Troubling Silences: Reflecting on Findings from an Integrative Review on Access to PrEP

Trombetta, T.; Tovillo, J. Benito Caine V.

BackgroundIn 2012, pre-exposure prophylaxis (PrEP) was approved as an HIV-prevention intervention. PrEP is a highly effective strategy for reducing the risk of HIV acquisition, particularly in populations at high risk of contracting the virus. In an integrative review of the literature, we explored barriers and facilitators to accessing PrEP and outlined potential interventions to mitigate access. In the integrative review, 48 studies were included. We also extracted data that provided information on potential interventions and recommendations that stakeholders and decision-makers can utilize to advance practice guidelines and health policies that will improve PrEP access among high-risk populations. In this paper, we reflect on the review findings and contemplate the silences that became visible when looking across all studies.MethodsWe engaged in the process of reflexivity as we looked across the included studies. Throughout this process, we made notes, engaged in conversations, and consulted with others who work in the field. Results/ConclusionWe noted three significant areas of silence. One was a lack of intersectional analysis, which considers multiple minority-stress factors acting simultaneously. With little understanding of the complexities impacting understudied populations’ intersectionalities, stakeholders and decision-makers lack not only formative contextual research, but also any effective implementable measure to increase PrEP uptake. The studies analyzed showed a lack of community-participatory research practice. At large, the studies found did not explore, nor perceive, communities at HIV risk as agents of their own health. Neither did they represent these communities as capable stakeholders and decision-makers in matters regarding sexual behavior and harm reduction. Peer-support involvement in public health measures to improve PrEP access has been scarce. Despite social connections and relationships representing efficient methods for PrEP awareness, education, and stigma reduction, peer involvement remains mostly unexplored in the literature in relation to PrEP access.