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Published in final edited form as: AIDS Behav. 2024 Sep 30;28(12):4069–4078. doi: 10.1007/s10461-024-04484-y

PrEPárate: Evaluation of a Community-Driven PrEP Social Marketing Intervention Tailored to Latino/a/x Individuals

Harita S Shah 1, Pedro A Serrano 2,3, Priya K Mathur 1, Ricardo Albarran 4, Esbeidy Torres Hondal 1, Cindy San Miguel 5, Michael G Curtis 2, Gregory Phillips II 2,3
PMCID: PMC12096463  NIHMSID: NIHMS2078190  PMID: 39347892

Abstract

Latino/a/x sexual minority men (SMM) and transgender women remain disproportionately impacted by HIV, with higher HIV incidence and lower uptake of pre-exposure prophylaxis (PrEP) than their non-Hispanic White peers. Disparities in PrEP uptake among Latino/a/x populations have been found to be due to structural, social, and personal barriers. Social marketing interventions have been shown to effectively address barriers and increase PrEP uptake in other populations, and thus offer potential as a tool to increase PrEP uptake for Latino/a/x populations. The PrEPárate campaign was developed through community based participatory research and ran from April to September 2022 in Cook County, Illinois. We conducted a mixed methods evaluation through surveys (N = 515) and semi-structured interviews with survey participants and community partners (N = 14). We examined cross-sectional associations of campaign exposure with PrEP awareness and uptake in adjusted multivariable regression models. We used rapid qualitative methods to analyze interviews and assess implementation outcomes following the RE-AIM framework. The campaign reached over 118,000 people on social media, with additional reach over public transit and local events. PrEPárate exposure was associated with increased PrEP awareness (aOR = 5.23; 95% CI [2.58, 10.63]) and PrEP uptake (aOR = 1.69; 95% CI [1.09, 2.62]). Survey respondents expressed that the campaign name, visuals, ambassadors, and distribution were effective in engaging the target audience. Community partners felt the campaign was implemented with fidelity to the original vision and identified future directions for PrEPárate. Social marketing campaigns, anchored in community engagement, may be an effective strategy to increase PrEP awareness and uptake among underserved Latino/a/x populations.

Keywords: PrEP, Latino, Social marketing, HIV prevention, Community

Introduction

Latino/a/x sexual minority men (SMM) and transgender women remain disproportionately impacted by HIV [1]. In 2022, Latino/a/x individuals represented approximately 19% of the U.S. population but accounted for 32% of the 31,800 new HIV diagnoses, primarily in individuals characterized as SMM [1]. Latina transgender women also had a significantly higher HIV prevalence relative to non-Hispanic White transgender women, estimated at 35% versus 17%, respectively [2]. Disparities in HIV incidence are in part driven by disparities in the use of pre-exposure prophylaxis (PrEP), a safe and effective means of biomedical HIV prevention [3, 4]. Although use of PrEP has increased overall, uptake among Latino/a/x individuals has lagged compared to their non-Hispanic White peers [5, 6]. Addressing disparities in PrEP use is essential to HIV prevention among Latino/a/x populations and is central to the U.S. Ending the HIV Epidemic initiative [7, 8].

Latino/a/x SMM and transgender women experience intersecting forms of social marginalization (e.g., racism, heterosexism, cisgenderism) that create multilevel barriers to PrEP use [9, 10]. Structural barriers to PrEP use among Latino/a/x populations often include lack of health insurance, language discordance, limited health literacy, and immigration status [11, 12]. At the community level, Latino/a/x SMM and transgender women are often dissuaded by peers or romantic partners from taking PrEP to avoid the stigma of being labeled as sexually irresponsible, promiscuous, or immoral [13, 14]. On an individual level, common barriers to PrEP uptake among Latino/a/x SMM and transgender women include medical mistrust, wariness of side effects, and lack of awareness [11, 15]. Low PrEP awareness remains an issue particularly among Latino/a/x immigrants with limited English proficiency [5, 11, 15–17].

