Table 3. Qualitative findings from four focus groups (n = 18).
| Focus Group Themes | Key Points | Illustrative Quotesa |
|---|---|---|
| Targeted advertisements can be stigmatizing | Targeted advertisements alienate targeted group | •It’s geared towards Black men, for the most part, and that is–it comes across as bad, whether you have sex with dudes or not. It’s–it’s bad. It’s almost like racism. [Laughter.] It’s like you’re over here, and everyone else is over here. You’re not–you’re terrible. You guys are bad. We don’t want you mixing with our people, so we’re gonna stay over here, but we’re gonna go ahead and do that to kinda keep you safe. [P12, FG3, Before] |
| Targeted advertisements associate targeted group with HIV | •If it’s solely for Black and African American people I would say that it, it, it definitely hits the nail on the head. However, I feel that, um, 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. [P2, FG1, After] | |
| •It also kinda paints a–a picture, whether that was the intention or not, that this is something that like, um, uh, gay men of color are kind of like, uh, doomed to enter to like, uh, the reality of being HIV-positive. [P9, FG2, Before] | ||
| Targeted advertisements can have other adverse consequences (beyond stigma) | Targeted advertisements fuel conspiracy theories | •I think a lotta people when it comes to marketing probably think the best idea might be to market–really market towards, uh, same gender lovin’, uh, Black male or same gender lovin’ men of color, period. So that might be why you often see, um, a lotta Black men. But conversely, that can also, you know, build some conspiracies around the drug as far as, well why they always, uh, you know, buildin’–why they always marketin’ towards Black men, um, or Black gay men? Can you trust it. . . ’Cause even though, you know, a lot of us think–know it’s somethin’ that can help us, some, uh, think that it is somethin’ that’s out to get us as well. [P16, FG4, Before] |
| Targeted advertisements miscommunicate the scope of the consumer market | •Do only gay people take this? Like, is it a gay drug?. . . That’s what it looks like. [P13, FG3, After] | |
| Advertisements featuring a diversity of people are preferable | Imagery should be inclusive of people of different races, sexual orientations, body types, ages, etc. | •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. [P12, FG3, Before] |
| •Like I said before, have a heterosexual, uh, White couple. Only because you–just ’cause you wanna show diversity maybe and a–and an Asian couple as well. You know, you just wanna have diversity because you wanna show that it is somethin’ that can benefit everybody. Uh, and right here, majority of the people appear to be of–of color, uh, Black or Hispanic. [P16, FG4, After] | ||
| Diversifying will make the advertisements more relatable to more people | •People buy products that relate to them. So when they see images or whatnot with people who look like them or identify with them they’re gonna be more likely to purchase that or to find out more information about that product. . . Like, I, for me, I wasn’t really too dead set on getting into PrEP and then I found out more about it and I was looking at some of the ads and whatnot and so I kinda went into that. So, you know, a diversity of the different people or different races and ethnicities, that’s kind of the target focus for me. [P3, FG1, Before] | |
| Diverse representations of Black people and Black SMM specifically are important | •I think having some diversity matters, but like I think, uh, like I think representation matters more. . . Diverse representations of Black love and–and acknowledging that like this doesn’t just affect Black people. . . There are a lotta different kinds of Black people. And like that diversity matters just as much. [P10, FG2, After] | |
| •One of the problems that, um, we in the, uh, gay Black community. . . there’s not a lot of representation for masculine men. . . when I look at [refers to PlaySure Black SMM advertisement] and I look at [refers to PrEPare for the Possibilities Black SMM advertisement], I see what appears to be two masculine Black men, uh, which could be eye-catching as well. Um [clears throat] and–and I guess the–I mean, the same could be said for, uh, majority of [column with diverse advertisements] as well. So that’s just what–I think that’s–I think that could help out as well, to show that there is representation in–within, uh, the–if we’re gonna target the Black gay community, there’s representation there as well. [P16, FG4, After] | ||
