Pre-exposure Prophylaxis Adoption in Sexual Health

Pre-exposure prophylaxis (PrEP) has emerged as a transformative biomedical intervention to prevent HIV infection among people at substantial risk. Its adoption reflects a complex interplay of clinical efficacy, individual motivations, social norms and structural factors. Early guidelines recommended daily antiretroviral dosing for men who have sex with men (MSM), people who inject drugs and serodiscordant couples. Since then, expanded national and regional programmes have widened eligibility, reduced cost barriers and promoted PrEP through community advocacy. Uptake remains uneven, however, with disparities driven by stigma, health‐care access, cultural beliefs and perceptions of sexual risk. Behavioural research has illuminated how beliefs about effectiveness, affordability and sexual quality of life evolve over time, while implementation studies have underscored the importance of supportive social networks and tailored adherence support. Digital outreach and sex‐positive public health campaigns have demonstrated promise in normalising PrEP and addressing multidimensional stigma. Looking ahead, integration of PrEP with routine sexual health services and adaptive delivery models—such as event-driven dosing—will be critical to achieving equitable coverage and maximal population‐level impact.

Research from Nature Portfolio

Recent studies have applied psychosocial network analysis to identify temporal shifts in motivations for PrEP uptake among HIV‐negative MSM. Data collected between 2017 and 2019 revealed that initial adoption was strongly linked to perceptions of clinical efficacy and cost, whereas later waves showed growing influence of perceived improvements in sexual wellbeing and supportive peer norms. These dynamic networks underscore the need for time-sensitive communication strategies that address evolving beliefs and social contexts.

Pre-exposure Prophylaxis Adoption in Sexual Health publication trend

The graph below shows the total number of articles in pre-exposure prophylaxis adoption in sexual health across all publications each year (not limited to Nature Index journals).

Technical terms

Pre-exposure prophylaxis (PrEP): A preventive regimen of antiretroviral medication taken by HIV-negative individuals to reduce the risk of HIV infection.

Adherence: The extent to which a person’s medication-taking behaviour corresponds with agreed recommendations from a health professional.

Stigma: Negative social attitudes or beliefs that lead individuals or communities to feel devalued or discriminated against for using PrEP.

Men who have sex with men (MSM): A term used in public health to describe males who engage in sexual activity with other males, irrespective of how they identify their sexual orientation.

Path analysis: A statistical method used to examine direct and indirect relationships among multiple variables in a hypothesised causal framework.

References

1. A psychosocial network approach studying biomedical HIV prevention uptake between 2017 and 2019. Scientific Reports (2023).
2. Influence of families and other adult support on HIV prevention outcomes among black men who have sex with men. BMC Public Health (2024).
3. #PrEP4Love: An Evaluation of a Sex-Positive HIV Prevention Campaign. JMIR Public Health and Surveillance (2019).
4. Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England. AIDS and Behavior (2022).
5. PrEP-related stigma and PrEP use among gay, bisexual and other men who have sex with men in Ontario and British Columbia, Canada. AIDS Research and Therapy (2022).