In studies of PrEP interest and acceptability, once aware of PrEP, Latino/a/x SMM reported willingness to adopt PrEP at the same or higher levels than non-Latino/a/x SMM [17, 18]. Given the disproportionate burden of the HIV epidemic among Latino/a/x SMM and transgender women, there is an urgent need to identify effective, tailored interventions to increase PrEP awareness and uptake in these populations [7, 8, 19]. Moreover, it is critical that PrEP interventions for Latino/a/x SMM and transgender women utilize community-based participatory research (CBPR) approaches to understand and synchronously address multilevel barriers to PrEP uptake and retention [5, 20]. CBPR is a collaborative approach that equitably involves community partners throughout the research process, facilitating empowerment of marginalized populations as well as optimizing translation and sustainability of HIV interventions [20].

Social marketing interventions are an effective means of improving HIV testing among Latino/a/x SMM and transgender women and offer tremendous potential as a tool to promote PrEP [16, 21, 22]. Social marketing involves the application of commercial marketing principles to design and implement programs to affect health behavior change, often through social media and offline advertisements [23]. Few PrEP social marketing interventions have been tailored to Latino/a/x SMM and/or transgender women [24, 25]. Social marketing interventions have been shown to raise awareness and uptake of PrEP in other populations, such as the Chicago-based PrEP4Love campaign tailored to Black SMM and transgender women [26–28]. Some PrEP campaigns have been developed for Black and Latino/x SMM jointly, though these groups have distinct cultural differences and may be better served by separately tailored interventions [29–32]. Of the limited social marketing literature that includes Latino/a/x SMM or transgender women, few have evaluated clinical outcomes and more research is needed to assess potential impact on PrEP uptake [24, 27, 29].

In 2022, we developed and piloted the PrEPárate social marketing intervention for Latino/a/x SMM and transgender women in Chicago and Cook County, IL [33]. Cook County, IL is one of seven priority jurisdictions identified as having a disproportionately high HIV incidence and low PrEP uptake among Latino/a/x populations [6–8]. Given ongoing HIV and PrEP disparities, there was community interest in adapting the PrEP4Love campaign for Latino/a/x Chicagoans. Thus, following the principles of CBPR, we formed partnerships between the Chicago Queer Latine (CQL) Collaborative and investigators at the University of Chicago, Northwestern University, and Cook County Health to adapt and pilot test this evidence-based intervention. The CQL Collaborative is a group of ten Latino/e and LGBTQ + stakeholders representing community-based organizations (CBOs) that provide HIV services to Latino/a/x individuals. The detailed adaptation process is published elsewhere and involved focus groups, surveys, and crowdsourcing over social media [33]. Key adaptations from PrEP4Love included the use of vibrant colors and the avoidance of sexual images, to promote conversations surrounding PrEP and to avoid perpetuating PrEP stigma, a prevalent issue in Latino/a/x communities [14].

The PrEPárate pilot social marketing intervention ran from April 2022 to September 2022. Advertisements featured recognizable Chicago-based Latino/a/x campaign ambassadors and strength-based messaging (Fig. 1). Paid advertisements were distributed on Facebook, Instagram, YouTube, and Grindr, in addition to organic (unpaid) sharing of content on local Latino/a/x and LGBTQ + focused social media pages. Offline advertisements included posters, flyers, Chicago Transit Authority bus and train advertisements (Fig. 2), and giveaway items at community events. The “call to action” of advertisements was to visit the PrEPárate website which featured PrEP information in English and Spanish, and options to access PrEP through the HIV Resource HUB bilingual hotline or a web-based PrEP services locator [34]. These options were chosen to facilitate PrEP access for low to no cost, regardless of insurance status. In its first year, PrEPárate reached over 118,750 people on social media with additional reach at community events and advertisements on public transit [33]. In this manuscript, we evaluate the PrEPárate pilot campaign using a mixed methods approach, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework [35].

Fig. 1.

Fig. 1

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PrEPárate social media advertisement

Fig. 2.

