I am on PrEP: A systematic review of barriers to effective PrEP utilisation among men who have sex with men in sub-Saharan Africa

Despite extensive research that recognises the potential of Pre-exposure prophylaxis (PrEP) as a highly effective HIV prevention strategy, particularly for men who have sex with men (MSM) in sub-Saharan Africa, a region with a high HIV burden, as reported in previous studies, there is a dearth of research that synthesises the misconceptions, misuse, and significant barriers that limit its optimal utilisation. This phenomenological systematic review synthesises misconceptions, misuse patterns, and barriers to effective PrEP use among MSM in sub-Saharan Africa. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was used to incorporate the papers considered for this review. A comprehensive search was conducted across PubMed, Scopus, and African Journals Online databases to identify studies published between 2000 and 2024. Two hundred seventy (270) studies were screened based on predefined inclusion criteria, and 20 studies were ultimately selected for inclusion. After completing thematic analysis of the included studies, findings revealed that there are misconceptions about PrEP’s side effects and the necessity to use it during periods of perceived low HIV risk. Misuse was characterised by inconsistent adherence and self-administration, without medical oversight. Barriers, such as stigma, inadequate healthcare access, and misinformation, were prevalent. Addressing these issues is critical to improving PrEP uptake and adherence among MSM in the region. Public health interventions and policies must target these barriers to ensure that MSM populations can fully benefit from PrEP's potential in reducing HIV transmission.