Stigma, the Media, and Pre-exposure Prophylaxis for HIV Prevention: Observations for Enhancing Knowledge Translation and Resisting Stigma in the Canadian Context
Pre-Exposure Prophylaxis (PrEP) is an effective, though sometimes stigmatized, strategy for HIV prevention. With the goal of examining how PrEP stigma can be addressed, this study examined the media’s handling of stigma related to PrEP by searching the Canadian Newsstream and Daily Xtra news databases for key terms related to PrEP. Overall, 101 media articles were thematically coded in triplicate; 36.3% of which included mentions of PrEP stigma. LGBT media sources were more likely than mainstream sources to have included content coded as relating to PrEP stigma (p = 0.02). In these articles, uncertainty regarding PrEP, and neo-liberal attitudes towards sexual responsibility were major factors associated with media discussion of PrEP stigma. We discuss the role that heuristics play in shaping lay readers perceptions and interpretation of PrEP media coverage and discuss methods for overcoming stigma using evidence-based communication strategies.
KeywordsMedia HIV Pre-exposure prophylaxis Risk compensation Knowledge translation
KGC is supported by a Canadian Institutes of Health Research Health Systems Impact Fellowship award, a Michael Smith Foundation for Health Research Trainee award, and a Canadian HIV Trials Network/Canadian Foundation for AIDS Research Postdoctoral Fellowship award. NJL is supported by a Michael Smith Foundation for Health Research Scholar award.
Compliance with Ethical Standards
Conflict of interest
All authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 2.Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet Lond Engl. 2013;381:2083–90.CrossRefGoogle Scholar
- 11.CBC News. Ontario to cover HIV prevention pill under public health plan [Internet]. CBC News. 2017 [cited 2017 Oct 5]. Available from: http://www.cbc.ca/news/health/hiv-prep-coverage-1.4302184.
- 12.Bell N. Want insurance to cover your PrEP? Good luck. Xtra [Internet]. 2016 Feb 18 [cited 2017 Oct 5]; Available from: https://www.dailyxtra.com/want-insurance-to-cover-your-prep-good-luck-70225.
- 17.Goffman E. Stigma: Notes on the Management of Spoiled Identity. Reissue ed. New York: Touchstone; 1986.Google Scholar
- 19.Van der Elst EM, Mbogua J, Operario D, Mutua G, Kuo C, Mugo P, et al. High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya. AIDS Behav. 2013;17:2162–72.CrossRefGoogle Scholar
- 20.Douglas M. Risk acceptability according to the social sciences. London: Psychology Press; 2003.Google Scholar
- 27.Mykhalovskiy E, Hastings C, Sanders C, Hayman M, Bisaillon L. Callous, cold, and deliberately duplicitous: racialization, immigration and the representation of HIV criminalization in Canadian Mainstream Newspapers. Toronto; 2016.Google Scholar
- 29.Benbow A. Mental illness, stigma, and the media. J Clin Psychiatry. 2007;68(Suppl 2):31–5.Google Scholar
- 36.Parkinson S, Jackson T, Berg K, editors. Risk, media and stigma: understanding public challenges to modern science and technology. London: Earthscan; 2001.Google Scholar
- 37.Bennett WL, Entman RM, editors. Mediated politics: communication in the future of democracy. 1st ed. Cambridge: Cambridge University Press; 2000.Google Scholar
- 38.Green G. Attitudes towards people with HIV: are they as stigmatizing as people with HIV perceive them to be? Soc Sci Med. 1982;1995(41):557–68.Google Scholar
- 39.Bernard H. In: Ryan G, editor. Analyzing qualitative data: systematic approaches. Los Angeles: Sage Publications; 2009.Google Scholar
- 41.R Core Team. R: a language and environment for statistical computing. [Internet]. 2017. http://www.R-project.org/.
- 43.Associated Press. Divide over HIV prevention drug Truvada persists. USA TODAY [Internet]. 2014 Apr 6 [cited 2017 Sep 14]. https://www.usatoday.com/story/news/nation/2014/04/06/gay-men-divided-over-use-of-hiv-prevention-drug/7390879/.
