Closing the Gap in Pre-Exposure Prophylaxis Access for Sexual and Gender Minorities in South Korea: Implications for HIV Prevention Policy

Abstract

Despite the availability of pre-exposure prophylaxis (PrEP) in the Republic of Korea, structural and social barriers continue to hinder its widespread adoption. This study aimed to examine longitudinal changes in PrEP awareness, utilization, and perceived barriers among sexual and gender minorities to inform national HIV prevention strategies. Two independent online cross-sectional surveys were conducted in January 2022 (DB1) and December 2024 (DB2), primarily targeting men who have sex with men; transgender individuals comprised 0.6% of DB1 and 10.6% of DB2. The surveys assessed sociodemographic characteristics, PrEP awareness, usage patterns, perceived barriers, sexual behaviors, and histories of sexually transmitted infections (STIs). PrEP awareness improved significantly, with the proportion of respondents who had "never heard of PrEP" decreasing from 33.8% to 19.0% (p <0.001). Actual usage remained low (5.5%), and 81.4% of current users relied on informal overseas channels rather than domestic prescriptions. Low-awareness individuals are primarily deterred by an uncertainty of need and situational factors, while high-awareness individuals identify pill burden and high cost as dominant. App-based partner-seeking and a higher number of sexual partners were associated with increased odds of bacterial STIs. PrEP use was not significantly associated with a history of STIs after adjustment for behavioral variables. Overall, PrEP users were more likely to exhibit established HIV risk factors, including use of dating apps, unprotected sex, and a higher number of sexual partners. Despite increased awareness, signifi-cant gaps remain in the PrEP care continuum in Korea, particularly in translating awareness into uptake. Targeted implementation strategies are needed to improve PrEP uptake and sustain engagement in care.