Barriers and facilitators to engagement with the PrEP care continuum among sexual minority men in China: a systematic review

Sexual minority men (SMM) in China are disproportionately affected by the HIV epidemic, yet utilization of HIV prevention services, such as pre-exposure prophylaxis (PrEP), remains low. This systematic review summarizes the barriers and facilitators to the PrEP care continuum among Chinese SMM using thematic analysis. Following PRISMA guidelines, a comprehensive literature search was conducted in English and Chinese databases, including PubMed, EMBASE, Web of Science, PsycINFO, CINAHL, CNKI and WanFang. From 820 records, 50 studies met inclusion criteria, revealing five key themes: (1) sexual behaviors and perceived HIV risk; (2) PrEP-related stigma and homophobia; (3) history of HIV and other STI care engagement; (4) perceptions of PrEP efficacy, side-effects and adherence, and (5) structural and access barriers, including cost, health insurance and residential status. Improving PrEP uptake among Chinese SMM requires addressing sexual risk behaviors, societal stigma and structural barriers. Comprehensive education around PrEP, stigma reduction and financial support are crucial. Targeted public health initiatives and policy changes are necessary to enhance PrEP awareness, accessibility and adherence among Chinese SMM. Additionally, integrating PrEP education into existing HIV/STI care frameworks, and fostering supportive environments within healthcare settings can further mitigate barriers. There is a need to explore and promote alternative PrEP modalities, including on-demand (event-driven) PrEP and long-acting injectable PrEP, to better meet the diverse needs of Chinese SMM. Collaboration between government, healthcare providers and community organizations is essential to develop and implement effective strategies for increasing PrEP uptake and ensuring sustained HIV prevention efforts among Chinese SMM.