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
Review
. 2020 Jul 27;7(3):265-274.
doi: 10.17294/2330-0698.1737. eCollection 2020 Summer.

HIV Preexposure Prophylaxis and Treatment as Prevention - Beliefs and Access Barriers in Men Who Have Sex With Men (MSM) and Transgender Women: A Systematic Review

Joshua J Matacotta  1 , Francisco J Rosales-Perez  2 , Christian M Carrillo  3
Affiliations
Review

HIV Preexposure Prophylaxis and Treatment as Prevention - Beliefs and Access Barriers in Men Who Have Sex With Men (MSM) and Transgender Women: A Systematic Review

Joshua J Matacotta et al. J Patient Cent Res Rev. .

Abstract

Purpose: While the annual rate of new HIV infections and diagnoses has remained stable for most groups, troubling increases are seen in transgender women and racial/ethnic-minority men who have sex with men (MSM), groups that are disproportionately affected by HIV. The primary purpose of this systematic review is to examine factors that impact attitudes and beliefs about preexposure prophylaxis (PrEP) and treatment as prevention (TasP) and to explore barriers to PrEP uptake in MSM and transgender women.

Methods: Using MeSH terms and relevant keywords, we conducted a systematic review of studies published between 2010 and 2019. We searched 4 literature databases and identified studies on MSM and transgender women to elucidate perceptions of PrEP and TasP as well as barriers to access.

Results: The search yielded several prominent themes associated with beliefs about HIV prevention approaches and barriers to PrEP access in MSM and transgender women. One was a lack of awareness or insufficient knowledge of PrEP and TasP. Structural barriers and geographic isolation also prevent access to HIV prevention. Sexual minority and HIV-related stigma, internalized homonegativity, and misinterpretations of messages within HIV prevention campaigns have negatively impacted PrEP uptake and beliefs about PrEP and TasP. Quality of the relationship MSM or transgender people have with their health care provider can facilitate or hinder HIV prevention. Finally, variability in beliefs about the efficacy of TasP has negatively affected the impact of TasP messaging campaigns.

Conclusions: Although there is evidence of increasing PrEP use in at-risk individuals, several barriers prevent wider acceptance and uptake. Misunderstanding about the meaning of "undetectable" and skepticism about the evidence behind TasP messaging campaigns are likely to delay the World Health Organization's stated goal of getting to zero transmissions.

Keywords: HIV; MSM; preexposure prophylaxis; transgender women; treatment as prevention.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest None.

Figures

Figure 1
Figure 1
Systematic literature review flowchart.
See this image and copyright information in PMC

References

    1. Ocfemia MCB, Dunville R, Zhang T, Barrios LC, Oster AM. HIV diagnoses among persons aged 13–29 years – United States, 2010–2014. MMWR Morb Mortal Wkly Rep. 2018;67:212–5. doi: 10.15585/mmwr.mm6707a2. - DOI - PMC - PubMed
    1. Pérez-Figueroa RE, Kapadia F, Barton SC, Eddy JA, Halkitis PN. Acceptability of PrEP uptake among racially/ethnically diverse young men who have sex with men: the P18 study. AIDS Educ Prev. 2015;27:112–25. doi: 10.1521/aeap.2015.27.2.112. - DOI - PMC - PubMed
    1. Mustanski B, Ryan DT, Remble TA, D’Aquila RT, Newcomb ME, Morgan E. Discordance of self-report and laboratory measures of HIV viral load among young men who have sex with men and transgender women in Chicago: implications for epidemiology, care, and prevention. AIDS Behav. 2018;22:2360–7. doi: 10.1007/s10461-018-2112-7. - DOI - PMC - PubMed
    1. Rendina HJ, Parsons JT. Factors associated with perceived accuracy of the Undetectable = Untransmittable slogan among men who have sex with men: implications for messaging scale-up and implementation. J Int AIDS Soc. 2018;21(1):e25055. doi: 10.1002/jia2.25055. - DOI - PMC - PubMed
    1. Rodger AJ, Cambiano V, Bruun T, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet. 2019;393:2428–38. doi: 10.1016/S0140-6736(19)30418-0. - DOI - PMC - PubMed

LinkOut - more resources