Fig. 2

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PrEPárate advertisement on public transit in Chicago

Methods

Surveys

We conducted cross-sectional surveys to evaluate campaign reach and effectiveness [35]. Eligible participants self-identified as Hispanic or Latino/a/x, 18 years of age or older, and living in Cook County, IL. We did not make gender or sexual identity an inclusion criterion in order to understand campaign reach and effectiveness across Latino/a/x populations. We included heterosexual and cis-gender individuals to assess if the campaign had reach beyond the target audiences of SMM and transgender women, given limits on social media targeting and the wide reach of offline advertisements (e.g., bus ads, community events). Moreover, we wanted to be inclusive of respondents with a disconnect between their sexual identity and behavior and thus risk for HIV. Online recruitment entailed distribution of a Qualtrics link over Chicago Latino/a/x-centric social media groups, followed by an option to share with peers upon survey completion. Qualtrics surveys were configured to prevent multiple responses from the same individual. In-person recruitment occurred at Latino/a/x-focused community events, health centers, bars, and consulates. Surveys were available in English and Spanish and assessed socio-demographics, exposure to the PrEPárate campaign, if and how the PrEPárate campaign impacted them, and primary outcomes of PrEP awareness and PrEP uptake. Survey respondents were offered a $15 gift card for their participation and the option to be contacted for a qualitative interview.

PrEP Awareness

We assessed exposure to PrEPárate by asking if respondents had seen or heard of the PrEPárate campaign, with a color logo to minimize confusion with other campaigns. PrEP awareness was measured by asking, “What is your experience with PrEP (pre-exposure prophylaxis) as of today?” with options of “I have never heard of PrEP,” “I have heard of PrEP but have not taken it,” “I have been on PrEP before but not currently,” or “I am currently on PrEP.” Responses of “I have never heard of PrEP” were categorized as “Not Aware” of PrEP, and any of the other responses to this question were categorized as “Aware” of PrEP.

PrEP Uptake

Surveys also included the Motivational PrEP Cascade to assess for potential impact at different stages of behavior change [36]. The Motivational PrEP Cascade is based on the Transtheoretical Model of Change to assess behavior change in the context of PrEP decision making over time, with the fourth stage being PrEP uptake [37]. We included survey questions that assessed for four stages of the Motivational PrEP Cascade: (1) PrEP Precontemplation, individuals who are unwilling to take PrEP or do not believe they are appropriate candidates; (2) PrEP Contemplation, individuals who are willing to initiate PrEP and self-identify as an appropriate candidate; (3) PrEParation, individuals who are planning to initiate PrEP; (4) PrEP Action & Initiation, individuals who have spoken with a provider and initiated PrEP.

Qualitative Interviews

We interviewed Latino/a/x SMM and transgender women to assess campaign effectiveness, continuing until reaching thematic saturation. Interviewees were selected using a random number generator to select from survey respondents who marked their interest. Interview topics included PrEP experiences; PrEPárate exposure, impact, appropriateness and acceptability; and future directions for similar work. Adoption, implementation, and maintenance were evaluated through semi-structured interviews with CQL Collaborative members. All collaborative members were invited to participate in voluntary interviews. Interviewees received a $40 gift card for their participation. All interviews were conducted over Zoom with audio recordings and transcribed using Otter.ai. Transcripts were cleaned and de-identified by a trained bilingual research assistant.

Data Analysis

Surveys

We compared socio-demographics between respondents with and without PrEPárate exposure using chi-squared analyses. We examined associations between PrEPárate exposure and the primary outcomes of PrEP awareness and PrEP uptake (stage 4 of the Motivational PrEP Cascade) using binary and ordinal logistic regression, respectively. People were identified as SMM if they self-identified as a cis-gender male with sexual orientation other than heterosexual.

Variables included in the multivariable models were identified through univariate analyses and were consistent with prior literature. Covariates in the PrEP awareness analysis included age, education level, English proficiency, primary care access, and sexual orientation [17, 38]. Covariates in the PrEP uptake analysis included age, education level, English proficiency, sexual orientation, and number of sexual partners in the last three months [28, 39]. Insurance status, race, health literacy, survey language, and transgender status were other variables considered for both models, but they were ultimately not selected and not significant on univariate analysis. All analyses were conducted in STATA version 18 [40].

