, with 21% of TikToks suggesting that PrEP facilitated this. Examples from the corpus suggested so-called ‘unsafe’ sexual practices including hook-up apps: ‘Get the fuck off my property you skanky ass bitch *Captioned: The PrEP pill protecting me against HIV after I bottomed for the blank profile*’; saunas ‘#You better work bitch# *Captioned: Taking my daily PrEP before going to the gay sauna*’ and orgies ‘#holy spirit activate# *Captioned: Taking two PrEP pills before the oar-gee. Action: Dancing*’.
Examples like these use humour to suggest the above ‘unsafe’ practices are positive; many imply they can be acceptable if done safely by, for example, using condoms: ‘*Captioned: When different HIV prevention methods meet at a hook-up: Condoms and PrEP. Action: Dance together in a positive way*’. In these examples, the discussion of sexual practices between men first plays into the theme of stigmatisation of gay men as unsafe, high-risk and untrustworthy; and second, that PrEP could be actively encouraging these practices, thus perpetuating the idea of PrEP increasing risk. On the other hand, these examples could be seen as challenging these themes; destigmatising sexual relationships between men so long as they are protected by PrEP or condoms.
Other TikToks implied that rather than increasing promiscuity and so-called ‘unsafe’ sexual practices, taking PrEP may result in gay men failing to take other precautions, including condom use and HIV testing (with six and one mentions respectively). ‘Are you tested recently? I’m on PrEP so… *Action: Dances. Caption: STI gang roll out*’. ‘Tell me you’re hitting it raw without telling me you’re hitting it raw *Action: Swallows PrEP pill*’. Despite light-heartedness, the discursive theme here suggests how PrEP could encourage truly unsafe and risky practices (i.e. by increasing the risk of other sexually transmitted infections (STIs) by not using condoms and testing).
On the other hand, some TikToks implied that only those at ‘high risk for HIV’ should be the beneficiaries of PrEP ‘Are you HIV negative and at high risk for HIV? You can take PrEP to prevent infection’. Others aimed to reframe PrEP positively, ‘It empowers people to take control of their sexual health’ and ‘PrEP is another way to take your own health into your own hands’. The discursive themes within these examples look to challenge HIV’s stigma as a ‘gay disease’, by giving it wider appeal and portraying PrEP as something empowering and smart to use, counteracting the theme that it increases risk.
What is PrEP as a drug?
PrEP access was a popular subject discussed within this category. Five TikToks implied that the medication was hard to access. ‘I’ve driven all over Kansas City to try and get my medication […] and it is difficult, why is it so difficult, it should not be this difficult, come on people, help the gays’. This portrayal of the barriers to access reflects discursive themes demonstrating the theme of poor healthcare provision for gay men challenging this theme.
On the other hand, 25 TikToks implied PrEP was easy to access. Two TikToks demonstrated how to access PrEP at their local clinics. By portraying the ease with which PrEP could be accessed, others could be encouraged to access it. ‘Where does one get this pill? At any local clinic’. These examples portray PrEP services as easy to use and non-judgemental, thus counteracting the theme of poor healthcare access for gay men.
The importance of correct dosing was the subject of 45 TikToks. ‘If you don’t take it correctly […] then obviously the pill isn’t going to work’. ‘PrEP is amazing, when taken properly, at preventing HIV’. On the one hand, these examples could be emphasising that for PrEP to protect, you must take it properly. On the other hand, they serve to perpetuate a discursive theme portraying other gay men as untrustworthy and unsafe. Eight TikToks discussed injectable PrEP, carrying the implication that gay men may benefit from it as they often forget to take oral medication. ‘Injection proved superior to Truvada […] why? Probably because you only have to do a shot every eight weeks instead of remembering a pill every day’.
Many (23) TikToks described PrEP as easy to take, with four likening it to the contraceptive pill. ‘PrEP is kinda like birth control for HIV’. On the surface, this seems to normalise taking a medication daily which may be helpful in challenging the theme stigmatising PrEP as risky. However, it could be interpreted as trying to increase PrEP’s acceptability by relating it to the health actions a monogamous heterosexual couple might take.
