Introduction Pre-exposure prophylaxis (PrEP) is a new biomedical intervention for HIV prevention. This study systematically reviews the acceptability of PrEP among men who have sex with men (MSM) worldwide.
Methods We searched PubMed database to identify English-language articles published between July 2007 and July 2016, which reported the acceptability of PrEP and associated population characteristics. Meta-analysis was conducted to estimate a pooled rate of acceptability, and meta-regression and subgroup analysis were used to analyse heterogeneities.
Results Sixty-eight articles were included. The estimated acceptance of PrEP was 58.7% (95% confidence internal (CI): 53.4%–63.8%) among MSM worldwide and showed no significant difference between developed and developing countries. MSM who were younger (4/5 studies, range of adjusted odds ratio (aOR)=1.49–3.47), better educated (7/7 studies, aOR=1.49–7.70), wealthier (3/3 studies, aOR=1.31–13.03), previously aware of PrEP (4/4 studies, aOR=1.33–3.30) and had greater self-perceived risk of HIV infection (4/5 studies, aOR=1.20–4.67) showed significantly higher acceptance of PrEP. Male sex workers (84.0% [26.3–98.7%]%] were more likely to accept PrEP than general MSM. Self-perceived low efficacy and concern about side effects, adherence, affordability, and stigma from health providers and society were main barriers for accepting PrEP.
Conclusion This review identifies a moderate acceptability of PrEP in MSM both developed and developing country settings. Efficacy, individuals’ perception of HIV risk and level of experienced stigma determine its acceptance.