Qualitative Interviews

Qualitative interview data were analyzed using rapid qualitative methods, which has been recommended for timely results in implementation science [41]. Each transcript was independently reviewed by 2 team members trained in rapid qualitative methods. Key points and quotes were included in a templated summary document. The templated summary documents were then moved to a matrix to identify key themes. Discrepancies were resolved through weekly meetings where expert qualitative analysts discussed data deviances and result issues to achieve consensus. Conclusions around preliminary effectiveness of this pilot intervention were drawn from convergent mixed methods analysis of surveys and interviews.

Results

Reach and Effectiveness

515 survey responses were collected between November 1, 2022, and June 30, 2023. Participant demographics and the primary outcomes of PrEP awareness and PrEP uptake are presented in Table 1. Most survey respondents were age 18–34 years (n = 374, 72.6%) and completed the survey in English (n = 356, 69.1%) versus Spanish (n = 159, 30.9%). 30.7% (n = 158) identified as SMM. 3.1% (n = 16) identified as transgender women and 6.8% (n = 35) identified as non-binary. In terms of PrEPárate exposure, 31.5% (n = 162) reported having seen or heard of the PrEPárate campaign. Social media metrics of reach from the PrEPárate campaign are published elsewhere [33].

Table 1.

Survey respondent demographics by PrEPárate campaign exposure

Total N = 515 No PrEPárate exposure (N, %) N = 353 PrEPárate exposure (N, %) N = 162 Chi-square test statistic P-value
Age Categories 4.955 0.175
 18–24 81 (23.0) 42 (25.9)
 25–34 165 (46.9) 86 (53.1)
 35–44 56 (15.9) 16 (9.9)
 45+ 50 (14.2) 18 (11.1)
Race 8.000 0.240
 Native American or Alaskan Native 22 (6.2) 18 (11.1)
 Black or African American 14 (4.0) 10 (6.2)
 Asian 2 (0.6) 2 (1.2)
 Native Hawaiian or Pacific Islander 1 (0.3) 1 (0.6)
 White 100 (28.3) 50 (30.9)
 Other 122 (34.6) 45 (27.8)
 Did not answer 92 (26.1) 36 (22.2)
Gender and Transgender Status 14.949 0.005
 Cisgender Men 174 (55.2) 73 (51.0)
 Cisgender Women 111 (35.2) 38 (26.6)
 Nonbinary 17 (5.4) 18 (12.6)
 Transgender Men 6 (1.9) 5 (3.5)
 Transgender Women 7 (2.2) 9 (6.3)
Sexual Orientation 42.710 < 0.001
 Heterosexual 136 (38.5) 27 (16.7)
 Bisexual 38 (10.8) 23 (14.2)
 Gay 85 (24.1) 59 (36.4)
 Lesbian 8 (2.3) 3 (1.9)
 Queer 21 (5.9) 29 (17.9)
 Other 55 (15.6) 19 (11.7)
Sexual Minority Men (SMM) 96 (27.7) 62 (38.8) 6.169 0.013
Education 2.076 0.557
 Less than high school 43 (12.2) 14 (8.6)
 Completed high school 189 (53.7) 92 (56.8)
 Bachelor’s degree 80 (22.7) 34 (21.0)
 Advanced degree 40 (11.4) 22 (13.6)
HIV Status 19.584 < 0.001
 Positive 20 (5.7) 18 (11.2)
 Negative 236 (67.4) 125 (78.1)
 Never been tested 94 (26.9) 17 (10.6)
Health Literacy Level 8.316 0.004
 High 258 (73.7) 138 (85.2)
 Low 92 (26.3) 24 (14.8)
English Proficiency Status 17.113 < 0.001
 English Proficient 185 (52.4) 103 (63.6)
 Somewhat English Proficient 51 (14.4) 24 (14.8)
 Limited English Proficiency 78 (22.1) 12 (7.4)
Type of Insurance 19.557 < 0.001
 None 94 (29.5) 23 (14.9)
 Medicare 53 (16.6) 42 (27.3)
 Medicaid 40 (12.5) 11 (7.1)
 Private 132 (41.4) 78 (50.6)
PrEP Awareness 54.636 < 0.001
 Not Aware 155 (47.8) 20 (13.0)
 Aware 169 (52.2) 134 (87.0)
PrEP Motivational Cascade Stage 25.375 < 0.001
 1 (PrEP Pre-Contemplation) 95 (34.5) 25 (19.5)
 2 (PrEP Contemplation) 100 (36.4) 37 (28.9)
 3 (PrEParation) 55 (20.0) 34 (26.6)
 4 (PrEP Action and Initiation) 25 (9.1) 32 (25.0)
PrEP Experience 57.008 < 0.001
 Never used PrEP 155 (47.8) 20 (13.0)
 Previously on PrEP 140 (43.2) 102 (66.2)
 Currently on PrEP 29 (9.0) 32 (20.8)
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When asked if and how the PrEPárate intervention affected those exposed, 80.2% (n = 130) said it impacted them in at least one way, only 15.4% (n = 25) reported no impact and 4.3% (n = 7) did not respond. Respondents were allowed to indicate multiple ways that PrEPárate affected them. 33.3% (n = 54) of those exposed to the campaign said it provided information on how to access PrEP, 21.0% (n = 34) said they learned about HIV prevention, 19.8% (n = 32) said they learned about PrEP, 14.8% (n = 24) said it influenced them to start PrEP, and 3.7% (n = 6) found a PrEP provider. 4.3% (n = 7) indicated PrEPárate affected them in another way.

