Breaking Stigma: Unraveling PrEP’s Impact on Aging LGBT Communities Living with HIV – A Scoping Review and Comparative Analysis between South Africa and Germany

This study aims to examine and map existing evidence on the relationship between Pre-Exposure Prophylaxis (PrEP) and stigma among aging LGBT communities living with HIV, using a scoping review methodology with a comparative focus on South Africa and Germany. Although PrEP is widely recognized as a biomedical HIV prevention strategy, its broader social implications, particularly its influence on stigma, identity, healthcare access, and quality of life among older LGBT individuals, remain underexplored. Aging LGBT populations living with HIV experience intersecting vulnerabilities linked to age, sexual orientation, gender identity, and HIV status, which are further shaped by cultural, structural, and health system contexts. The primary purpose of this research is to systematically map and synthesize the existing body of literature addressing how PrEP discourse, implementation, and perception intersect with experiences of stigma (enacted, anticipated, and internalized) among older LGBT individuals living with HIV. By adopting a comparative lens, the study will explore similarities and differences between South Africa and Germany two countries with distinct epidemiological profiles, healthcare systems, sociocultural norms, and policy environments related to HIV and sexual and gender diversity. Guided by established scoping review frameworks and the PRISMA-ScR reporting guidelines, the study will include qualitative, quantitative, and mixed-methods research, as well as relevant reviews and grey literature published from 2010 onward. The review will focus on key thematic areas including PrEP awareness and uptake, stigma experiences, healthcare access and utilization, social support, and quality of life among aging LGBT populations living with HIV. Particular attention will be given to how structural and sociocultural factors such as healthcare policies, social norms, and discrimination shape PrEP-related experiences in each national context. The expected outcomes of this study include (1) a comprehensive mapping of the scope, nature, and distribution of existing evidence; (2) identification of key knowledge gaps and under-researched areas; (3) a thematic synthesis of how PrEP intersects with stigma and aging within LGBT communities; and (4) comparative insights that highlight context-specific and cross-cutting patterns between South Africa and Germany. Ultimately, the findings aim to inform future research agendas, support evidence-based policy and practice, and contribute to the development of stigma-reducing, inclusive, and age-responsive HIV prevention and care strategies for LGBT communities living with HIV.