Theoretical Background and research questions/hypothesis: Over the last decade, new treatment strategies to prevent HIV transmission have led to the development of pre-exposure prophylaxis (PrEP). The aims of PrEP are to actively prevent against transmission through the daily consumption of an oral drug, named Truvada. Although studies have shown Truvada to be highly effective at reducing the risk of infection by up to 99%, uptake has been relatively slow. As both state and national newspapers continue to work as a key source of health information for at-risk populations, this study provides formative research into how Truvada has been presented in Floridian and national newspapers. In line with effective health-risk message theory, the authors used the Extended Parallel Process Model (EPPM) as a lens in which to analyze stories about Truvada, and to identify whether they differ in their presentation of health-risk information across four levels of message appraisal: severity, susceptibility, self-efficacy and response efficacy.
Methods: 61 news articles were identified with keyword searches of “Truvada,” “pre-exposure prophylaxis,” or “PrEP.” As Florida has more cities/metro areas (six) in the top 25 cities ranked by HIV incidence, state newspapers were selected solely from these areas (n=17). Five national newspapers were selected by circulation and because they were also based within cities that have high HIV incidence (n=44). A time frame of July 1, 2012 to June 30, 2014 was chosen because it encompassed a two-year span from the month Truvada was first approved by the FDA for prevention during sexual intercourse.
Results: The geographic context (local, state, national or international) of severity (mortality) and susceptibility (incidence and/or method of contraction) was coded for. Not surprisingly, national newspapers were more likely to report national HIV mortality rates [X2 (1, N=61) =7.37, p=.007]. Interestingly, however, Florida newspapers were actually more likely to report international incidence rates [X2 (1, N=61) =8.17, p=.019], but there was no significant difference in reporting the methods of HIV contraction (e.g., sexual intercourse, blood transfusion, etc.). Cost, insurance coverage, daily adherence, and where to obtain Truvada were coded for as self-efficacy. Florida newspapers were more likely to report the need for daily adherence of the drug [X2 (1, N=61) =2.45, p=.045], but were less likely to report where to obtain it [X2(1, N=61) =3.24, p=.049]. Response efficacy was coded for across several variables, including drug transmission success, risk compensation rates (i.e., a reduction in other safe-sex practices as a result of taking Truvada), side effects, use for serodiscordant, homosexual and heterosexual couples, and the need for continual HIV screening when on Truvada. There were no significant differences across any of the response-efficacy variables.
Conclusions: The findings from this formative research provide an interesting insight into how perceptions of Truvada are potentially formed in at-risk populations. In particular, Florida newspapers were more likely to present barriers to using Truvada successfully (daily adherence) and less likely to provide facilitators for usage (where to obtain it).
Implications for research and/or practice: Moreover, these findings will be used to help shape a tailored-message intervention for at-risk Florida populations on the benefits of Truvada.