Willingness to use long-acting injectable HIV pre-exposure prophylaxis (PrEP) among men who have sex with men: A meta-analysis

Background Men who have sex with men (MSM) face a high risk of HIV acquisition globally. Oral pre-exposure prophylaxis (PrEP) is effective but limited by adherence and stigma. Long-acting injectable PrEP (LAI-PrEP) offers a promising alternative, yet global acceptance among MSM remains unclear. This study aimed to estimate the pooled willingness to use LAI-PrEP among MSM and identify key determinants. Methods PubMed, Embase, Web of Science, and CINAHL were searched up to March 26, 2026. The search strategy contained the keyword willingness and interest and the MeSH terms for MSM and PrEP. Data analysis was performed using R. The systematic review has been registered with PROSPERO (CRD420261432493). Results Thirteen cross-sectional studies involving a total of 11,750 participants were included in the review. The pooled willingness rate was 69.9% (95% CI: 62.9%–76.9%). The test for subgroup differences showed no statistically significant difference among regions ( χ 2 = 0.46, p = 0.686). Six variables were significantly associated with higher willingness to use LAI-PrEP (all p < 0.05): oral PrEP use experience (OR = 2.67), history of HIV testing (OR = 1.99), engagement in transactional sex (OR = 1.79), having two or more male sexual partners in the past 6 months (OR = 1.74), heard of PrEP (OR = 2.13), and awareness of post-exposure prophylaxis (PEP) (OR = 1.67). Conclusions Willingness to use LAI-PrEP among MSM was high, but a substantial proportion expressed unwillingness. Therefore, we recommend integrated education campaigns, leveraging HIV testing as an entry point, and prioritizing high-risk subgroups for targeted LAI-PrEP promotion to optimize HIV prevention in this population.