Within this category, the most referenced (76 times) and popular subject was PrEP as effective (). ‘The amazing thing about PrEP is that it is incredibly effective and in most of the big clinical trials no one became infected’. The underlying intention of this claim was to educate the public. The corpus specifically considered the issue of education, ‘^Interviewer:^ Do you know what PrEP is? ^Interviewee:^ Urrrrm not really’; ‘Loads of people still don’t know about it!’; ‘There is a serious lack of queer sex ed that’s accessible […] when kids can’t find adequate information at school, where do they turn? The internet’.
Together, these examples reflect a discursive theme that exemplifies the lack of PrEP knowledge and sex education for gay men and other beneficiaries of PrEP but also implies what an influential tool the Internet may be. Additionally, four TikToks suggested that there is poor knowledge among healthcare professionals too. ‘^Doctor:^ You’re on Truvada, how long have you been HIV positive? ^Patient:^ I’m not. ^Doctor:^ What? ^Patient:^ I take Truvada as a form of preventative care […] ^Doctor:^ That’s crazy, I had no idea’. The discursive theme underlying this interaction aims to draw attention to poor knowledge among healthcare professionals.
Sexual health and HIV
A large part of the corpus emphasised how PrEP does not protect against other STIs, and condoms are still important: ‘PrEP can help protect you against HIV but not other sexually transmitted diseases’. Condom use was referenced 27 times and was one of the most ‘liked’ across the corpus (). Some examples were explicit in their promotion of condoms, ‘*Caption: Is PrEP a reason not to use protection?* No’. ‘*Caption: PrEP Checklist: Barriers with new partners*’. However, others were less clear about this: ‘Always use a condom no matter what, unless you, like, really trust the person I guess’. These and similar examples aimed to educate about the importance of other STIs, which contrasts with the theme of HIV as a ‘gay disease’. Additionally, the theme that PrEP increases unsafe sexual practices was counteracted by encouraging condom use and emphasising that PrEP is not an excuse to stop using barrier methods of protection. However, another potential discursive theme that could be seen in all of these examples is an untrusting view of gay men.
One of the most ‘liked’ subjects was HIV fear and worry (). ‘Aren’t we all concerned about HIV?’, ‘HIV is no joke, you can’t get rid of her’. These examples demonstrate fear regarding HIV’s ‘untreatability’. On the other hand, many TikToks discussed the ‘Undetectable = Untransmittable’ (‘U = U’) campaign and how much has changed when it comes to HIV prognosis: ‘Dating with the virus is a lot safer than it used to be’; ‘*Caption: HIV prevention in the 80s: Just don’t have sex, use condoms. HIV prevention in 2022: PrEP, U = U, PEP*’. Such examples seek to disrupt the damaging theme of HIV’s poor prognosis. ‘Steps to prevent HIV […] Help destigmatise HIV’. TikToks like these suggest that destigmatising HIV is one step towards its prevention. They aim to disrupt the theme regarding HIV’s stigmatisation as a ‘gay disease’ with a poor prognosis.
Identities and engagement
There was variation in discursive themes between differing groups. shows the most popular subjects within different creator characteristic groups, and also the more unique subjects being discussed by these groups.
Universally, the most discussed subject was PrEP’s effectiveness. However, a larger number of health care providers’ TikToks discussed this (76%) than did the public more generally (54%). Additionally, 100% of TikToks focusing on injectable PrEP and 66% of them discussing differences between Truvada and Descovy were made by healthcare providers. Contrastingly, 68% of the TikToks made by the general public associated PrEP and risk-taking, compared with 12% of TikToks made by providers. Regarding sexual orientation, 76% of TikToks created by queer creators (i.e. creators whose profile clearly identified them as not straight) associated PrEP with risk-taking.
shows the frequency of different TikTok subjects receiving over 10,000 likes, with the most liked TikToks discussing PrEP’s effectiveness and HIV fear and stigma. shows the relationship with different identities, demonstrating no obvious trend between identity and engagement.
