A decade of PrEP: the evolution of HIV pre-exposure prophylaxis content and sentiments in South African print news media, 2012–2021

Abstract

After nearly a decade of HIV pre-exposure prophylaxis (PrEP) rollout in sub-Saharan Africa, there has been limited study of PrEP messaging in news media. We selected twenty South African newspapers with the highest circulation volumes to retrieve articles published in 2012–2021 mentioning PrEP (N = 249). Using inductive content analysis, we developed a structured codebook to characterise PrEP-related content and sentiments, as well as their evolution over time, in the South African press. Many articles espoused favourable attitudes towards PrEP (52%), but a sizeable fraction espoused unfavourable attitudes (11%). Relative to PrEP-favourable articles, PrEP-unfavourable articles were significantly more likely to emphasise the drawbacks/consequences of PrEP use, including adherence/persistence requirements (52% vs. 24%, p = .007), cost (48% vs. 11%, p < .001), and risk compensation (52% vs. 5%, p < .001). Nevertheless, the presence of these drawbacks/consequences in print media largely declined over time. Key populations (e.g. adolescents, female sex workers) were frequently mentioned potential PrEP candidates. Despite message variations over time, prevention effectiveness and adherence/persistence requirements were the most widely cited PrEP benefits and drawbacks, respectively. Study findings demonstrate the dynamic nature of PrEP coverage in the South African press, likely in response to PrEP scale-up and real-world PrEP implementation during the study period.

Keywords:

• HIV prevention
• key populations
• mass media
• content analysis
• South Africa

Acknowledgements

We thank TB HIV Care staff in South Africa for their assistance with media translation. We are grateful to Amelia Rock and Carly Comins for their early contributions to the study design and analytic approach.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Replication data for the manuscript are available upon reasonable request from the corresponding author.

Additional information

Funding

This study was supported by the US National Institute of Mental Health (R01MH121161). JGR was supported by the US National Institute of Mental Health (R25MH083620). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or the US Government.