A study published in PLOS ONE found that Black gay and bisexual men prefer PrEP (pre-exposure prophylaxis) advertisements that highlight racial, sexual and gender diversity among the couples they feature, according to the HIV and AIDS information organization aidsmap.

Ads with diverse couples were less stigmatizing to Black men who have sex with men than ads depicting only Black gay and bisexual male couples. Ads with diverse couples were also more appealing than those with no couples, according to the study, which is part of a larger longitudinal study on PrEP advertisements and Black gay and bisexual men in the United States.

PrEP uptake among Black gay and bisexual men is low compared to white gay and bisexual men. To improve PrEP use among this population, advertisers must successfully navigate the intersection of racism, homophobia and stigma surrounding sex, PrEP and HIV.

For the study, Sarah Calabrese, PhD, of George Washington University, and colleagues analyzed the impact of visual elements of a series of PrEP ads from three different campaigns, looking specifically at the couples shown in the ads. The ads included one with a Black queer couple, one with a Black heterosexual couple, one with multiple couples representing racial, sexual and gender diversity and one with no people in it.

Nearly 100 participants provided feedback on the ads through an online survey and in-person focus groups.

Findings revealed that the couple composition affected how “eye-catching, motivating, stigmatizing, relatable, memorable and pleasant” the advertisements were. Ads featuring a queer couple were noted as very or extremely stigmatizing for about 42% of participants. Other participants agreed that ads that target Black gay and bisexual men can be alienating and associate them with HIV, according to aidsmap.

“To certain people, it can come across as insulting, ’cause it’s almost like saying we are the ones who have the disease, like we’re the only ones with the problem,” one participant said.

“I would love to see a line of people standing up, um, every height, every age, every race, just standing there, and then it’s PrEP. That’s it. This is who it represents. It doesn’t just represent Black men. It represents everyone who is sexually active. This day and age, anyone can contract HIV, so I think it needs to be broadcast to every type of person,” another said.

Some participants thought the ads with sexualized images of couples were unnecessary. “It kind depicts it as, like, OK, well if you—like if you are a little more promiscuous…PrEP is for you. And if I’m not as promiscuous, maybe it’s not for me,” one participant said.

The study’s findings should help improve how PrEP is marketed in the future with the aim of boosting uptake among all people at risk for HIV.