Discussion
This study conducted a detailed examination of underlying discursive themes in a corpus of TikToks regarding PrEP. Insights from discourse analysis, queer theory and social media research enabled the identification of four discursive themes, as discussed below. Our most significant finding across these themes demonstrates that the majority of the corpus content perpetuates institutionalised heteronormative and homophobic ideals. This was true despite a minority of TikToks that sought to challenge these themes.
The stigmatisation of HIV as a ‘gay disease’ with a poor prognosis was the first theme demonstrated throughout the corpus. These associations originate from HIV’s initial emergence and poor prognosis among gay men, which spread fear through a heteronormative society fuelling stigma (Halkitis Citation2012). This association can be valuable, as it enables targeted prevention towards those at the highest HIV risk. However, our results demonstrate the reinforcement of a homophobic discourse, which not only frames gay sex as risky but also leaves others unaware they may be at high risk. This unawareness, compounded by fear of being assumed to be gay alongside prevailing falsehoods regarding prognosis and treatability, which are present in the corpus, may mean others at high risk of HIV do not seek PrEP or HIV treatment (Hafeez et al. Citation2017; Schraer Citation2021). In contrast, other messaging present in the corpus aims to challenge this association, appealing to ‘those at risk of HIV’ and Black women, as well as referencing U = U, thus counteracting homophobic and heteronormative assumptions acting as barriers to prevention and treatment.
The stigmatisation of gay men as unsafe, high-risk and untrustworthy was the corpus’s second prominent theme. This likely has its origins in representations of sex between men as deviant, unsafe and abnormal. The corpus’s positive references to hook-ups, saunas and orgies may promote the idea of ‘unsafe’ sexual practices between men, thus perpetuating homophobic discourses. However, these same references may be seen as challenging monogamous, ‘normal’ ideals. The sole discussion of injectable PrEP by healthcare professionals as benefiting those who often forget to take oral medication may suggest a deep-seated distrust of gay men in healthcare. Two recent CDAs extend findings to UK newspaper accounts (Jones and Collins Citation2020; Mowlabocus Citation2020), which portray gay men as risk-takers and frame PrEP less as a ‘wonder drug’ and more as a ‘promiscuity pill’.
The stigmatisation of PrEP as increasing ‘unsafe’ sexual practices was the third theme within the corpus. PrEP’s negative association with promiscuity is rooted in homophobia, being seen to facilitate ‘unsafe’ sexual practices outside heteronormative ideals (Calabrese Citation2020; Haire Citation2015; Jaspal and Nerlich Citation2017; Jones and Collins Citation2020; Lovelock Citation2018). Our results showed that many TikToks reinforced the negative association between PrEP use and an increase in high-risk and stigmatised sexual practices associated with gay men (as examined in our second theme). A CDA of British media (Lovelock Citation2018) had similar findings, exemplifying how PrEP is often presented as a drain on the NHS. Pawson and Grov (Citation2018), further demonstrated that many of the 32 gay and bisexual men they interviewed saw PrEP as ‘an excuse to slut around’, labelling users as ‘Truvada whores’, results that may represent the negative internalisation of homophobic discourses by gay men. This finding was echoed within our corpus, with queer creators linking PrEP to risk-taking. This could be seen to reinforce this association but also could be seen as challenging heteronormative monogamous ideals.
Our results demonstrate discussion of PrEP use being associated with decreased use of condoms and testing. This association could be seen as genuinely unsafe, as it creates increased risk to other STIs (Centres for Disease Control and Prevention Citation2021) and may reinforce the ideas present in our second and third themes. However, the association between PrEP use and decreased use of condoms and testing is yet to be firmly established in epidemiological accounts (Freeborn and Portillo Citation2018), with other elements of the corpus emphasising that using condoms alongside PrEP is important and that PrEP is empowering and smart, and enables sex-positivity. This could be seen as challenging PrEP’s association with promiscuity and gay men’s stigmatisation as unsafe thus aiming to promote truly safe sex for gay men.
