Reframing HIV prevention
A narrative synthesis review using the 5C vaccine hesitancy framework to understand and measure HIV pre-exposure prophylaxis hesitancy
Bibliographic Data
| ID | 19440216 |
|---|---|
| Authors | Nurul Fazilah Aziz (0000-0003-2684-5223, Universiti Putra Malaysia), Fatimah Ahmad Fauzi (0000-0002-0073-8748, Universiti Putra Malaysia, corresponding author), Rosliza Abdul Manaf (0000-0003-1488-1235, Universiti Putra Malaysia) |
| Year | 2026 |
| Volume | 38 |
| Issue | 9 |
| Pages | 1-18 |
| Publication date | 2026-03-30 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | AIDS Care (JOURNAL) |
| Journal identifiers | ISSN: 0954-0121 • E-ISSN: 1360-0451 |
| Publisher | Informa UK Limited (PUBLISHER • GB) |
| DOI | 10.1080/09540121.2026.2643355 |
| PMID | 41911420 |
| OpenAlex | W7143502524 |
| Language | EN |
| References cited | 77 |
BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is an effective biomedical prevention strategy, but uptake remains low among key populations, raising concerns about PrEP hesitancy. This review examines the relevance of the 5C Vaccine Hesitancy Framework in explaining psychosocial and contextual factors influencing PrEP hesitancy. OBJECTIVE: To apply the 5C Vaccine Hesitancy Framework to better understand reasons for PrEP hesitancy. METHOD: A systematic search was conducted in May 2025 across PubMed, Google Scholar, Scopus, and Sage Journal. English-language studies published between 2010 and May 2025 were included using the keywords 'HIV', 'PrEP', 'acceptance', 'rejection', 'refusal', and 'uptake'. Findings from 162 studies were synthesized narratively. RESULTS: Confidence was influenced by mistrust in healthcare providers and concerns about side effects. Complacency arose from low perceived HIV risk. Constraints included cost, stigma, and restrictive policies. Calculation reflected trade-offs between protection, pill burden, and stigma. Collective responsibility was supported by peers and communities but undermined by family stigma. Additional barriers included privacy concerns, digital literacy, and service delivery preferences, while mHealth and differentiated care models showed promise. CONCLUSIONS: The 5C Framework is a useful model for understanding PrEP hesitancy and informing context-specific interventions and tailored measurement tools to improve Pr EP uptake
Cognitive reframing · Context (archaeology) · Human immunodeficiency virus (HIV) · Measure (data warehouse) · Narrative · Narrative review · Behavioral Health and Interventions · HIV/AIDS Research and Interventions · Vaccine Coverage and Hesitancy
Stigma, Partners, Providers and Costs
A Global Estimate of the Acceptability of Pre-exposure Prophylaxis for HIV Among Men Who have Sex with Men
Values and Preferences on the Use of Oral Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Multiple Populations
Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention
Understanding, Contextualizing, and Addressing PrEP Stigma to Enhance PrEP Implementation
Sexual Risk Behaviors and Acceptability of HIV Pre-Exposure Prophylaxis Among HIV-Negative Gay and Bisexual Men in Serodiscordant Relationships
Beyond confidence
PrEP Stigma
Awareness and willingness to use HIV pre‐exposure prophylaxis among men who have sex with men in low‐ and middle‐income countries
Acceptability of pre-exposure prophylaxis as an HIV prevention strategy
Awareness and Uptake of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention Among Men who have Sex with Men in Nepal
PrEP eligibility, HIV risk perception, and willingness to use PrEP among high-risk men who have sex with men in India
Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients
Barriers and Facilitators to Acceptability and Uptake of Pre-Exposure Prophylaxis (PrEP) Among Black Women in the United States
Barriers and Facilitators to Pre-Exposure Prophylaxis by Men Who Have Sex with Men and Community Stakeholders in Malaysia
Determinants of PrEP Uptake, Intention and Awareness in the Netherlands
Facilitators and barriers to HIV pre-exposure prophylaxis (PrEP) uptake through a community-based intervention strategy among adolescent girls and young women in Seme Sub-County, Kisumu, Kenya
Multilevel Barriers to HIV PrEP Uptake and Adherence Among Black and Hispanic/Latinx Transgender Women in Southern California
Identifying HIV PrEP Attributes to Increase PrEP Use Among Different Groups of Gay, Bisexual, and Other Men Who Have Sex with Men
Low HIV Testing and PrEP Uptake of Adolescent and Young Men who have Sex with Men in Vietnam
HIV Risk Perception, Willingness to Use PrEP, and PrEP Uptake Among Young Men who have Sex with Men in Washington, DC
Predictors of PrEP Uptake Among Patients with Equivalent Access
Why aren’t you on PrEP? You’re a gay man’
Exploring Perceived Barriers and Facilitators of PrEP Uptake among Young People in Uganda, Zimbabwe, and South Africa
| Citation velocity | historical |
|---|---|
| Highly cited | No |