- 44.Barsotti N. US: CDC recommends expanded use of PrEP. Xtra [Internet]. 2014 May 15 [cited 2017 Sep 14]. https://www.dailyxtra.com/us-cdc-recommends-expanded-use-of-prep-60661.
- 45.Christopher N. Coming out of the PrEP closet. Xtra [Internet]. 2015 Dec 1 [cited 2017 Sep 14]. https://www.dailyxtra.com/coming-out-of-the-prep-closet-69540.
- 46.Miksche M. Can we end the North American HIV epidemic? Xtra [Internet]. 2016 Nov 7 [cited 2017 Sep 14]. https://www.dailyxtra.com/can-we-end-the-north-american-hiv-epidemic-72327.
- 47.Bell N. PrEP is now approved in Canada. What happens now? Xtra [Internet]. Vancouver, Canada; 2016 Mar 2 [cited 2017 Sep 13]. https://www.dailyxtra.com/prep-is-now-approved-in-canada-what-happens-now-70344.
- 48.Miksche M. Waiting in purgatory (Part 1). Xtra [Internet]. 2015 Mar 11 [cited 2017 Sep 14]. https://www.dailyxtra.com/waiting-in-purgatory-part-1-66665.
- 49.Miksche M. Why I had to stop taking PrEP. Xtra [Internet]. 2016 Mar 14 [cited 2017 Sep 14]. https://www.dailyxtra.com/why-i-had-to-stop-taking-prep-70437.
- 50.Miksche M. What the rise of the alt-right means for HIV prevention. Xtra [Internet]. 2016 Nov 21 [cited 2017 Sep 14]. https://www.dailyxtra.com/what-the-rise-of-the-alt-right-means-for-hiv-prevention-72462.
- 51.Cruikshank J. An ounce of prevention. Xtra [Internet]. Vancouver, Canada; 2014 Sep 25 [cited 2017 Sep 13]. https://www.dailyxtra.com/an-ounce-of-prevention-63917.
- 52.Miksche M. PrEP and the birth control pill. Xtra [Internet]. 2016 Oct 11 [cited 2017 Sep 14]. https://www.dailyxtra.com/prep-and-the-birth-control-pill-72142.
- 53.Glenwright D. For the love of fucking [Internet]. Xtra. 2014 [cited 2017 Sep 14]. https://www.dailyxtra.com/for-the-love-of-fucking-57930.
- 54.Gilbert S. What they don’t want you to know about Truvada [Internet]. Xtra. 2015 [cited 2017 Sep 14]. https://www.dailyxtra.com/what-they-dont-want-you-to-know-about-truvada-67669.
- 55.Houston A. Concerns raised about HIV pill study. Xtra [Internet]. 2010 Nov 22 [cited 2017 Sep 14]. https://www.dailyxtra.com/concerns-raised-about-hiv-pill-study-8646.
- 56.Miksche M. How bareback culture has evolved since the AIDS epidemic. Xtra [Internet]. 2016 Dec 12 [cited 2017 Sep 14]. https://www.dailyxtra.com/how-bareback-culture-has-evolved-since-the-aids-epidemic-72629.
- 57.Miksche M. A safer way to party and play? [Internet]. Xtra. 2016 [cited 2017 Sep 14]. https://www.dailyxtra.com/a-safer-way-to-party-and-play-71310.
- 58.Prendergast F. If PrEP is a party drug, then cue the DJ. Xtra [Internet]. 2014 Apr 29 [cited 2017 Sep 14]. https://www.dailyxtra.com/if-prep-is-a-party-drug-then-cue-the-dj-60116.
- 59.Miksche M. Why the AIDS vigil should remind communities to work harder. Xtra [Internet]. 2016 Jul 1 [cited 2017 Sep 14]. https://www.dailyxtra.com/why-the-aids-vigil-should-remind-communities-to-work-harder-71420.
- 60.Hunter P. Party pill or drug of hope?: Increasingly, the drug Truvada is being used to prevent HIV transmission. But some fear it will encourage unsafe sex. Tor Star Tor Ont. Toronto, Ont., Canada; 2014 Nov 23;IN.1.Google Scholar
- 61.Ren P. Can a pill prevent HIV? Xtra [Internet]. 2009 Jan 28 [cited 2017 Sep 14]. https://www.dailyxtra.com/can-a-pill-prevent-hiv-13617.
