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Gay men show higher rates of PrEP awareness and use than bisexual menGay men more likely to use HIV prevention tools

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Key Takeaway
Note that while both groups show similar PrEP intent, gay men have significantly higher rates of PrEP awareness and use.

This meta-analysis evaluated the prevalence of biomedical HIV prevention strategies among a large population of 514,543 bisexual and gay men. The study specifically examined several key metrics: PrEP awareness, PrEP intention, PrEP use (categorized as any, lifetime, and current), and U = U knowledge. The primary objective was to compare the implementation of these biomedical strategies between gay and bisexual cohorts to identify disparities in prevention engagement.

The analysis compared gay men to bisexual men across multiple dimensions of HIV prevention. For the primary outcomes related to PrEP awareness, the data showed 61.4% for gay men versus 42.9% for bisexual men. Regarding any PrEP use, the prevalence was 22.5% in gay men and 15.2% in bisexual men. Lifetime PrEP use was reported at 21.5% for gay men compared to 11.9% for bisexual men. Current PrEP use was recorded at 20.9% for gay men and 16.0% for bisexual men. Additionally, U = U knowledge was higher in gay men (76.3%) than in bisexual men (69.3%).

In terms of effect sizes, the meta-analysis reported an Odds Ratio (OR) of 1.52 to 2.77 across several metrics including PrEP awareness, any PrEP use, lifetime PrEP use, current PrEP use, and U = U knowledge. These results indicate a consistently higher prevalence of these biomedical prevention markers among the gay male population compared to the bisexual male population. However, for the secondary outcome of PrEP intention, the data showed 55.6% for gay men and 56.7% for bisexual men, indicating no significant difference between the two groups in terms of their intent to use PrEP.

Safety and tolerability data were not reported in the source material, as the study focused on prevalence and awareness rather than clinical adverse events or treatment discontinuation rates. The findings are based on a large sample size of 514,543 individuals, providing a robust look at population-level disparities. However, because this is a meta-analysis of observational data, it identifies associations in prevalence rather than establishing a causal link between gender identity and uptake.

These results highlight significant gaps in the reach of HIV prevention programs for bisexual men. While both groups express similar intentions to use PrEP, the actual implementation—including awareness and current usage—is notably lower among bisexual men. This suggests that while the desire for protection exists across both demographics, the pathways to obtaining and maintaining PrEP may be less accessible or less effectively communicated to bisexual men.

The findings suggest a need for targeted interventions specifically designed for bisexual men. Clinicians and public health officials should consider more tailored policies and strategies to increase awareness and facilitate access to biomedical prevention tools for this specific population. Future research is needed to identify the specific barriers preventing bisexual men from translating their intention into actual PrEP use, as well as the factors contributing to higher awareness levels in the gay male population.

For many people in the LGBTQ+ community, preventing HIV is a primary health goal. One of the most effective tools available today is PrEP (pre-exposure prophylaxis), a daily medication that significantly reduces the risk of contracting HIV. However, even with these tools available, not everyone has equal access to information or consistent use of the medication. This research looks specifically at how different groups within the community are engaging with these life-saving prevention methods.

The researchers conducted a large-scale analysis involving over 500,000 participants to compare HIV prevention behaviors between gay and bisexual men. They looked at several key factors: whether people knew about PrEP, if they intended to use it, if they were currently taking it, and if they understood the concept of 'Undetectable equals Untransmittable' (U=U), which means that people with an undetectable viral load cannot pass HIV to others.

The findings revealed a notable gap in several areas. While both groups showed similar levels of intention to use PrEP, gay men were significantly more likely to be aware of the medication and actually use it. Specifically, about 61% of gay men knew about PrEP compared to roughly 43% of bisexual men. Furthermore, nearly 21% of gay men reported using PrEP at some point in their lives, while only about 12% of bisexual men reported doing the same. There was also a higher rate of U=U knowledge among gay men.

It is important to note that this study shows an association between identity and prevention habits, but it does not prove that one group is more 'willing' than the other. Instead, it highlights that current outreach programs might be reaching some groups more effectively than others. The data suggests that bisexual men may face different barriers, such as less targeted information or different community resources.

For patients and community members, this means that while PrEP is a highly effective tool for everyone, the way we talk about it needs to change. Healthcare providers and community organizations can use this information to create more specific outreach programs tailored to bisexual men. If you are looking for ways to protect your health, these findings emphasize that seeking out specialized resources and clear communication from your doctor is vital to ensuring no one is left behind by current prevention strategies.

What this means for you:
Gay men show higher rates of PrEP awareness and use than bisexual men, highlighting a need for targeted outreach.

Study Details

Study typeMeta analysis
Sample sizen = 514,543
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
INTRODUCTION: The field of HIV/STI prevention research has primarily focused on gay men, leaving bisexual men overshadowed in broader discussions on sexual minority men's health. Although also at increased risk of HIV acquisition, bisexual men are less likely to access biomedical HIV prevention. This systematic review and meta-analysis summarizes the prevalence of implementation of biomedical HIV prevention strategies among bisexual men as compared with gay men. METHODS: We searched PsycINFO, CINAHL, Scopus, PubMed and Web of Science for studies published between 1 January 2012 and 1 February 2024, with prevalence data of specified HIV biomedical prevention strategies (awareness, intention, adherence and use of pre-exposure prophylaxis [PrEP], post-exposure prophylaxis [PEP] and U = U). Studies that did not provide bisexual-specific data were excluded. We conducted six random-effect meta-analysis models to analyse PrEP awareness, PrEP intention, PrEP use and U = U use among bisexual men and gay men. We conducted trend analyses to determine variations in the prevalence of PrEP awareness, intention and use, fitted by locally estimated scatterplot smoothing regression and linear regression. This study was registered with PROSPERO (CRD42024519650). RESULTS: Data were extracted from 114 articles, encompassing 514,543 participants, including 94,004 bisexual men (18.3%) and 420,539 gay men (81.7%). The overall pooled prevalence of PrEP awareness (g: 61.4% vs. b: 42.9%), any PrEP use (g: 22.5% vs. b: 15.2%), lifetime PrEP use (g: 21.5% vs. b: 11.9%), current PrEP use (g: 20.9% vs. b: 16.0%) and U = U use (g: 76.3% vs. b: 69.3%) among gay men was significantly higher than among bisexual men, with odds ratios ranging from 1.52 to 2.77. There was no difference for PrEP intention (g: 55.6% vs. b: 56.7%). For both gay and bisexual men, the trends for PrEP awareness and use generally increased, while the trend for PrEP intention decreased over time. CONCLUSIONS: Results demonstrate that bisexual men are engaging less than gay men with biomedical HIV prevention strategies, indicating the need for increased dissemination, awareness, and tailored policies and strategies for bisexual men.
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