{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:45:33Z","timestamp":1785422733919,"version":"3.56.0"},"reference-count":32,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"crossref","award":["RS-2023-00245180"],"award-info":[{"award-number":["RS-2023-00245180"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"crossref"}]},{"award":["RS-2023-00245180"],"award-info":[{"award-number":["RS-2023-00245180"]}],"id":[{"id":"https:\/\/ror.org\/013aysd81","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Background: Although pre-exposure prophylaxis (PrEP) has demonstrated strong clinical efficacy in preventing HIV infection among men who have sex with men (MSM), real-world utilization remains suboptimal. In South Korea, MSM constitute a major population within the domestic HIV epidemic; however, PrEP uptake has not increased pro-portionally to awareness. This discrepancy has been conceptualized as the \u201cawareness\u2013uptake gap,\u201d reflecting multi-level barriers beyond individual knowledge. Purpose: This integrative review aimed to compare PrEP awareness, acceptance, and utilization among MSM populations in South Korea and international settings, and to identify structural, institutional, and psychosocial determinants contributing to the awaness, uptake gap. The study further sought to derive practical implications for nursing practice and health policy. Methods: An integrative literature review was conducted following Whittemore and Knafl\u2019s five-step methodology and reported in line with PRISMA guidance. Electronic searches were performed in PubMed, Google Scholar, RISS, ScienceON, and DBpia for peer-reviewed studies published between 2015 and 2025 in English or Korean. The final search was completed on 31 January 2026. A total of 5952 records were identified, and 187 studies met the inclusion criteria after screening and duplicate removal. Quality appraisal was conducted using AXIS, Newcastle-Ottawa Scale, RoB 2.0, CASP, and MMAT according to study design, and the findings were synthesized within an environmental\u2013structural\u2013individual framework. Results: The included studies consistently showed that awareness of PrEP exceeded actual uptake. Across settings, the awareness\u2013uptake gap was shaped by policy environment, service accessibility, stigma, privacy concerns, economic burden, institutional complexity, and provider preparedness. Comparative evidence from China, Thailand, Belgium and France, Brazil, and West Africa further suggested that awareness alone did not ensure uptake when service pathways were fragmented, culturally unsafe, or poorly understood. Conclusions: Closing the awareness\u2013uptake gap requires integrated policy and practice strategies that extend beyond cost reduction. Strengthening confidentiality systems, simplifying service pathways, and enhancing provider competency\u2014particularly through nurse-centered PrEP navigation and counseling models\u2014may support more sustainable PrEP expansion among MSM populations in global settings.<\/jats:p>","DOI":"10.3390\/nursrep16050148","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T14:29:03Z","timestamp":1776868143000},"page":"148","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Comparative Analysis of Pre-Exposure Prophylaxis Awareness, Acceptance, and Barriers Among Populations of Men Who Have Sex with Men in Global Settings: An Integrative Literature Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0498-6183","authenticated-orcid":false,"given":"Won Ju","family":"Hwang","sequence":"first","affiliation":[{"name":"College of Nursing Science, Kyung Hee University, Seoul 02447, Republic of Korea"},{"name":"School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwiyun","family":"Kim","sequence":"additional","affiliation":[{"name":"College of Nursing Science, Kyung Hee University, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy R.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ribeiro Banze, \u00c1., Muleia, R., Nuvunga, S., Boothe, M., and Sem\u00e1 Baltazar, C. 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