What Factors Are Associated With Willingness to Use HIV Pre-exposure Prophylaxis (PrEP) Among U.S. Men Who Have Sex With Men Not on PrEP? A Systematic Review and Meta-analysis.
Emiko Kamitani, Megan E Wichser, Yuko Mizuno and 2 others
PMID 36563302WHAT IT FOUND
Among U.S. men not taking PrEP, Hispanic/Latino or Black identity, younger age, no college degree, income under $20,000, recent condomless sex, STI, many partners, and HIV prevention counseling were linked to greater PrEP willingness.
These are associations, not proof of uptake.
Key findings
01Sociodemographic factors linked to greater willingness included Hispanic/Latino or Black race/ethnicity, no college degree, income below $20,000, and younger age.
02Behavioral factors linked to greater willingness included recent condomless anal sex, STI diagnosis in the past 12 months, six or more sex partners in the past 12 months, and receiving an HIV behavioral intervention in the past 12 months.
03PrEP and HIV perception factors linked to greater willingness included fewer concerns about long-term drug side effects, more perceived PrEP benefits, and greater perceived HIV risk.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most studies were cross-sectional and measured willingness, not PrEP uptake, so they cannot show what causes willingness or whether men actually started PrEP. The meta-analysis used unadjusted odds ratios because adjusted models differed, so other factors may explain the associations. Heterogeneity was high for several factors, including Hispanic/Latino, Black, age, and condomless sex, even after adjusting for study year. Some factors had few studies, so sensitivity analyses and generalizability were limited. Only peer-reviewed English studies were included, so relevant non-peer-reviewed findings may be missing. No included studies were conducted after major PrEP assistance programs, so current access context may differ.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not read these associations as evidence that counseling or addressing risk factors causes men to start PrEP. The studies measured willingness, mostly cross-sectionally, and pooled unadjusted odds ratios with high heterogeneity.