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Intersectionality and Its Influence on PrEP Uptake and Adherence Among MSM: A Scoping Review

Quoc Tuan Tran1, Lucy Ngaihbanglovi Pachuau1, Sam Hogan1

  • 1Western Sydney University, New South Wales, Australia.

Health Education & Behavior : the Official Publication of the Society for Public Health Education
|August 18, 2026
PubMed

Insights

Oral pre-exposure prophylaxis (PrEP) is effective for HIV prevention. This review highlights how intersecting identities and multilevel factors impact PrEP use among men who have sex with men (MSM), emphasizing the need for tailored strategies.

Area of Science:

  • Public Health
  • Epidemiology
  • Social Sciences

Background:

  • Oral pre-exposure prophylaxis (PrEP) is a key biomedical HIV prevention tool.
  • Men who have sex with men (MSM) face disproportionately high HIV rates due to systemic inequities.
  • Existing research often lacks multilevel and intersectional perspectives on PrEP engagement.

Purpose of the Study:

  • To map global evidence on factors influencing oral PrEP uptake and adherence among MSM.
  • To examine how intersecting identities shape these influences on PrEP engagement.
  • To synthesize multilevel factors affecting PrEP use in MSM populations worldwide.

Main Methods:

  • Scoping review of studies published and conducted between 2015 and 2025.
  • Searched four electronic databases: MEDLINE, CINAHL, Scopus, and ProQuest.
  • Analyzed 13 eligible studies using the Social-Ecological Model and Intersectionality Framework.

Main Results:

  • Identified barriers: low perceived HIV risk, stigma, healthcare mistrust, limited provider engagement, financial constraints.
  • Identified facilitators: risk awareness, perceived PrEP benefits, supportive providers, affirming communities.
  • Intersecting factors (ethnicity, religion, relationship status, socioeconomic status) significantly shaped PrEP engagement.

Conclusions:

  • Multilevel and intersectional strategies are crucial for equitable HIV prevention among MSM.
  • Addressing stigma, enhancing provider capacity, and promoting culturally affirming healthcare are essential.
  • Tailored interventions are needed to overcome barriers and optimize PrEP uptake and adherence in diverse MSM populations.
Keywords:
MSMPrEPPrEP adherencePrEP uptakeintersectionality frameworksocial-ecological model

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