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Barriers to HIV pre-exposure prophylaxis uptake for men who have sex with both men and women: A global scoping review

Jodie Crossman https://orcid.org/0000-0002-0979-0710 [email protected] and Daniel Richardson https://orcid.org/0000-0003-0955-6307View all authors and affiliations

Volume 36, Issue 6

https://doi.org/10.1177/09564624251321564

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Abstract
References

Abstract

Background

Although PrEP is a highly effective HIV prevention method, some groups are underrepresented in PrEP uptake. Much HIV prevention research groups gay, bisexual and other men who have sex with men together; however, men who have sex with both men and women (MSWM) may have needs distinct from those who identify as exclusively gay. This scoping review aims to explore documented barriers to PrEP use among MSWM.

Methods

Literature was searched using four databases. Studies were included if data referring to MSWM were reported as a distinct category. Data were extracted using a standardised form, and findings were stratified into relevant categories of the social ecological framework.

Results

Alongside intersectional barriers, MSWM were found to have lower awareness of PrEP, and access sexual health services less than men who have sex only with men. Those who did not identify with the LGBT community often missed out on health promotion messages for this group and were less likely to be offered HIV prevention interventions. MSWM identified more stigmatisation around PrEP use than gay men. However, when aware of PrEP, MSWM were very motivated to use this intervention.

Conclusions

Not all MSM will identify within the LGBTQ + community and may miss out on valuable opportunities for HIV prevention. PrEP information should be widely available in a variety of health and community settings. Health care professionals should avoid assumptions when assessing patients and provide information about HIV and STI prevention to all attending sexual health services.

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References

1. McCormack S, Dunn DT, Desai M, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet 2016; 387(10013): 53–60.

2. Molina JM, Charreau I, Spire B, et al. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV 2017; 4(9): e402–e410. https://www.ncbi.nlm.nih.gov/pubmed/28747274

3. Baeten JM, Haberer JE, Liu AY, et al. Preexposure prophylaxis for HIV prevention. JAIDS Journal of Acquired Immune Deficiency Syndromes 2013; 63: S122–S129.

4. Fonner VA, Dalglish SL, Kennedy CE, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS 2016; 30(12): 1973–1983.

5. World Health Organization. Global state of PrEP [internet]. https://www.who.int. 2023. https://www.who.int/groups/global-prep-network/global-state-of-prep

6. Ogaz D, Logan L, Curtis TJ, et al. PrEP use and unmet PrEP-need among men who have sex with men in London prior to the implementation of a national PrEP programme, a cross-sectional study from June to August 2019. BMC Public Health 2022; 22(1): 1105.

7. Gov.UK. HIV testing, PrEP, new HIV diagnoses, and care outcomes for people accessing HIV services: 2022 report [Internet]. GOV.UK, 2022. https://www.gov.uk/government/statistics/hiv-annual-data-tables/hiv-testing-prep-new-hiv-diagnoses-and-care-outcomes-for-people-accessing-hiv-services-2022-report

8. Public Health England. HIV in the UK: towards zero HIV transmissions by 2030 [Internet]. GOV.UK, 2020. https://www.gov.uk/government/news/hiv-in-the-uk-towards-zero-hiv-transmissions-by-2030

9. Coukan F, Murray KK, Papageorgiou V, et al. Barriers and facilitators to HIV pre-exposure prophylaxis ( PrEP ) in specialist sexual health services in the United Kingdom: a systematic review using the PrEP care continuum. HIV Med 2023.

10. Curtis TJ. The sexual behaviour and sexual health of heterosexual-identifying men who have sex with men: understanding an understudied population to inform public health policy and practice - UCL Discovery. Uclacuk 2022. https://discovery.ucl.ac.uk/id/eprint/10143978/

11. Watson RJ, Morgan E, Sherman J, et al. Pre-exposure prophylaxis (PrEP) use, anticipated PrEP stigma, and bisexual identity among a Black and Hispanic/Latino sexual and gender diverse sample. Behav Med 2022; 49: 283–291.

12. Friedman MR, Wei C, Klem ML, et al. HIV infection and sexual risk among men who have sex with men and women (msmw): a systematic review and meta-analysis. Plos One 2014; 9(1): e87139. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907399

13. Oster AM, Wertheim JO, Hernandez AL, et al. Using molecular HIV surveillance data to understand transmission between subpopulations in the United States. J Acquir Immune Defic Syndr 2015; 70(4): 444–451.

