JMIR Publications

ABSTRACT

Background:

Twitter is becoming an increasingly important avenue for people to seek information about HIV prevention. Most previous research on HIV prevention discussions on Twitter has focused on pre-exposure prophylaxis (PrEP). Key findings include that tweets about PrEP are correlated with higher rates of PreP use in counties with higher rates of men who have sex with men. Moreover, higher rates of HIV-specific tweets per capita are associated with lower HIV incidence in the following year. Despite these useful findings, most studies have utilized samples of tweets that span a relatively limited period (e.g., a few weeks) and have neglected to investigate trends in how people tweet about HIV prevention over time. Moreover, little research has explored the relative attention received by different prevention topics on this platform.

Objective:

The primary objective of this study was to investigate trends in the characteristics of tweets about HIV prevention over a period of six years. The secondary objective was to investigate the relative attention received by different prevention topics on Twitter over this period.

Methods:

We used the Twitter Application Programming Interface to obtain English-language tweets employing #HIVPrevention between Jan 1, 2014 and Dec 31, 2019 (n = 69,197, globally). Using iterative content analysis on samples of tweets, we developed a keyword list to categorize the tweets into ten prevention topics and compared the frequency of tweets about each topic over time. We assessed the odds of a #HIVPrevention tweet mentioning each prevention topic in 2019 as compared to 2014 using logistic regression models. We also conducted descriptive analyses to determine the accounts posting the most original tweets, the accounts retweeted most frequently, the most frequently used word pairings, and the spatial distribution of tweets in the USA.

Results:

Pre-exposure prophylaxis (PrEP) (20.08% of total tweets) and HIV testing (11.11%) were mentioned most frequently, whereas topics such as condom use (4.25%) and post-exposure prophylaxis (PEP) (1.19%) were mentioned relatively less frequently. The proportion of tweets mentioning PrEP (14.5% in 2014, 39.1% in 2019; OR: 1.28, 95% CI 1.26-1.30) and HIV testing (9.2%, 16.9%; 1.08, 1.06-1.09) was higher in 2019 compared to 2014. The top retweeted accounts are mostly UN-affiliated entities; celebrities and HIV advocates are also represented. Geotagged #HIVPrevention tweets in the US are aligned with the spatial distribution of 2018 age-adjusted HIV prevalence rates.

Conclusions:

Among the prevention methods investigated, PrEP and HIV testing dominate in terms of frequency of mentions in #HIVPrevention tweets between 2014 and 2019 and are more likely to be mentioned in 2019 compared to 2014. Strategic messaging about other prevention topics such as condoms and PEP on Twitter may aid in combatting the epidemic. Leveraging the influence of celebrities and HIV advocates may also be advantageous.