Addressing PrEP Disparities: A Literature Review of Access Barriers and Health Equity Solutions in HIV Prevention

Background: Pre-exposure prophylaxis (PrEP) has emerged as a highly effective biomedical intervention for HIV prevention, yet significant disparities persist in access and utilization across racial, ethnic, geographic, and socioeconomic lines. Despite demonstrated efficacy rates exceeding 90% when taken consistently, PrEP uptake remains disproportionately low among populations at highest risk for HIV acquisition. Objective: This systematic literature review examines barriers to PrEP access and identifies evidence-based interventions to address health equity gaps in HIV prevention. We synthesized findings from peer-reviewed studies to understand multilevel factors influencing PrEP disparities and evaluate intervention effectiveness. Methods: We conducted a comprehensive search of PubMed, Embase, PsycINFO, and Web of Science databases from January 2012 to December 2024, using terms related to PrEP, disparities, barriers, and interventions. Inclusion criteria encompassed peer-reviewed studies examining PrEP access disparities, intervention evaluations, and equity-focused research. Two independent reviewers screened articles and extracted data using standardized forms. Results: Analysis of 127 studies revealed multilevel barriers including individual factors (limited awareness, stigma, risk perception), interpersonal factors (provider knowledge gaps, communication barriers), and structural factors (insurance coverage, geographic access, healthcare system capacity). Racial and ethnic minorities, rural populations, and individuals with lower socioeconomic status faced compounded barriers. Successful interventions demonstrated effectiveness through community engagement, provider training, and policy changes, with community-based approaches showing particular promise for addressing equity gaps. Conclusions: PrEP disparities reflect complex, interconnected barriers requiring comprehensive, multilevel interventions. Evidence supports the effectiveness of community-engaged approaches, provider capacity building, and structural policy changes. Future research should prioritize implementation science studies and long-term population-level impact evaluations to advance health equity in HIV prevention.