PrEP Awareness

People who were exposed to PrEPárate had a higher odds of PrEP awareness relative to people who were not exposed to PrEPárate (Table 2), adjusting for age, education, limited English proficiency, primary care access, and sexual orientation. People who saw PrEPárate were five times more likely than people who did not see PrEPárate to be aware of PrEP (aOR = 5.23; 95% CI [2.58, 10.63]).

Table 2.

Association between PrEPárate exposure and PrEP awareness in various models

Unadjusted model N = 478 Adjusted modelaN = 363
Aware of PrEP (N, row %) Unaware of PrEP (N, row %) OR of PrEP Awareness (95% CI) aOR of PrEP Awareness (95% CI)
Exposed to PrEPárate 134 (87.0) 20 (13.0) 6.14**(3.66, 10.31) 5.23**(2.58, 10.63)
Not Exposed to PrEPárate 169 (52.2) 155 (47.8) 1 (reference) 1 (reference)
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a

Adjusted Model: Adjusted for age, education, limited English proficiency, primary care access, and sexual orientation.

**

Statistically significant p < 0.001

PrEP Uptake

The association of PrEPárate campaign exposure with PrEP uptake was measured through ordered logistic regression given the PrEP Motivation Cascade consists of four unique ordered stages, with PrEP uptake being the final stage [36]. The odd ratio obtained from ordered logistic regression expresses the odds of participants being in stage 4 (PrEP uptake) relative to stages 1 through 3. People exposed to the PrEPárate campaign had a higher odds of PrEP uptake relative to people not exposed to PrEPárate (aOR = 1.69; 95% CI [1.09, 2.62]), adjusting for age, education, limited English proficiency, sexual orientation, and number of sexual partners in the last three months (Table 3).

Table 3.

Association between PrEPárate exposure and PrEP uptake

Unadjusted Model N = 403 Adjusted Modela N = 373
Stages 1–3 (N, row %) Stage 4: PrEP Uptake (N, row %) OR of PrEP Uptake (95% CI) aOR of PrEP Uptake (95% CI)
Exposed to PrEPárate 96 (75.0) 32 (25.0) 2.58** (1.74, 3.81) 1.69* (1.09, 2.62)
Not Exposed to PrEPárate 250 (90.9) 25 (9.1) 1 (reference) 1 (reference)
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a

Adjusted model: Adjusted for age, education, limited English proficiency, sexual orientation, and number of sexual partners in the last three months.

