Protocol for a systematic review and critical discourse analysis of research on HIV pre-exposure prophylaxis programme use among gay, bisexual, and other men who have sex with men

Abstract

Background HIV pre-exposure prophylaxis (PrEP) is a pill that prevents the transmission of HIV from sexual partners living with HIV; it is frequently taken by gay, bisexual, and other men who have sex with men (gbMSM). PrEP is often provided through formal PrEP programmes. Research on these programmes may employ discourses shaped by heteronormativity and homophobia. Given that expert language influences how HIV prevention is understood and delivered, problematic discourses in research likely extends into PrEP programme implementation. This review will use critical discourse analysis (CDA) to explore research on PrEP programme implementation for gbMSM. Within this literature, we will identify interpretive repertoires used to discuss gbMSM; the subject positions afforded to gbMSM; and the implications of these interpretive repertoires and subject positions for gbMSM engaging with HIV PrEP programmes. Methods Relevant articles will be identified through timebound searching (2012-present) in ProQuest ASSIA, EBSCOhost PsycInfo, OVID Medline, OVID Embase, and EBSCOhost CINAHL, with forward and backward citation searching of included studies. Grey literature will be identified through ProQuest and Google Scholar. Screening will be conducted by two independent reviewers, who will conduct double screening for titles, abstracts, and full texts. Data will be analysed and synthesised using CDA informed by critical realism (CR). CDA focuses on relationships between language and power, including how language enables inequality. The analytic process will explore the background of included studies, identify overarching themes, analyse external and internal relations in included studies, and interpret the meaning of identified themes and relations. Conclusions Highlighting issues with discourses in PrEP implementation may enhance reflective engagement with assumptions underlying this research, preventing further stigmatisation of gbMSM’s sexual and protective practices. As PrEP programmes become more common globally, more diverse and inclusive perspectives in PrEP programme research may inform interventions that enhance their acceptability and ultimately their implementation.