HIV Pre-Exposure Prophylaxis Among People with Criminal Justice Involvement in the United States: A Systematic Review

People with criminal justice involvement (PCJI) face a heightened risk of HIV yet remain underserved by prevention strategies such as pre-exposure prophylaxis (PrEP). This systematic review synthesizes current evidence on PrEP utilization among PCJI, identifying key barriers and facilitators that influence uptake and adherence. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a comprehensive literature search and thematic analysis. Twenty-five studies met inclusion criteria, with most conducted in the Northeast and Southern United States, and few from the Midwest or West. Barriers to PrEP utilization included competing post-release priorities, unstable housing and transportation, stigma, medical mistrust, lack of social support, and fear of re-incarceration. Conversely, facilitators of PrEP engagement included streamlined prescription procedures, patient navigation services, and coordinated linkage to care during reentry. The findings underscore the need for targeted, multi-level interventions that not only address individual knowledge and behavior but also tackle broader structural determinants of health. These include improving housing stability, integrating PrEP into correctional and post-release care systems, and fostering collaborative partnerships between criminal justice agencies, health care providers, and community-based organizations. To our knowledge, this is the first systematic review to comprehensively examine PrEP utilization among PCJI. As the United States continues efforts to end the HIV epidemic, addressing the unique needs of justice-involved populations is essential. This review provides a critical foundation for public health professionals and policymakers to design more equitable, effective HIV prevention strategies tailored to this marginalized group.