*

Statistically significant p < 0.05

**

Statistically significant p < 0.001

A total of 14 qualitative interviews were completed after survey collection to assess pilot implementation outcomes following the RE-AIM framework. We conducted interviews with seven SMM and transgender women survey respondents to assess intervention effectiveness. Community members had a median age of 27 years, were English proficient, had completed high school, and identified as SMM (n = 5), as a transgender woman (n = 1) or as transgender non-binary (n = 1). Interviewees discussed that the PrEPárate campaign impacted them in different ways: considering if PrEP was right for them, serving as a tool they recommended to others, and affecting the younger generation’s awareness and access to PrEP. They felt the campaign was well-suited for queer and bilingual Latino/a/x audiences because of the playful colors, incorporation of Spanish language, and diverse representation of ambassadors in campaign materials. Interviewees liked the PrEPárate logo and design because it felt representative of Latino/a/x communities. They recalled seeing PrEPárate on public transit advertisements, social media, YouTube, and Grindr ads. Some participants wished for greater representation of Afro-Latino/a/x individuals, older individuals, and cis-gender women.

“By giving it that bright color, the pop of life, the celebratory feel, we’re reframing people’s perspectives…this doesn’t have to be a bad thing, protection and health and advocating for myself doesn’t have to be something that has to be traumatic.”

-Community Member.

Adoption

Seven CQL Collaborative members participated in interviews assessing the adoption, implementation, and maintenance of the intervention. CQL Collaborative partners noted that CBOs mainly adopted PrEPárate materials on social media accounts or for distribution at community events and health fairs. CBO adoption of PrEPárate materials was most robust when the CBO was represented by a person in the CQL Collaborative. Once CBOs adopted the campaign materials, they found materials to be effective conversation starters at tabling events or with CBO clients. Social media was also an important facilitator for adoption by community groups. A barrier to adoption of the campaign was delays in distribution of grant funding to cover costs related to printing and displaying materials. Additionally, CQL Collaborative partners suggested more in-person outreach in the future to reach marginalized populations more effectively, particularly for immigrants and older adults. CQL Collaborative interviewees felt the campaign was well received by different generations when their CBOs were promoting PrEPárate at community events.

Implementation

When developing PrEPárate, CQL Collaborative partners felt heard throughout the creative process and thought the community artists accurately captured the project vision. Barriers to campaign development and implementation included funding and administrative delays.

“We did the thing that we set out to do, right, of like creating a social media campaign that was about engaging Latinos in this conversation around PrEP.”

– CQL Collaborative Member.

Maintenance

We evaluated this pilot intervention 6 months after the paid social media advertisements ended, in accordance with the RE-AIM guidelines for assessing maintenance [42]. To maintain PrEPárate, CQL Collaborative partners expressed the need for ongoing funding to continue and expand marketing efforts. Potential barriers identified included the political climate, social media limits on targeting and advertising, and uncertainty that social marketing alone could reach highly marginalized populations. CQL Collaborative partners were excited about opportunities to build on or expand the campaign. Future iterations of the campaign could include local Latino/a/x community centers such as libraries, shops, and churches to expand reach beyond SMM and transgender women. They discussed tailoring the campaign to certain groups such as older Spanish-speaking immigrants and addressing social determinants of health that affect PrEP uptake such as mental health, substance use, or employment. CQL Collaborative partners also expressed interest in adapting and expanding PrEPárate in other settings across the United States.

Discussion

PrEPárate is one of the first PrEP social marketing interventions in the U.S. tailored to Latino/a/x SMM and transgender women. Findings from this pilot evaluation suggest that exposure to PrEPárate is associated with increased PrEP awareness and PrEP use. The qualitative evaluation showed that PrEPárate was developed and implemented with effective community engagement, aligned well with the original project vision, and was well received by the target audience. Combining social marketing with community engagement is a promising strategy to create relevant and engaging messaging surrounding PrEP.

Among the few PrEP social marketing interventions tailored to Latino/a/x populations, even fewer have assessed clinically relevant outcomes such as PrEP awareness and uptake. Our results support findings from social marketing studies in Black populations and diverse populations which found increases in PrEP awareness and uptake [30, 43]. PrEPárate was adapted from PrEP4Love, a PrEP-focused social marketing campaign in Chicago tailored to Black populations, in which individuals who had seen PrEP4Love ads were more likely to have taken PrEP in the last six months [26–28]. Similarly, our findings showed higher odds of PrEP uptake in Latino/a/x individuals who had seen PrEPárate. We believe that providing multiple options for PrEP access outside of traditional clinic settings, including a PrEP hotline and online PrEP provider tool, was important to facilitating PrEP uptake.

