Structural and socio-cultural barriers to HIV prevention tools among key populations: a scoping review

Despite decades of HIV prevention efforts, key populations - MSM, transgender people, PWUD, sex workers, and migrants - remain disproportionately affected by HIV. Although prevention tools are widely available, global targets remain unmet, largely due to persistent structural and sociocultural barriers, resulting in an important societal cost.

This scoping review analyzes 197 studies (2018-2022) quantitative and qualitative, from 48 countries to map barriers to HIV prevention across five key populations and five continents, using Medline and Scopus databases according to the PRISMA-ScR methodology. It reveals widespread legal and institutional obstacles: lack of health insurance, criminalization of their condition, stigma (including HIV and internalized stigma), violence, poverty, low health literacy, and healthcare mistrust. It also identifies major gaps in research coverage around the world.

Despite major progress in HIV prevention, inequities persist in implementation and access. Our study highlights the urgent need of coordinated governmental and institutional efforts to ensure universal access to prevention tools, social protection, and stigma reduction interventions, as requested by UNAIDS. An intersectional approach that responds to the overlapping vulnerabilities faced by key populations is essential. Without systemic change, biomedical progress alone will not be sufficient to put an end to HIV.