Equity and Access in HIV Prevention: Addressing Global Disparities in PrEP Use Among Men Who Have Sex With Men...

Despite proven efficacy in preventing HIV, the global uptake of pre-exposure prophylaxis (PrEP) remains limited and uneven, particularly among men who have sex with men (MSM). A meta-analysis by Zhao et al. reveals that only 20% of PrEP-eligible MSM have ever used the medication, with stark disparities across regions and income levels. While uptake has increased over time, significant barriers persist, especially in low- and middle-income countries (LMICs). These barriers include financial constraints, limited health care infrastructure, provider knowledge gaps, and pervasive stigma, which together impede equitable access to PrEP. In regions such as sub-Saharan Africa, Asia, and Latin America, MSM face challenges related to health care access, while younger MSM and marginalized groups, including transgender individuals, are particularly underserved. This viewpoint calls for global strategies that address these inequities through targeted, evidence-based interventions that focus on reducing systemic barriers and incorporating intersectional approaches. To scale up PrEP access and ensure equitable HIV prevention, multilevel strategies are necessary, involving policy changes, provider training, community-led initiatives, and youth-centered outreach. Addressing the financial, structural, and social determinants of health is essential for bridging these gaps and ensuring that PrEP fulfills its potential as a global tool for HIV prevention.