Social barriers to pre-exposure prophylaxis uptake within sexual and gender minorities in the UK

Abstract

Background: Pre-exposure prophylaxis (PrEP) is a biomedical tool taken by HIV-negative individuals to prevent HIV transmission.(1) HIV prevalence is disproportionately high for transwomen and Afro-Caribbean men who have sex with men (ACMSM).(2, 3) This suggests that maximising PrEP uptake could be fundamental in curbing HIV prevalence, thus social barriers inhibiting its uptake warrants a deep understanding. The aim of this critical inquiry is to develop an understanding of PrEP social barriers faced by ACMSM and transwomen in the United Kingdom (UK). Methods: The following data bases were used for this critical inquiry: JSTOR, PubMed, and Web of Science. Out of the 30 studies identified as potentially relevant, 10 studies were included in the review. Results: PrEP social barriers identified include: stigma, awareness, adherence, and patient-provider relationships.(4-12) Social situations can lead to fear of PrEP stigma, deterring ACMSM from PrEP uptake.(4) A homophobic upbringing and racism could shield these individuals from PrEP awareness and adherence. Transphobia and the all-consuming oppression transwomen face may reduce PrEP access.(9) Meanwhile, trans-informed PrEP providers may boost PrEP adherence and PrEP awareness. Conclusion: Intersectionality could explain the strengthened PrEP social barriers faced by transwomen and ACMSM.(4, 9, 10, 13) Continued training on intersectionality and SGM health are essential for enhancing patient-PrEP providers.(14) Increasing policy representation of transwomen may resolve the impact of social oppression. Public perception of PrEP funding is positive,(11) suggesting improvements for PrEP stigma. Incorporation of SGM sexual health in sex education may continue to improve SGM acceptance, and fight SGM discrimination.