Barriers to HIV pre-exposure prophylaxis uptake for men who have sex with both men and women: A global scoping review

BackgroundAlthough PrEP is a highly effective HIV prevention method, some groups are underrepresented in PrEP uptake. Much HIV prevention research groups gay, bisexual and other men who have sex with men together; however, men who have sex with both men and women (MSWM) may have needs distinct from those who identify as exclusively gay. This scoping review aims to explore documented barriers to PrEP use among MSWM.MethodsLiterature was searched using four databases. Studies were included if data referring to MSWM were reported as a distinct category. Data were extracted using a standardised form, and findings were stratified into relevant categories of the social ecological framework.ResultsAlongside intersectional barriers, MSWM were found to have lower awareness of PrEP, and access sexual health services less than men who have sex only with men. Those who did not identify with the LGBT community often missed out on health promotion messages for this group and were less likely to be offered HIV prevention interventions. MSWM identified more stigmatisation around PrEP use than gay men. However, when aware of PrEP, MSWM were very motivated to use this intervention.ConclusionsNot all MSM will identify within the LGBTQ + community and may miss out on valuable opportunities for HIV prevention. PrEP information should be widely available in a variety of health and community settings. Health care professionals should avoid assumptions when assessing patients and provide information about HIV and STI prevention to all attending sexual health services.