AIDS and Behavior

, Volume 22, Issue 4, pp 1080–1095 | Cite as

The Use of Online Posts to Identify Barriers to and Facilitators of HIV Pre-exposure Prophylaxis (PrEP) Among Men Who Have Sex with Men: A Comparison to a Systematic Review of the Peer-Reviewed Literature

  • Alisse Hannaford
  • Madeleine Lipshie-Williams
  • Joanna L. Starrels
  • Julia H. Arnsten
  • Jessica Rizzuto
  • Phillip Cohen
  • Damon Jacobs
  • Viraj V. Patel
Original Paper


Pre-exposure prophylaxis (PrEP) remains an under-utilized HIV prevention tool among men who have sex with men (MSM). To more comprehensively elucidate barriers and facilitators to PrEP use among US MSM, we conducted a systematic review of peer-reviewed published articles and content analysis of online posts about PrEP. We searched peer-reviewed databases (Medline, Web of Science, Google Scholar) using MESH headings and keywords about PrEP and/or HIV prevention from 2005 to 2015. We included original studies among MSM in the US that reported on barriers, facilitators, or other factors related to PrEP use. We also searched online posts and associated comments (news articles, opinion pieces, blogs and other social media posts) in diverse venues (Facebook, Slate Outward, Huffington Post Gay Voices, Queerty, and My PrEP Experience blog) to identify posts about PrEP. We used content analysis to identify themes and compare potential differences between the peer-reviewed literature and online posts. We identified 25 peer-reviewed articles and 28 online posts meeting inclusion criteria. We identified 48 unique barriers and 46 facilitators to using PrEP. These 94 themes fit into six overarching categories: (1) access (n = 14), (2) attitudes/beliefs (n = 24), (3) attributes of PrEP (n = 13), (4) behaviors (n = 11), (5) sociodemographic characteristics (n = 8), and (6) social network (n = 6). In all categories, analysis of online posts resulted in identification of a greater number of unique themes. Thirty-eight themes were identified in the online posts that were not identified in the peer-reviewed literature. We identified barriers and facilitators to PrEP in online posts that were not identified in a systematic review of the peer-reviewed literature. By incorporating data both from a systematic review of peer-reviewed articles and from online posts, we have identified salient and novel information about barriers to and facilitators of PrEP use. Traditional research approaches may not comprehensively capture current factors important for designing and implementing PrEP related interventions.


Pre-exposure prophylaxis HIV Men who have sex with men Barriers to care 



We would like to acknowledge the Einstein-Montefiore Division of General Internal Medicine’s Qualitative affinity group for feedback on earlier versions of this manuscript.


This study received no sources of funding.

Compliance with Ethical Standards

Conflicts of interest

Alisse Hannaford declares that she has no conflict of interest. Madeleine Lipshie-Williams declares that she has no conflict of interest. Joanna Starrels is funded by NIH Grant R01DA039046. Julia Arnsten declares that she has no conflict of interest. Jessica Rizzuto declares that she has no conflict of interest. Phillip Cohen declares that he has no conflict of interest. Damon Jacobs declares that he has no conflict of interest. Viraj Patel is funded by NIH Grant K23MH102118.

Ethical Approval

Our research did not involve human participants or animals.

Supplementary material

10461_2017_2011_MOESM1_ESM.docx (35 kb)
Supplementary material 1 (DOCX 34 kb)


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© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Icahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Albert Einstein College of Medicine and Montefiore Medical CenterBronxUSA
  3. 3.Licensed Marriage and Family TherapistNew YorkUSA

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