14. McLeroy KR, Bibeau D, Steckler A, et al. An ecological perspective on health promotion programs. Health Educ Q 1988; 15(4): 351–377. https://pubmed.ncbi.nlm.nih.gov/3068205/

15. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting Items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2019; 151(4): 264–269. https://www.acpjournals.org/doi/abs/10.7326/0003-4819-151-4-200908180-00135

16. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005; 8(1): 19–32.

17. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018; 169(7): 467–473.

18. Iniesta C, Folch C, Meyer S, et al. Would eligible gay, bisexual and other men who have sex with men use PrEP? Awareness, knowledge, eligibility and intention to use PrEP among EMIS-2017 participants in Spain. Prev Med 2022; 156: 106962.

19. Zohar M, Guy S, Itzchak L. Knowledge of and willingness to take pre-exposure prophylaxis among men who have sex with men in Israel. Isr J Health Pol Res 2021; 10(1): 71.

20. Morgan J, Ferlatte O, Salway T, et al. Awareness of, interest in, and willingness to pay for HIV pre-exposure prophylaxis among Canadian gay, bisexual, and other men who have sex with men. Can J Public Health 2018; 109(5-6): 791–799.

21. Colyer S, Lachowsky NJ, Schmidt AJ, et al. Measures of HIV pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in Canada and demographic disparities among those at elevated likelihood for HIV acquisition. AIDS Behav 2021.

22. Hope A, Haire B. “No-one’s driving this bus” - qualitative analysis of PrEP health promotion for Aboriginal and Torres Strait Islander gay and bisexual men. Aust N Z J Publ Health 2018; 43(1): 18–23.

23. Graham SM, Okall DO, Mehta SD, et al. Challenges with PrEP uptake and adherence among gay, bisexual, and other men who have sex with men in kisumu, Kenya. AIDS Behav 2022; 27(4): 1234–1247.

24. Brown JR, Reid D, Howarth AR, et al. Changes in STI and HIV testing and testing need among men who have sex with men during the UK’s COVID-19 pandemic response. Sexually Transmitted Infections [Internet] 2022. https://sti.bmj.com/content/early/2022/07/17/sextrans-2022-055429

25. Fitch C, Haberer JE, Serrano PA, et al. Individual and structural-level Correlates of Pre-exposure Prophylaxis (PrEP) lifetime and current use in a nationwide sample of young sexual and gender minorities. AIDS Behav 2022; 26(10): 3365–3377.

26. Spieldenner A, Santella AJ, Cooper SC, et al. Knowledge, attitudes, and practices towards PrEP from cisgender men and transgender women who have sex with men in the largest suburban HIV epidemic. Int J Environ Res Publ Health 2022; 19(18): 11640.

27. Furukawa NW, Maksut JL, Zlotorzynska M, et al. Sexuality disclosure in U.S. Gay, bisexual, and other men who have sex with men: impact on healthcare-related stigmas and HIV pre-exposure prophylaxis denial. Am J Prev Med 2020; 59(2): e79–87.

28. Eger WH, Adaralegbe A, Khati A, et al. Exploring drivers of pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in Malaysia. Int J STD AIDS 2022; 33(9): 821–828.

29. Jaiswal J, Griffin M, Singer SN, et al. Structural barriers to pre-exposure prophylaxis use among young sexual minority men: the P18 cohort study. Curr HIV Res 2018; 16(3): 237–249. https://nyuscholars.nyu.edu/en/publications/structural-barriers-to-pre-exposure-prophylaxis-use-among-young-s

30. Birnholtz J, Kraus A, Schnuer S, et al. “Oh, I don’t really want to bother with that:” gay and bisexual young men’s perceptions of barriers to PrEP information and uptake. Cult Health Sex 2021; 24: 1548–1562.

31. Parent MC, Woznicki N, Dillon FR, et al. Psychosocial barriers to pre-exposure prophylaxis (PrEP) uptake: the roles of heterosexual self-presentation, sexual risk, and perceived peer prep use. Psychology of Men & Masculinities 2020.

32. Karuga RN, Njenga SN, Mulwa R, et al. “How I wish this thing was initiated 100 Years ago!” Willingness to take daily oral pre-exposure prophylaxis among men who have sex with men in Kenya. Plos One 2016; 11(4): e0151716.