- 62.LGBTQ RIGHTS; Community fights stigma; Event to promote open dialogue on race, sex, HIV status, experience of young people. Chron—Her Halifax NS. Halifax, N.S., Canada; 2016 Mar 26;A6.Google Scholar
- 63.Miksche M. Getting the facts right about PrEP, serosorting and your sexual health. Xtra [Internet]. 2016 Oct 24 [cited 2017 Sep 14]. https://www.dailyxtra.com/getting-the-facts-right-about-prep-serosorting-and-your-sexual-health-72243.
- 64.Ellis E. Insurer stops covering HIV prevention drug. Vanc Sun [Internet]. 2016 May 6 [cited 2017 Sep 14]. http://vancouversun.com/news/local-news/insurer-stops-covering-hiv-prevention-drug.
- 65.Syms S. Got PrEP? Xtra [Internet]. 2008 Jan 30 [cited 2017 Sep 14]. https://www.dailyxtra.com/got-prep-38667.
- 66.Barsotti N. Almost half of gay men bareback: study. Xtra [Internet]. 2013 Jan 14 [cited 2017 Sep 14]. https://www.dailyxtra.com/almost-half-of-gay-men-bareback-study-1568.
- 67.McCann M. Canadians already on PrEP while drug sits in regulatory limbo. Xtra [Internet]. 2014 Feb 7 [cited 2017 Sep 14]. https://www.dailyxtra.com/canadians-already-on-prep-while-drug-sits-in-regulatory-limbo-57946.
- 68.Christopher N. US approves drug to prevent HIV infection. Xtra [Internet]. 2012 Jul 19 [cited 2017 Sep 14]. https://www.dailyxtra.com/us-approves-drug-to-prevent-hiv-infection-3110.
- 69.Lecheler S, de Vreese CH. News framing and public opinion: a mediation analysis of framing effects on political attitudes. J Mass Commun Q. 2012;89:185–204.Google Scholar
- 78.Duran D. Truvada Whores? [Internet]. Huffington Post. 2012 [cited 2017 Sep 14]. http://www.huffingtonpost.com/david-duran/truvada-whores_b_2113588.html.
- 79.Cadelago C, White JB. Spending big on sex and drug initiatives, AIDS activist Michael Weinstein says he ‘can’t lose.’ Sacram Bee [Internet]. 2016 Oct 10 [cited 2017 Sep 14]. http://www.sacbee.com/news/politics-government/capitol-alert/article107156677.html.
- 80.Waddell C, Lomas J, Lavis JN, Abelson J, Shepherd CA, Bird-Gayson T. Joining the conversation: newspaper journalists’ views on working with researchers. Healthc Policy. 2005;1:123–39.Google Scholar
- 82.Soroka S, Lawlor A, Farnsworth S, Young L. Mass media and policymaking. Routledge Handb Public Policy Process. London: Routledge; 2013. p. 204–14.Google Scholar
- 83.Scheufele DA. Framing Effects. Int Encycl Commun [Internet]. John Wiley & Sons, Ltd; 2008 [cited 2017 Oct 5]. http://onlinelibrary.wiley.com/doi/10.1002/9781405186407.wbiecf039.pub2/abstract.
- 92.Salas S. Beca I [Mass media communication of biomedical advances]. Rev Med Chil. 2008;136:1348–52.Google Scholar
- 93.Guidotti TL. Evaluation of scientific evidence in law, adjudication and policy: when occupational health takes the witness chair. Med Lav. 2006;97:167–74.Google Scholar
- 96.GildeZúñiga H. Social media use for news and individuals’ social capital, civic engagement and political participation. J Comp-Med Commun. 2012;17:319–36.Google Scholar
- 97.Kwak H, Lee C, Park H, Moon S. What is Twitter, a Social Network or a News Media? Proc 19th Int Conf World Wide Web [Internet]. New York, NY, USA: ACM; 2010 [cited 2017 Sep 14]. p. 591–600. http://doi.acm.org/10.1145/1772690.1772751.