Facilitators and Barriers to Pre-Exposure Prophylaxis (PrEP) Acceptability among Ethnic Minority Men-who-have-Sex-with-Men (EMMSM): A Systematic Review
Ethnic Minority Men-who-have-Sex-with-Men (EMMSM) are at disproportionately high risk of HIV infection. Racial disparities also exist in the use of Pre-Exposure Prophylaxis (PrEP), an intervention highly effective at reducing the risk of HIV acquisition. This systematic review aims to identify the facilitators and barriers to PrEP use in EMMSM and provide recommendations to improve uptake.
A systematic search of nine databases identified primary research published in English after 2000 exploring the acceptability of PrEP among EMMSM in high-income countries. Studies were screened independently by two review authors; data was extracted, and methodological quality was appraised using standardised forms. Facilitators and barriers to PrEP uptake in EMMSM were categorised using a socio-ecological model and analysed by narrative review.
X 54 studies were included for review. Facilitators and barriers were mapped to the individual, interpersonal, community, institutional and structural level. Common facilitators included its perceived benefit to serodiscordant relationships, the psychological reassurance it offers, and a self-perceived high risk of HIV infection. Common barriers to PrEP use were associated with social stigma, fear of side-effects and poor relationships with healthcare providers.
A broad consensus was found in the extant literature, with well-established facilitators and barriers to PrEP use in EMMSM which were mapped and described using a socio-ecological model. We identified key areas of interest and gave recommendations to improve PrEP uptake and optimisation. Future efforts should focus on improving cultural competency in healthcare providers, and developing multi-level strategies to improve PrEP awareness, education, and outreach to EMMSM communities.
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