The Use of Online Posts to Identify Barriers to and Facilitators of HIV Pre-exposure Prophylaxis (PrEP) Among Men Who Have Sex with Men: A Comparison to a Systematic Review of the Peer-Reviewed Literature

Abstract

Pre-exposure prophylaxis (PrEP) remains an under-utilized HIV prevention tool among men who have sex with men (MSM). To more comprehensively elucidate barriers and facilitators to PrEP use among US MSM, we conducted a systematic review of peer-reviewed published articles and content analysis of online posts about PrEP. We searched peer-reviewed databases (Medline, Web of Science, Google Scholar) using MESH headings and keywords about PrEP and/or HIV prevention from 2005 to 2015. We included original studies among MSM in the US that reported on barriers, facilitators, or other factors related to PrEP use. We also searched online posts and associated comments (news articles, opinion pieces, blogs and other social media posts) in diverse venues (Facebook, Slate Outward, Huffington Post Gay Voices, Queerty, and My PrEP Experience blog) to identify posts about PrEP. We used content analysis to identify themes and compare potential differences between the peer-reviewed literature and online posts. We identified 25 peer-reviewed articles and 28 online posts meeting inclusion criteria. We identified 48 unique barriers and 46 facilitators to using PrEP. These 94 themes fit into six overarching categories: (1) access (n = 14), (2) attitudes/beliefs (n = 24), (3) attributes of PrEP (n = 13), (4) behaviors (n = 11), (5) sociodemographic characteristics (n = 8), and (6) social network (n = 6). In all categories, analysis of online posts resulted in identification of a greater number of unique themes. Thirty-eight themes were identified in the online posts that were not identified in the peer-reviewed literature. We identified barriers and facilitators to PrEP in online posts that were not identified in a systematic review of the peer-reviewed literature. By incorporating data both from a systematic review of peer-reviewed articles and from online posts, we have identified salient and novel information about barriers to and facilitators of PrEP use. Traditional research approaches may not comprehensively capture current factors important for designing and implementing PrEP related interventions.

“Little Tablets of Gold”: An Examination of the Psychological and Social Dimensions of PrEP Among LGBTQ Communities

“…Finally, the PrEP users who participated in our study identified an important role for peer support in initiating and continuing PrEP use and expressed significant enthusiasm for sharing their own experiences. This finding adds to previous research demonstrating that peer support or approval can facilitate PrEP uptake (Hannaford et al, 2018;Koechlin et al, 2017). While peer-to-peer or patient navigation interventions are recommended for promoting retention in HIV care, more research is needed to explore how similar interventions may be used to support PrEP use.…”

Making Meaning of the Impact of Pre-Exposure Prophylaxis (PrEP) on Public Health and Sexual Culture: Narratives of Three Generations of Gay and Bisexual Men

“…Lack of interest or unwillingness to use PrEP appears to be associated with concerns about side effects (Goedel et al, 2016;Mutchler et al, 2015), lack of knowledge (Goedel et al, 2016), perceived inaccessibility and unaffordability (Calabrese et al, 2016;Goedel et al, 2016;Hubach et al, 2017;Kubicek et al, 2015;Oldenburg et al, 2016;Pérez-Figueroa et al, 2015;Whitfield, John, Rendina, Grov, & Parsons, 2018), perceived stigma (Franks et al, 2018;Hubach et al, 2017;Kubicek et al, 2015;Mutchler et al, 2015;Pérez-Figueroa et al, 2015;Young, Flowers, & McDaid, 2016), and 1 3 the perception that PrEP will lead to reduced condom use and greater sexual risk behavior (Eaton et al, 2017b;Grov, Rendina, Whitfield, Ventuneac, & Parsons, 2016;Hoff et al, 2015;Kubicek et al, 2015;Oldenburg et al, 2016;Pérez-Figueroa et al, 2015). Research has begun to document positive changes to sex and sexual culture some men on PrEP identify, such as more direct communication about HIV (Hannaford et al, 2018), reduced stigma against HIV-positive partners (Storholm, Volk, Marcus, Silverberg, & Satre, 2017), and reduced anxiety associated with sex (Brooks et al, 2012;Hojilla et al, 2016;Kwakwa et al, 2016;Storholm et al, 2017).…”

Access to HIV Pre-exposure Prophylaxis in Practice Settings: a Qualitative Study of Sexual and Gender Minority Adults’ Perspectives

“…8,12,13 Research among potential PrEP users identifies awareness and knowledge of PrEP, costs, side effects, PrEP stigma, beliefs about HIV, and access to health care as important factors impacting uptake of PrEP. [14][15][16][17][18][19][20][21] Findings from open-label trials and demonstration projects have been similar, [22][23][24] although research in these contexts has focused on adherence and sexual behavior changes rather than uptake. [25][26][27][28][29][30] Others have studied provider barriers to PrEP implementation, finding that provider education is an important aspect of PrEP access.…”