| Divergent participant viewpoints favoring targeted advertising (expressed by minority) | Targeting based on HIV epidemiology is reasonable | •I don’t think it would be stigmatizing to, uh, to focus on the gay community. I mean, it’s–it’s just a fact. You know, it would be silly to somehow think that just having some generic marketing campaign with, you know, some blonde, blue-eyed 20-year-old girl in the ad, who is probably way down on the totem pole when it comes to, uh, potentially becoming HIV positive, would be silly. [P8, FG2, Before] |
| Resources should be prioritized for reaching those who need PrEP the most | •I think it makes sense [clears throat] to, uh, focus on the gay community. I mean, we’re still the–we still have the highest rate of HIV infections, so if you want–if you want an ad to reach the greatest number of potential customers, then that’s the way to go. I’m assuming there’s–there’s not unlimited resources to do full campaigns for every single person that is at risk for HIV, so I mean, if you have to–if you have to choose, if that’s–I mean, if that’s the case, then I think gay men, that’s probably the–the first group that you should advertise to. [P8, FG2, Before] | |
| Targeting can be received positively by targeted group | •I think that targeting communities actually lets [them] know that you care. Um, it actually lets [them] know that you have some cultural, like, competence about understanding them. [P2, FG1, Before] | |
| Advertisements without people are unappealing | •Images without people are not visually engaging | •[Referring to column of advertisements with no couples] In my opinion, if I were walking by and I see this advertisement at the train station, the, on those electric, um, screens, I wouldn’t bat an eye to it because it didn’t really catch my attention. [P5, FG1, After] |
| •I don’t like [refers to column of advertisements with no couples] though … it’s boring. [P17, FG4, After] | ||
| Divergent participant viewpoints favoring advertisements without people (expressed by minority) | Advertisements without people are a solution to targeting | •Advertisers can come up with more alternatives in–in who they choose for–for a particular ad for PrEP. . . worse come to worse, don’t put anybody. You know, like getting back to what I was saying, you know, use somethin’ else besides a person that look like they evidently, you know, slept around and, you know, and they’re gay. [P18, FG4, Before] |
| •I actually think–I actually think [refers to PrEP4Love advertisement with no couples], I think that is the best ad in that whole. . . I like that more than anything else in that whole–in the rest of ’em. [Laughs] It just–it just doesn’t look–you know, they need somethin’ that, again, somethin’ that’s not targeting the average LGBT whoever. [P18, FG4, After] | ||
| Highly sexualized advertisements can discourage PrEP | Sexualized imagery is unnecessary | •I don’t need to see intimacy. I don’t need to see kissing, hugging, touching, I don’t need to see skin. I think it–it’s more appealing when you’re watering the–the grass and just doin’ regular, everyday stuff. I think it kind of moving away from touching and sex. Um, they might get it and kind of explain that, hey, you can–I take PrEP, or I use PrEP or whatever, whatever the–the, um, text is. But I don’t necessarily wanna see anybody kissing or hugging. [P12, FG3, After] |
| •I think I would show it as not bein’ somethin’ that is a medicine just for somethin’ sexual, if that makes sense. Kind of takin’–thinkin’ of it as somethin’ for like a vitamin, you know, just a, uh, it doesn’t have to be necessarily a sexual tie-in. . . So I just think that, to kind of take the trashiness out of it. [P16, FG4, Before] | ||
| Sexualized images deter consumers who do not perceive themselves as highly sexual | •[Referring to advertisement in PrEP4Love campaign with diverse couples] Not a big fan of them sittin’ on top each other and, uh, so that’s pretty much the main one. And the–the same images larger [refers to Black SMM couple advertisement in PrEP4Love campaign]. Um, but some playfulness is okay, but. . . it also kinda depicts it as like, okay, well if you–like if you are a little more promiscuous and, you know, PrEP is for you. And if I’m not as promiscuous, maybe it’s not for me. [P6, FG2, After] | |
