Access to pre-exposure prophylaxis (PrEP) for young gay, bisexual and other men who have sex with men in rural areas

Background:<br/>Young gay, bisexual and other men who have sex with men (GBMSM) continue to be disproportionately impacted by HIV health disparities, including access to pre-exposure prophylaxis (PrEP) despite this intervention being proven to be highly effective in preventing HIV infection. Despite the proven effectiveness of PrEP, access to PrEP remains inconsistent, with significant barriers existing in rural areas due to limited healthcare infrastructure. For 18- to 25-year-old GBMSM, these barriers are further compounded by unique socio-cultural challenges such as stigma surrounding sexual and gender diversity. Rural GBMSM are also hindered by specific obstacles that differ from those encountered in the larger urban areas. Geographic isolation, limited availability of culturally safe health services, and financial constraints, as well as privacy concerns amplify the challenges in accessing PrEP, pointing to the need for a nuanced exploration of access issues specific to young men in rural areas.<br/><br/>Methods:<br/>This scoping review was conducted in accordance with JBI methodology and reported following the PRISMA checklist. The review protocol was prospectively registered with OSF.IO. The Levesque framework which examines healthcare access through dual lenses: the service characteristics that make healthcare accessible and the user capabilities required to access that care, was applied to the included articles to allow for a comprehensive mapping of access barriers and facilitators, considering both systemic factors and individual capacities.<br/><br/>Results:<br/>Despite successful initiatives to improve access to PrEP, significant barriers including geographic and infrastructure barriers, poor access to telehealth services and transportation, as well as financial barriers are significant obstacles to accessing PrEP. A lack of culturally competent care is also a significant barrier to accessing PrEP.<br/><br/>Conclusion:<br/>Targeted approaches to reduce the barriers to accessing health and increasing access to culturally competent care are crucial to improving access to PrEP in rural areas.<br/>