Uptake, Acceptability of HIV Pre-Exposure Prophylaxis Treatment Influenced by Knowledge, Perception of Risk in MSM

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Although increased knowledge and understanding could increase uptake and acceptability of pre-exposure prophylaxis for HIV, action is needed to remove barriers and improve accessibility.

Key Takeaways:

1. Factors Influencing PrEP Uptake and Acceptability: The review highlights several interconnected factors that affect pre-exposure prophylaxis (PrEP) uptake and acceptability among men who have sex with men (MEM), including willingness, availability and accessibility, knowledge, perceptions, and various barriers to PrEP use.

2. Challenges and Disparities in PrEP Uptake: The authors discuss the disparities in PrEP uptake among different regions, cultures, ethnic groups, and subpopulations of MSM. While PrEP uptake was relatively high in North America, Latin America, and Europe, it remained low in Asia and Africa. Factors affecting PrEP acceptance included perceptions of risk, interactions with healthcare professionals, stigma, fear of adverse effects, cost, and lack of information.

3. Moving Toward the Future: There are significant disparities in PrEP uptake—particularly in low- and middle-income countries—where access, affordability, and awareness remain major challenges. The authors suggest that availability and accessibility of PrEP while addressing barriers should be prioritized moving forward.

Despite the effort to end the HIV and AIDS epidemic, the rate of new HIV infections among men who have sex with men (MSM) remains high. Due to its efficacy, oral pre-exposure prophylaxis (PrEP) has been an important tool in reducing the risk in HIV infection, and uptake and acceptability are needed to achieve this.

A review published in the American Journal of Men’s Health evaluates prior research on the context of PrEP uptake and acceptability among MSM. Further, the authors determine how certain elements (eg, willingness, accessibility, knowledge, barriers, and perceptions) interrelate and influence PrEP uptake and acceptability.

The review included 55 studies in which the problem was HIV and AIDS, had interest in PrEP uptake and acceptability among MSM, and used the population, intervention, comparison, and outcome concept. Further, the review included studies that focused on bisexual men, gay men, transgender women, and other MSM, with additional gender minority groups included in the study population if MSM were included in the results. The most notable themes throughout the studies were willingness to use PrEP, availability and accessibility of PrEP, perceptions toward PrEP, knowledge of PrEP, facilitators, and barriers to PrEP use.

The efficacy of PrEP varied across geographic locations, with its success depending on the willingness to adopt it for those who need it. Factors such as education, knowledge, and awareness influenced MSM’s willingness to use PrEP; however, being knowledgeable and aware of PrEP did not always result in a desire to use it.

Availability, which is defined as being accessible by MSM at any time and to know where to get it, can be affected by different issues (eg, limited resources, overstretched health systems). Although PrEP is an effective HIV-prevention tool, the issue of availability interferes with its success, according to the authors. Further, they note 11 different studies that specifically address how the lack of availability affects the uptake and willingness to use PrEP. Further, availability is not always associated with an increased uptake and accessibility in MSM populations.

Man holding oral PrEP pill and a glass of water

Image credit: samael334 | stock.adobe.com

In addition, knowledge and awareness of PrEP among MSM impact PrEP uptake, acceptability, adherence, and willingness, according to the study authors. In research that evaluated the perceptions of PrEP in MSM populations, it was found that 7 of the 17 studies (40%) reported a positive attitude to PrEP, which were attributed to self-awareness. Not including knowledge and awareness, 31 studies identified additional barriers (eg, information, health care system, risk perception, social support, stigma) that may influence the uptake and acceptability of PrEP in MSM in different geographic locations.

Despite PrEP’s high efficacy, its uptake and acceptance varied widely across different locations, cultures, ethnic groups, and MSM subpopulations, with uptake being high in North America, Latin America, and Europe, and low in Asia and Africa; however, differences within locations were still present. For example, 2 studies conducted in the United States had reported different levels of acceptability, with 1 noting MSM were hesitant to use PrEP despite being knowledgeable, and the other identified high uptake and willingness in MSM to use PrEP. Factors for accepting or non-willingness to use PrEP may be associated with individuals’ perceptions of risk, interactions with health care professionals, stigma, fear of adverse effects (AEs), cost, and lack of information, according to the authors.

Further, the review reported an overall low uptake and acceptability of PrEP in different countries, particularly in low- and middle-income countries (eg, Thailand, Peru, Ghana). To improve the uptake and acceptability of PrEP, the authors note the importance of ensuring availability and accessibility of PrEP among MSM. According to prior research, MSM preferred free PrEP and it was associated with a higher acceptance, but it does not necessarily result in a higher acceptance as there are other factors (eg, stigma, fear of AEs, and perception of not being at risk) that have a role in reducing uptake and willingness.

A limitation of the study is that comparisons on the uptake and acceptability of PrEP among MSM were made in previous research, therefore, the results from these studies may be inaccurate. In addition, on the assessment of global knowledge levels, people became knowledgeable with time and the figures that were identified may not accurately portray the current levels of PrEP knowledge within the MSM population.

Although research on MSM and PrEP shows that PrEP is being implemented in different regions, there is still a low uptake among MSM in certain countries. The authors suggest that health intervention programs specifically designed to introduce or increase the use of PrEP should be implemented, as well as other elements to influence uptake and acceptability among MSM.

Reference

Moyo PL, Nunu WN. Oral Pre-exposure Prophylaxis Uptake and Acceptability Among Men Who Have Sex With Men: A Scoping Review of the Literature. American Journal of Men’s Health. 2023;17(5). doi:10.1177/15579883231201729

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