Table 2.

Themes and subthemes identified from the systematic review of systematic reviews (n = 49)

Theme and subtheme	Supporting systematic review evidence (AMSTAR appraisal)
Individual-level of socioecological model
Biomedical prevention method shape HIV infection—1A • Use of ART, despite condomless sex, reduces HIV risk • PrEP use reduces risk of HIV infection • Greater PrEP adherence further reduces risk of HIV infection • PEP use generally reduces risk of HIV infection • Early initiation of ARVs reduces risk of HIV infection	Bryant et al. 2009 (high) Chou et al. 2019 (high) Huang et al. 2018 (high) Jiang et al. 2020 (moderate) Okwundu et al. 2012 (high) Stromdahl et al. 2015 (high) Wang et al. 2020 (high)
Sexual & sex-seeking behaviors influence HIV infection- 1B • Public sex associated with higher HIV risk • Gender of sexual partners shapes HIV risk acquisition • Use of apps show mixed results for HIV risk • Transactional sex increases risk of HIV • Rectal douching increases risk of HIV infection • Condomless sex increases HIV risk • Drug use (amphetamine, party drugs, nitrites) increases risk of HIV infection • Number of sexual partners can increase HIV risk	Choi et al. 2017 (moderate) Dong et al. 2019 (high) Friedman et al. 2014 (high) Guerra et al. 2020 (moderate) He et al. 2011 (high) Hibbert et al. 2021 (high) Li et al. 2011 (high) Li et al. 2019 (high) Malta et al. 2010 (high) Oldenburg et al. 2015 (high) Vu et al. 2015 (high) Wang et al. 2015 (high) Wang et al. 2018 (moderate) Zhang et al. 2016 (high) Zhang et al. 2020 (high) Zou et al. 2017 (high)
Behavioral prevention methods can shape HIV infection—1C • Serosorting reduces odds of HIV infection when condoms not used • Condoms are more protective against HIV infection than serosorting • Sexual position shapes HIV risk (receptive increases risk)	Baggaley et al. 2018 (high) Baggaley et al. 2010 (moderate) Coelho et al. 2021 (moderate) Dong et al. 2019 (high) He et al. 2011 (high) Kennedy et al. 2013 (high) Li et al. 2011 (high) Malta et al. 2010 (high) Meng et al. 2015 (high) Millett et al. 2008 (high) Purcell et al. 2017 (high) Sharma et al. 2018 (moderate) Stromdahl et al. 2015 (high) Wiysonge et al. 2011 (high) Woodward et al. 2017 (moderate) Yuan et al. 2019 (high) Zhang et al. 2016 (high) Zhang et al. 2016 (high)
Individual level characteristics & infections influence HIV infection-1D • Lower SES associated with elevated risk of HIV infection • Higher education associated with less risk of HIV infection • Age associated with elevated risk of HIV infection • Circumcision status and HIV risk findings are mixed (protective for insertive sexual position in certain geographies) • Syphilis, Gonorrhea, Chlamydia, HPV, HBV, HSV-2 infections all associated with elevated risk of HIV infection associated with risk of HIV infection	Coelho et al. 2021 (moderate) Dong et al. 2019 (high) Freeman et al. 2006 (high) Houlihan et al. 2012 (high) Li et al. 2011 (high) Malekinejad et al. 2021 (high) Malta et al. 2010 (high) Millett et al. 2008 (high) Sharma et al. 2018 (moderate) Stromdahl et al. 2015 (high) Wiysonge et al. 2011 (high) Wu et al. 2021 (high) Yuan et al. 2019 (high) Zhang et al. 2019 (moderate) Zhang et al. 2016 (high)
Interpersonal-level of socioecological model
Lived experiences and interpersonal relationships shape HIV infection-2A • Incarceration elevates HIV infection • History of childhood sexual abuse elevate risk of HIV infection • Interpersonal experiences of homophobia are associated with elevated HIV risk • Motivational interviewing as an interpersonal intervention may lower HIV risk	Berg et al. 2011 (high) Buller et al. 2014 (high) Coelho et al. 2021 (moderate) Jeffries et al. 2021 (moderate) Harawa et al. 2018 (high) LLoyd et al. 2012 (moderate) Wirtz et al. 2018 (moderate) Wiysonge et al. 2011 (high)
Structural-level of socioecological model
Country-level income influences HIV infection—3A • GBMSM in low-middle income countries have lower risk of HIV than middle-income countries	Baral et al. 2007 (moderate) Blondeel et al. 2016 (high)
Country-level prevalence shapes HIV infection- 3B • GBMSM have higher odds of HIV infection in low prevalence countries	Baral et al. 2007 (moderate) Blondeel et al. 2016 (high)
Structural stigma shapes HIV infection – 3C • Country level legal protections for GBMSM reduces risk of HIV infection • Country level legal protections for sex workers reduces risk of HIV infection among GBMSM who engage in transactional sex	Oldenburg et al. 2018 (high) Stannah et al. 2018 (high)