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

Men who have sex with men (MSM) in the United States are at disproportionate risk for HIV. Once-daily pre-exposure prophylaxis (PrEP) for HIV prevention is a highly effective method of preventing HIV infection; however, optimal adherence is necessary to maintain effectiveness. Many studies have prof...

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Bibliographic Details
Published in:AIDS care 2021-06, Vol.33 (6), p.697-705
Main Authors: Edeza, Alberto, Karina Santamaria, E., Valente, Pablo Kokay, Gomez, Ashley, Ogunbajo, Adedotun, Biello, Katie
Format: Article
Language:English
Subjects:
Adherence
AIDS/HIV
Barriers
Disease prevention
Drug therapy
Drugs
Ethnography
Exposure
FDA approval
Gays & lesbians
Gender
Health risks
HIV
Human immunodeficiency virus
Intervention
Men
Men who have sex with men
Mens health
Patient compliance
Peers
Pre-exposure prophylaxis
Prevention
Prevention programs
Preventive medicine
Prophylaxis
qualitative
Qualitative research
Sexually transmitted diseases
Social identity
STD
Stigma
Systematic review
Telemedicine
Underserved populations
Uptake
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Summary:Men who have sex with men (MSM) in the United States are at disproportionate risk for HIV. Once-daily pre-exposure prophylaxis (PrEP) for HIV prevention is a highly effective method of preventing HIV infection; however, optimal adherence is necessary to maintain effectiveness. Many studies have profiled perceived barriers to adherence among at-risk MSM; however, nearly a decade after FDA approval, there has been little work examining experienced barriers to adherence among MSM who have previously used the medication. To assess the current state of this literature and its implications for behavioral interventions, we conducted a meta-ethnography (i.e., A systematic review and synthesis of qualitative studies) of experiences with PrEP use among cis-gender MSM in the United States. We found that structural-level interventions, such as telehealth and pharmacist-prescribed approaches to PrEP distribution, may circumvent barriers to uptake and adherence for some MSM, but may not be enough for already underserved communities, such as MSM of color. Furthermore, interpersonal-level factors, such as enacted PrEP stigma by providers and peers, highlight the necessary consideration of social identity in the branding of PrEP for HIV prevention. Tailored interventions should consider experienced barriers to PrEP adherence across socioecological levels to be most effective.
ISSN:0954-0121
1360-0451
DOI:10.1080/09540121.2020.1778628