Barriers and Facilitators of Oral PrEP Uptake Against HIV Among Selected Priority Populations: A Global Perspective

Purpose of the Review This review examines the multifaceted barriers and facilitators influencing PrEP uptake among priority populations, including MSM, PWUD, sex workers, transgender individuals, and AGYW, with a focus on generating actionable recommendations for governments, providers, and community organisations to scale effective HIV prevention models globally. Recent Findings Despite PrEP's proven efficacy, uptake remains constrained by intersecting individual, provider, structural, and systemic barriers. Key challenges include limited awareness, misinformation, provider-level stigma, structural discrimination, legal repression, prohibitive costs, and healthcare inaccessibility, burdens that fall disproportionately on priority populations in low- and middle-income countries. Conversely, evidence from sub-Saharan Africa, Asia, Europe, and the Americas demonstrates that community-led awareness campaigns, integration of PrEP into sexual and reproductive health services, long-acting injectable formulations, mobile clinics, peer support structures, and digital health and telemedicine tools meaningfully improve access and adherence, particularly among youth and rural populations. Policy-level interventions, including decriminalisation of sex work, same-sex relationships, and drug use, alongside subsidised access and inclusion in universal health coverage frameworks, are identified as critical enablers of equitable reach. Summary Achieving global HIV prevention targets requires more than biomedical innovation. This review underscores that rights-based, community-embedded, and culturally affirming strategies paired with structural reform and sustained investment are essential to expanding PrEP access and equity. PrEP must be positioned not merely as a clinical tool, but as a cornerstone of an equity-driven HIV prevention architecture.