Assessing PrEP messaging and communication: A review of the qualitative literature.

Pre-exposure prophylaxis (PrEP) is a biomedical HIV prevention intervention approved by the FDA in 2012. Nevertheless, most sexual minority men (SMM) who could benefit from its use are not currently prescribed PrEP. The literature during the first decade of PrEP availability has suggested a diverse set of multi-level barriers and facilitators to PrEP uptake and adherence. Through a scoping review, 16 qualitative studies were surveyed to assess these barriers and facilitators, specifically regarding messaging and communication. Seven main themes were identified: information & misinformation, peer messaging, expansion of sexual experiences, relationships with providers, expectations & stigma, navigation support, and barriers to uptake & adherence. Data suggest that peer support, messaging around empowerment and agency, and PrEP's role in shifting sociosexual norms contributed to uptake and adherence. On the other hand, stigma, provider disconnection, and access issues hindered PrEP uptake and adherence. Findings could inform multi-level, strengths-based, and holistic approaches to designing effective interventions for PrEP engagement among SMM.