Lastly, poor healthcare and education for gay men and other beneficiaries of PrEP was the final theme in the corpus. Many TikToks from the corpus commented directly on the relationships between institutionalised homophobia, heteronormativity and poor healthcare, education and knowledge, a relationship reflected in other research (Epps, Markowski, and Cleaver Citation2023; Hafeez et al. Citation2017). More subtly, many TikToks aimed to educate readers about efficacy, access and the importance of adherence, and their popularity and frequency indirectly suggest a current lack of PrEP knowledge that may be the result of inadequate relationships and sexuality education, and institutionalised homophobia in education. However, many TikToks aiming to educate were created by healthcare professionals, especially where these related to topics not discussed by anyone else (e.g. injectable PrEP). This educative element alongside the direct challenge of our identified themes demonstrates the importance and influence of not just healthcare professionals on TikTok but the platform of TikTok as a whole in challenging institutionalised homophobia and education.
Policy and practice implications
This is the first study of its kind. Further research is required to examine other aspects of PrEP uptake, especially in relation to groups other than gay men. TikTok and social media offer public health professionals with a powerful, yet underutilised means to educate about PrEP and HIV while reducing stigma (Gabarron and Wynn Citation2016; Kudrati, Hayashi, and Taggart Citation2021). This study revealed the presence of positive and negative discourses on TikTok showing there is no one dominant discourse regarding PrEP. Healthcare professionals should take advantage of this, using TikTok to amplify positive discourses that aim to portray PrEP as an empowering solution to HIV and counteract discourses that associate PrEP with increased sexual risk. As there was no strong association between user engagement with TikToks (measured by likes) and user group, healthcare professionals should also seek to utilise prominent members of the general public to further the amplification of positive discourse and provide education. Doing this may help destigmatise PrEP and increase PrEP uptake.
Strengths and weaknesses
This study’s focus on social media is a strength of the work described in this paper, and its relatively uncurated nature offers a unique insight into a highly stigmatised set of issues (Birnholtz et al. Citation2020; Roberts and Rajah-Kanagasabai Citation2013). Although rarely utilised in public health research, the interpretive lens provided by CDA provides valuable insight into pertinent issues and their impacts (Aguinaldo Citation2012; Lupton Citation1992). The blending together of quantification of popularity and characteristics provides a nuanced look at who and what are significant in shaping discursive themes of relevance to future health education and health promotion.
There were of course limitations to this analysis. There was limited scope for theoretical sampling, as our selection took place using the TikTok algorithm, a search tool that is based on TikToks that receive the most interactions (among other factors) (Klug et al. Citation2021). As a result, our sample may not be considered direct. However, as TikToks with more interactions are more likely to be prominent voices within the discourse, this method was considered an appropriate representation. Additionally, although comparable with similar studies, our sample size of 121 was small, and work with larger, more representative samples is needed.
Conclusion
PrEP is an important means of preventing HIV. With a focus on TikToks regarding PrEP, this CDA revealed underlying discursive themes stigmatising HIV as a ‘gay disease’; gay men as unsafe, untrustworthy and high risk; PrEP as increasing ‘unsafe’ sexual practices; and discussion of poor healthcare and education for gay men and other beneficiaries of PrEP. These themes are shaped by heteronormativity and homophobia, and sub-themes within them reflect a range of discourses from those mostly supportive of our themes to those that sometimes challenge them. Findings from this research are complementary to those in the existing literature yet offer a unique take on the way in which TikTok’s discussion of PrEP perpetuates and sometimes challenges homophobia and heteronormativity, ultimately informing the next steps in preventing HIV.
Acknowledgements
The authors are grateful to the University of Exeter for its support.
Disclosure statement
No potential conflict of interest was reported by the authors.
Additional information
Funding
References
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