Community engagement with local Latino/a/x community members and CBOs was essential to producing an intervention that resonated with local Latino/a/x individuals. Multiply-marginalized populations, such as Latino/a/x LGBTQ + groups, have unique histories and intersectional identities that can often be better served by culturally responsive, tailored interventions [29, 30]. We found that using a range of community engagement strategies including focus groups, interviews, a crowdsourcing contest, contracting local artists and designers to create the campaign, shared ownership with the CQL Collaborative, and feedback from local Latino/a/x youth and adult advisors allowed for greater community input and empowerment [33]. The results of this work - the PrEPárate campaign name, vibrant colors, and relatable ambassadors - were found to be key to engaging members of the Latino/a/x community in this evaluation. Featuring local influencers as campaign ambassadors may have encouraged Latino/a/x SMM and transgender women to consider PrEP by highlighting the positive experiences of trusted community members.

Our study had multiple limitations. One inherent limitation was the cross-sectional nature of this pilot study. It is possible that some of the effect could be explained by the intervention preferentially reaching younger SMM and transgender women with higher education and greater baseline exposure to PrEP. Future research should build on these findings through rigorous longitudinal or randomized design to understand if PrEP social marketing campaigns affect PrEP use and HIV incidence. A second limitation was the time between the intervention and the evaluation. Due to administrative and funding delays, surveys and interviews were conducted up to 9 months after the end of the campaign. This delay may have reduced campaign recall, though it is encouraging that for some people exposed, the campaign was memorable even months later. Finally, a nonrandom sample of survey participants was used, as we partnered with local organizations to recruit an adequate sample of SMM and transgender women. Participants recruited through HIV-focused CBOs may have been more experienced with HIV prevention, though we attempted to mitigate this by also recruiting at non-HIV related events and through peer referrals. The SMM and transgender women interviewees were survey participants who consented to an interview and may have been subject to selection bias. Thus, this evaluation may have had limited recruitment of individuals who are not well connected to Latino/a/x CBOs, community events, or social media.

Conclusion

PrEP social marketing campaigns tailored through community engagement may be a promising means of increasing PrEP awareness and uptake among Latino/a/x populations. Promoting awareness while simultaneously addressing barriers to PrEP access is key to reducing disparities along the PrEP care continuum. The impact of PrEPárate was only possible through strong community partnerships in the development, implementation, and evaluation of the campaign. Future directions for research based on our qualitative evaluation include addressing PrEP stigma, dedicated outreach to immigrants and older populations, and multilevel interventions to address mental health needs and social determinants of health that impact HIV vulnerability within Latino/a/x communities.

Acknowledgements

We thank the members of the Chicago Queer Latine (CQL) Collaborative for their dedication and partnership in this work: Alfredo Flores, Carlos Fragoso, J Saxon-Maldonado, Roger Fierro, Erik Elias Glenn, J. Luis Puga-Moreno, Matthew Graham, Juan Jose Lopez, Daniel Mendez, and Ricardo Albarran. We thank the talented artists who created the campaign materials: Veronica Martinez, Jose Rosa, Daniel Reyes, and Andre Perez. Our gratitude goes to the PrEPárate ambassadors who courageously shared their stories as the face of the campaign. We appreciate the contributions of Alejandro Muñoz for web design, the HIV Hub for use of their hotline, and Commando for social media campaign management. We appreciate the collaboration of CALOR, Project VIDA, and Impulse Chicago to share and evaluate the PrEPárate campaign.

Funding

This project was funded by an Ending the HIV Epidemic (EHE) Supplement Award (5P30AI117943–07) via the Third Coast Center for AIDS Research and a KL2 Award (KL2TR002387) via the Chicago Institute for Translational Medicine.

Footnotes

Competing interests The authors have no relevant financial or non-financial interests to disclose.

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