Experienced barriers to adherence to pre-exposure prophylaxis for HIV prevention among MSM: a systematic review and meta-ethnography of qualitative studies

Sociodemographic Characteristics of HIV Pre-Exposure Prophylaxis Use and Reasons for Nonuse Among Gay, Bisexual, and Other Men Who Have Sex with Men from Three US Cities

“…19,21,44 Having representation of current, previous, and never users in our sample allowed us to examine sociodemographic and behavioral associations with PrEP use status, and reasons for nonuse, in an era of increasingly common PrEP use where gaps persist in access, uptake, and persistence of use for MSM. 11,12,16,20 Compared with never users, current and previous PrEP users were similar in reporting CAS, younger age, and higher education. The association between CAS and PrEP use is not surprising, because CAS is an indication for PrEP use.…”

“…These findings highlight the need for messaging about: relatively low side effects to ease concerns about PrEP, personal risk assessment and indications for PrEP, and PrEP clinics and assistance programs to help cover PrEP costs. 12,16,20,21,[64][65][66][67][68] Evidence of effective messaging through advertisement campaigns and social networks to enhance PrEP uptake has been encouraging and might be expanded to reach more MSM who need PrEP. 46,47 We found that insurance coverage and access were prominent reasons for never using PrEP among MSM who reported CAS.…”

“…7 Although PrEP use has increased to 19-35% among MSM, [8][9][10] challenges remain in reaching men at the highest risk. [11][12][13] PrEP use and persistence are lower for MSM who are younger (18-24 years), of racial/ethnic minorities, and living in the US South. 8,10,11,[13][14][15][16][17][18][19][20][21][22][23][24] Prior research found that condomless anal sex (CAS), substance use, lack of insurance, and other sociodemographic factors were associated with current PrEP nonuse.…”

PrEParing for NextGen: Cognitive Interviews to Improve Next Generation PrEP Modality Descriptions for Young Men Who have Sex with Men

“…While there has been a recent five-fold increase in PrEP uptake among adult MSM in urban areas in the US [1], adolescents account for less than 1% of new PrEP prescriptions [2,3]. This trend is particularly troubling, as young MSM (YMSM; ages [13][14][15][16][17][18][19][20][21][22][23][24] account for nearly one-third of new infections among MSM in the US [4]. Despite their high PrEP need, only 3% of eligible YMSM have been prescribed PrEP, substantially lower than their older peers [5,6]; PrEP uptake among YMSM under 18 years old is even lower, contributing to continued HIV transmission among this group [2].…”

“…Factors impeding daily oral PrEP uptake and adherence among YMSM include cost, accessibility, side effects, stigma, and competing stressors [9][10][11][12][13][14]. Access to daily oral PrEP is even more limited for YMSM under 18 years old due to developmental circumstances (e.g., establishing identities, vulnerability to stigma, inexperience navigating the healthcare system), and lack of access to HIV prevention services without parental consent in some jurisdictions [15][16][17][18][19]. Taking these considerations into account, HIV prevention scientists are actively developing and testing the efficacy of next generation PrEP formulations that could circumvent some of the challenges with daily oral PrEP.…”