Abstract
Background: The use of post-exposure prophylaxis (PEP) is effective in reducing HIV risk, but it is underused by men who have sex with men (MSM) due to certain psychological and sociostructural factors. This article assessed the awareness and use of PEP among MSM in an effort to increase the visibility and uptake of PEP among at-risk populations.Methods: We conducted a systematic literature search of the PubMed, Web of Science, PsycINFO, and Google Scholar electronic databases. Studies were screened for inclusion, and relevant data were abstracted, assessed for bias, and synthesized. Pooled effect estimates were calculated using random effects meta-analysis, meta-regression and subgroup analysis, and a qualitative review and risk of bias assessment were performed (PROSPERO, CRD42019123815).Results: Twenty eligible studies involving 12,579 MSM were included in the meta-analysis. The pooled estimate of the proportions of MSM who were aware of PEP was modest at 59.9% (95% CI: 50.5~68.7) and that of MSM who previously used PEP was very low at 4.9% (95% CI: 2.4~9.8). PEP awareness showed no clear change over time, while PEP use significantly changed over time. Multiple factors affected awareness, including educational attainment, race/ethnicity, levels of HIV stigma, access to condoms, and so on. Many factors could potentially impede or facilitate the use of PEP, such as income, lack of PEP information, and partnership.Conclusion: We observed that PEP is an underused HIV prevention strategy among MSM and that once MSM become aware of PEP, the majority are willing to use it if they are supported appropriately in terms of a range of individual, social, and structural barriers.Systematic Review Registration: http://www.cdr.york.ac.uk/prospero, PROSPERO [CRD42019123815].
Highlights
Gay men, bisexual men, and other men who have sex with men (MSM) are a critical population at risk for Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) throughout the world [1]
The pooled estimate of the proportions of MSM who were aware of post-exposure prophylaxis (PEP) was modest at 59.9% and that of MSM who previously used PEP was very low at 4.9%
PEP awareness showed no clear change over time, while PEP use significantly changed over time
Summary
Bisexual men, and other men who have sex with men (MSM) are a critical population at risk for HIV/AIDS throughout the world [1]. The HIV prevalence among MSM exceeds 10% in many regions, which is disproportionately high compared to the general population [2]. In many highly developed countries where the overall HIV epidemic is in decline, there have been re-emergent epidemics among MSM [3]. PEP was initially used for the prevention of occupational HIV exposure, and recently, research hotspots have demonstrated its safety and feasibility in non-occupational incidents among high-risk populations such as MSM [7]. The use of post-exposure prophylaxis (PEP) is effective in reducing HIV risk, but it is underused by men who have sex with men (MSM) due to certain psychological and sociostructural factors. This article assessed the awareness and use of PEP among MSM in an effort to increase the visibility and uptake of PEP among at-risk populations
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