medication use

Global Data Assessment of HIV PrEP Awareness, Willingness to Use

Authors conducted a meta-analysis of global data to examine pre-exposure prophylaxis (PrEP) awareness and willingness to use PrEP among men who have sex with men (MSM). A better understanding with integrated knowledge may be useful for HIV prevention in high incidence groups.

Investigators searched online electronic databases for article prior to August 31, 2021. They pooled studies analyzing PrEP awareness and willingness to use PrEP. LOESS regression and linear regression were applied to fit the trends over time for the proportion of MSM aware of PrEP and willing to use PrEP. Dose-response meta-analysis (DRMA) was conducted by a restricted cubic spline model to explore the relationship between willingness to use PrEP and selected factors.

Authors ultimately included 156 articles involving 228,403 MSM. Pooled proportions of MSM aware of PrEP and willing to use PrEP were 50.0 (95% CI, 44.8–55.2) and 58.6% (95% CI, 54.8–62.4), respectively.

Variations were seen regarding PrEP awareness among countries with different economic status and different WHO regions, among different publication and research years, PrEP types, and support policies. PrEP willingness differed among countries with different economic status and groups with different risks of HIV. The awareness of PrEP increased from 2007 to 2019 with a slope of 0.040260 (P<.0001), while the proportion of MSM willing to use PrEP decreased from 2007 to 2014 (slope = –0.03647, P=.00390) but increased after 2014 (slope = 0.04187, P=.03895).

The main facilitators of willingness to use PrEP were “PrEP awareness, condomless sexual behaviors, high perceived risk of HIV infection and influence of social network.” The main barriers included doubts about the efficacy and side effects of PrEP. DRMA results indicate that MSM with more sexual partners and lower level of education were more willing to use PrEP. No publication bias was noted.

Authors concluded that, since 2014, the proportions of PrEP awareness and willingness to use PrEP among MSM have increased, however, the awareness was low and the willingness was moderate.

“Improving awareness of PrEP through increasing access to PrEP-related health education and enhancing risk perceptions of HIV infection could have positive effects on the willingness to use PrEP among MSM,” authors noted.


—Amanda Del Signore



Sun Z, Gu Q, Dai Y, et al. Increasing awareness of HIV pre-exposure prophylaxis (PrEP) and willingness to use HIV PrEP among men who have sex with men: a systematic review and meta-analysis of global data. J Int AIDS Soc. 2022;25(3):e25883. doi:10.1002/jia2.25883