Disparities in Awareness, Willingness and Uptake of Biomedical HIV Prevention Among Bisexual and Gay Men: A Systematic Review and Meta‐Analysis

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.