From virus to viral: content analysis of HIV-related Twitter messages among young men in the U.S.

Adolescents and young adults account for over 21% of new HIV infections in the U.S. with most new cases among young men. As an important information source for this group, social media can uniquely reveal the perspectives and communicative patterns of this key population. We identified 6,439 young male Twitter users (ages 13–24) in the U.S. using an NLP pipeline with geolocations. From their Twitter timelines, we collected 24,600 HIV-related tweets, among which the most retweeted and favorited tweets (n = 472) were analyzed through a content analysis.

Three themes arose in this online viral discourse around HIV among young men: (i) othering, (ii) politics and activism, (iii) risk and wellness. Othering tweets contained stigmatizing jokes and insults alienating individuals who identify as lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, or being elsewhere on the gender and sexuality spectrum (LGBTQIA +), and people with HIV. Politics and activism tweets discussed awareness, stigma, HIV criminalization, violence, LGBTQIA + , and women’s rights. Risk and wellness tweets discussed risk behaviors for sexually transmitted infections (STIs) (e.g., condomless sex, transactional sex, multiple sexual partners), or safer sex and preventive practices (e.g., pre-exposure prophylaxis [PrEP], condom use, achieving undetectable viral load, medication adherence, and STI testing).

The social acceptability of high-risk sex behaviors is high among young male Twitter users. Given the double-edged nature of social media—health-promoting (e.g., awareness, health activism) as well as risk-promoting (e.g., risky behavior endorsement, identity attacks)— this population may benefit from targeted health communication intervention. Future HIV prevention efforts should counter the stigma, misinformation, and risk-promoting viral messages prevalent on social media.