Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Jun 26;20(1):21580.
doi: 10.7448/IAS.20.1.21580.

Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis

Siyan Yi  1   2 , Sovannary Tuot  1 , Grace W Mwai  3 , Chanrith Ngin  1 , Kolab Chhim  1 , Khoundyla Pal  1 , Ewemade Igbinedion  4 , Paula Holland  5 , Sok Chamreun Choub  1 , Gitau Mburu  5
Affiliations
Meta-Analysis

Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis

Siyan Yi et al. J Int AIDS Soc. .

Abstract

Introduction: To facilitate provision of pre-exposure prophylaxis (PrEP) in low- and middle-income countries (LMIC), a better understanding of potential demand and user preferences is required. This review assessed awareness and willingness to use oral PrEP among men who have sex with men (MSM) in LMIC.

Methods: Electronic literature search of Cochrane library, Embase, PubMed, PsychINFO, CINHAL, Web of Science, and Google Scholar was conducted between July and September 2016. Reference lists of relevant studies were searched, and three authors contacted for additional data. Non-peer reviewed publications were excluded. Studies were screened for inclusion, and relevant data abstracted, assessed for bias, and synthesized.

Results: In total, 2186 records were identified, of which 23 studies involving 14,040 MSM from LMIC were included. The proportion of MSM who were aware of PrEP was low at 29.7% (95% CI: 16.9-44.3). However, the proportion willing to use PrEP was higher, at 64.4% (95% CI: 53.3-74.8). Proportions of MSM aware of PrEP was <50% in 11 studies and 50-70% in 3 studies, while willingness to use PrEP was <50% in 6 studies, 50-70% in 9 studies, and over 80% in 5 studies. Several factors affected willingness to use PrEP. At the individual domain, poor knowledge of PrEP, doubts about its effectiveness, fear of side effects, low perception of HIV risk, and the need to adhere or take medicines frequently reduced willingness to use PrEP, while PrEP education and motivation to maintain good health were facilitators of potential use. Demographic factors (education, age, and migration) influenced both awareness and willingness to use PrEP, but their effects were not consistent across studies. At the social domain, anticipated stigma from peers, partners, and family members related to sexual orientation, PrEP, or HIV status were barriers to potential use of PrEP, while partner, peer, and family support were facilitators of potential use. At the structural domain, concerns regarding attitudes of healthcare providers, quality assurance, data protection, and cost were determinants of potential use.

Conclusions: This review found that despite low levels of awareness of PrEP, MSM in LMIC are willing to use it if they are supported appropriately to deal with a range of individual, social, and structural barriers.

Keywords: HIV; low and middle income countries; men who have sex with men (MSM); pre-exposure prophylaxis (PrEP); systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure 1.
Figure 1.
Scope of this review.
Figure 2.
Figure 2.
Study selection.
Figure 3.
Figure 3.
Pooled estimate of awareness of PrEP among MSM in low- and middle-income countries.
Figure 4.
Figure 4.
Pooled estimate of willingness to use PrEP among MSM in low- and middle-income countries.
Figure 5.
Figure 5.
Relationship between awareness and willingness to use PrEP in studies reporting both outcomes.
See this image and copyright information in PMC

References

    1. Murray CJ, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet. 2015;386(10009):2145–27. doi: 10.1016/s0140-6736(15)61340-x - DOI - PMC - PubMed
    1. Wang H, Wolock TM, Carter A, Nguyen G, Kyu HH, Gakidou E, et al. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015. Lancet HIV. 2016;3(8):e361–87. doi: 10.1016/s2352-3018(16)30087-x - DOI - PMC - PubMed
    1. UNAIDS Global AIDS update, 2016. Geneva: UNAIDS; 2016.
    1. WHO Guidance on Pre-Exposure Oral Prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV. Recommendations for use in the context of demonstration projects. Geneva: World Health Organization; 2012. - PubMed
    1. WHO Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: World Health Organization; 2015. - PubMed

Substances

LinkOut - more resources