Influence of Stigma on Pre-Exposure Prophylaxis (PrEP) Care Continuum Among Men and Transwomen Who Have Sex with Men (MTWSM) in the United States.

Jude Ssenyonjo,Michael Copenhaver,Roman Shrestha

doi:10.11648/j.ijhpebs.20190502.18

Abstract

Despite evidence from recent trials of the efficacy of pre-exposure prophylaxis (PrEP) in reducing the risk of contracting HIV, PrEP uptake has been slow due to a range of social, structural, and behavioral factors. In this systematic review, we examined the influence of stigma on the PrEP care continuum among men and transwomen who have sex with men (MTWSM). We conducted a literature search in the PubMed electronic database (2012-2018) that focused on the PrEP care continuum among high-risk MTWSM. We explored studies that specifically looked at the influence of stigma on the PrEP cascade among these socially disadvantaged populations. Our search yielded 161 articles, of which nine were ultimately included in our systematic review. The results showed a significant association between stigma and unwillingness to seek or use PrEP suggesting that stigma may negatively affect willingness and uptake of PrEP among these high-risk groups.

Highlights

Men who have sex with men (MSM) account for 70% of all the HIV diagnoses [1] in the United States and are not consistently reached by existing prevention interventions
Since Pre-exposure prophylaxis (PrEP) was only approved by the Food and Drug Administration (FDA) in July 2012, we only considered studies conducted between 2012 and 2018
We excluded all studies from other countries outside of the United States (n=13), those that did not have “pre-exposure prophylaxis or PrEP” within their title or abstract (n=30), those that were conducted before 2012 (n=12) and those that were not focusing on men and transwomen who have sex with men (n=12)

Summary

Introduction

Men who have sex with men (MSM) account for 70% of all the HIV diagnoses [1] in the United States and are not consistently reached by existing prevention interventions. Significant strides have been made, with a notable decline in HIV transmission across the board, except among Men and Transwomen who have Sex with Men (MTWSM [3]). PrEP is an essential innovation in evidence-based HIV prevention for high-risk populations, including men and transwomen who have sex with men, especially with high adherence [4, 5]. According to the CDC, an estimated 1.2 million adults aged 18 to 59 years would benefit from PrEP in the United States, including 400,000 high-risk MTWSM [6]. Despite PrEP effectiveness in reducing the risk of HIV transmission, uptake has been slow, and focus

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Discussion

Conclusion