| Context is paramount to the acceptability of sexual advertisements | Sexual advertisements belong in sexual spaces | •P9: In terms of like marketing, I like feel like these would all be in very different places, though. Like [refers to row of PrEPare for Possibilities advertisements], I feel like would be like on the metro bus or in the subway. And row–P10: In very mainstream places. P9: Yeah. And [refers to PlaySure row of advertisements], I feel like that would like be on like college campuses. And [refers to PrEP4Love advertisements], I feel like you might see like, you know, um, in like–P10: Online, at the club, at the bath house. [P9 and P10, FG2, After] |
| •Especially on billboards and bus stops, you don’t wanna push sex and so onto my–tryin’ to have my sandwich on the train. . . and then I see this, and it’s disgustin’ whether it’s gay sex or straight sex. Doesn’t even matter. It’s just I don’t feel like I wanna see someone straddling anybody. I don’t wanna see her riding him [laughter] in the early mornin’. [P12, FG3, After] | ||
| •It’s just a lot, um, that you almost would feel weird to stop and look at it. Like, that’s what I think is–like, if the bus stops, and I’m starin’ at this, and people are starin’ at me, [laughter] then I look, and–you know, like, what kinda moment would that be? [P11, FG3, After] | ||
| Sexual advertisements are inappropriate for some viewers | •I think it just depends on the context of the advert as well, because as you were saying earlier, on dating apps, um, there is the assumption that people will be there looking for a sexual encounter. So I think that’s what they do, they’ll use, for instance, pictures that are in [refers to row of PrEP4Love advertisements]. Whereas, if it’s something on the Metro they might use something a bit less salacious that’s more family friendly just because they have to be mindful of the fact that there are more conservative people on the trains and the–you know, it’s a context where there are children and it’s not, you know, only sexual. [P2, FG1, After] | |
| •I don’t really care for it. I think it’s too sexual. . . [refers to diverse couples advertisement and Black SMM couple advertisement in PrEP4Love campaign] I think, uh, it’s just too sexual [laughter] for me. It’s a little much. So, if I’m ridin’, and I have my kid with me, I don’t–I don’t want him to see that. It’s kinda like soft porn. [P12, FG3, After] | ||
| Targeted advertisements that are sexual in nature can be especially stigmatizing | Targeting hypersexualizes Black people | •I think there’s somethin’ to be said, like, for maybe–sometimes with ads–and it’s harder to Black people. I feel like they gotta be like, super-explicit. But, like, think about ED commercials, where you got two people holdin’ hands in a bathtub. Like, there’s–there’s an ability to be suggestive. . . They’re not, like, all hugged up and, like, just dry-humpin’. Their significant other is, like, suggestive, like, oh, like, maybe handholding, maybe–I don’t know. I just think that, like, these come across like–to me, very, very, very, like, strong. [P11, FG3, After] |
| Sexual advertisements of Black SMM can stigmatize Black SMM in mainstream public spaces | •If it’s going on a Jack’d ad or a Grindr, it should be sexual, ’cause you’re having sex, so I mean, like, I mean I–I mean I just think, like, that, it lends itself to a certain audience. So–If it was on a hookup app then that would be appropriate. If I am walking down and it’s next to Walgreens, I’m not sure that–I’m not sure if that is really the message that you’re–’cause then that can put out the stigma. Yeah, that would put out the stigma that that then Black gay men are suggestive and that’s all they are. [P3, FG1, After] |
Note. Rows highlighted in blue reflect findings related to targeted advertising. Rows highlighted in yellow reflect findings related to the sexual nature of advertisements. Rows highlighted in green reflect findings related to the intersection of the two. Rows with italicized content contain viewpoints expressed by one or a few participants that diverged from the majority.
aParenthetical content includes participant (P) number, focus group (FG) number, and whether the statement was made before or after the 4x3 grid of visual advertisements had been presented to the group.
SMM = Sexual minority men