33. Driver R, Cortopassi AC, El-Krab R, et al. Examining stigmatizing beliefs about PrEP use among Black sexual minority men: a test of explanatory mechanisms. Psychol Men Masc 2022; 23(1): 26–34.

34. Beltran RM, Schuyler AC, Blair CS, et al. “That’s kind of like the big struggle right now is can we get PrEP?”: facilitators and barriers to PrEP uptake among active duty gay and bisexual men. Sex Res Soc Pol 2021.

35. Kevin JB, Torres TS, Hoagland B, et al. Moderating effect of pre-exposure prophylaxis use on the association between sexual risk behavior and perceived risk of HIV among Brazilian gay, bisexual, and other men who have sex with men: cross-sectional study. JMIR public health and surveillance 2023; 9: e45134–e45144.

36. Nutland W, Weil B. Understanding the PrEP and sexual health needs and experiences of young GBMSM in London [Internet]. London: The Love Tank, 2023. https://prepster.info/wp-content/uploads/2024/02/GBMSM_U25_Report.pdf

37. Yiu TS, Randolph ME. Sex conservatism, internalized homonegativity, PrEP stigma, and intention to use PrEP: a study of Chinese-speaking gay and bisexual male youth in Hong Kong. AIDS Educ Prev 2022; 34(6): 467–480.

38. Valente PK, Bauermeister JA, Lin WY, et al. Next generation pre-exposure prophylaxis for young men who have sex with men: lessons from system and provider-level barriers to oral PrEP. AIDS Behav 2022; 26(10): 3422–3435.

39. Aidoo-Frimpong GA, Rabiu Abu-Ba’are G, Apreku A, et al. “We have our reasons”: exploring the acceptability of pre-exposure prophylaxis among gay, bisexual, and other men who have sex with men in Ghana. medRxiv 2023.

40. Quinn KG, Christenson E, Spector A, et al. The influence of peers on PrEP perceptions and use among young black gay, bisexual, and other men who have sex with men: a qualitative examination. Arch Sex Behav 2020.

41. Young I, Valiotis G. Strategies to support HIV literacy in the roll-out of pre-exposure prophylaxis in Scotland: findings from qualitative research with clinical and community practitioners. BMJ Open 2020; 10(4): e033849.

42. Farley JE, Beuchamp G, Bergman AJ, et al. The impact of stigma and sexual identity on PrEP awareness and use among at-risk men who have sex with men in four U.S. cities (HPTN 078). Stigma and Health 2022.

43. Peterson M, Nowotny K, Dauria E, et al. Institutional distrust among gay, bisexual, and other men who have sex with men as a barrier to accessing pre-exposure prophylaxis (PrEP). AIDS Care 2018; 31(3): 364–369.

44. Cahill S, Taylor SW, Elsesser SA, et al. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care 2017; 29(11): 1351–1358.

45. Hayes R, Nutland W, Rayment M, et al. “Sex without fear”: exploring the psychosocial impact of oral HIV pre-exposure prophylaxis on gay men in England. AIDS Res Ther 2023; 20(1): 81.

46. Jaramillo J, Pagkas-Bather J, Waters K, et al. Perceptions of sexual risk, PrEP services, and peer navigation support among HIV-negative latinx and black men who have sex with men (MSM) residing in western Washington. Sex Res Soc Pol 2021; 19(3): 1058–1068.

47. Jones JT, Coleman M, Hoover KW, et al. Reproductive intentions among HIV-negative gay and bisexual men initiating pre-exposure prophylaxis in the Sustainable Health Center Implementation pre-exposure prophylaxis pilot study, 2014–2016. Int J STD AIDS 2021; 33(2): 186–192.

48. Dangerfield DT. A principal investigator as a PrEP-using peer change agent for HIV prevention among black gay and bisexual men: an autoethnography. Int J Environ Res Publ Health 2023; 20(7): 5309–5399.

49. Dos Santos LA, Unsain RF, Brasil SA, et al. PrEP perception and experiences of adolescent and young gay and bisexual men: an intersectional analysis. Cad Saude Publica 2023; 39: e00134421. https://www.scielo.br/j/csp/a/VFnvjkv8NTbQhwg4hYrttQL/?lang=en

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