Purpose: Incidence of HIV diagnoses is higher in Black men who have sex with men (BMSM) than any other socio-demographic population in the United States. BMSM account for 26% of all new HIV diagnoses in the U.S. yet make up an estimated 1% of the U.S population. In 2017, Centers for Disease Control and Prevention (CDC) predicted 50% of BMSM would be diagnosed with HIV in their lifetime. Oral HIV pre-exposure prophylactic (PrEP) medications developed to prevent sexual transmission of HIV are 95-99% effective. However, Blacks represent only 10% of PrEP prescriptions. Targeted Social Marketing initiatives on Instagram need to be explored as a potential channel for informing BMSM about the benefits of PrEP and encouraging use.

Methods: To evaluate interest in a social marketing campaign to increase PrEP interest and use, we systematically deployed an advertisement on the online social media platforms Facebook and Instagram targeting user accounts that show high engagement with lesbian, gay, bisexual, transgender, and queer (LGBTQ), Black LGBTQ, queer-identified, and Black queer-identified (Instagram) accounts. Those accessing the ad by either taping on the link through their mobile device or clicking the link with their computer mouse and agreeing to participate in the survey, completed up to 26 sociodemographic and sexual behavior questions adapted from other surveys of men who have sex with men. Thereafter, respondents were separately invited to follow @The_InstaPrEP_Project on Instagram where followers received 31 educational images developed by the U.S. Centers for Disease Control and Prevention released individually over six weeks. Followers that engaged the Instagram account (@The_InstaPrEP_Project) could view the 31 social marketing interventions as they became available and throughout the intervention. Followers were asked to complete a post-test survey at completion of the intervention. Descriptive, and parametric and non-parametric statistics explored associations between race, age, geography, and sexual-behavioral characteristics and in relationship to engagement of and perceptions of PrEP-specific social marketing campaign materials distributed on Instagram. The study protocol was evaluated as not representing human research by the UCLA Institutional Review Board (IRB#20-000123, South Campus) and declared exempt.

Results: Fifteen users completed the pre-intervention survey. Of the 550 followers gained through the six-week intervention, six (1%) completed the post-intervention survey. Among pre-survey respondents, fewer than half reported themselves as African American (27%, 4/15) or non-white (20%, 3/15), but most stated they were cis-males (93%, 14/15) who have sex with men or mostly men (80%, 12/15). Most reported their age to be between 18 and 39 years (73%) and the majority stated they never used PrEP to prevent HIV (60%). Overall, most reported being HIV-uninfected (73%) at the outset of the intervention.

The intervention account generated 550 followers,19,601 content views by unique user accounts, and 1,326 indications of a favorable opinion (likes) over the six-week intervention. Post-survey data suggested the intervention should be recommended to people like me, is a good addition to regular health care, and increased access to care. Interestingly, the intervention did not invade personal privacy, daily routines, or cause feelings of discomfort.

Conclusion: Greater engagement in the content, given the absence of robust survey participation, suggests Instagram may be an effective tool to engage MSM at high risk for primary HIV infection to use PrEP. Optimized content and engagement strategies may allow for primary prevention strategies using Instagram to improve PrEP uptake and adherence.