Understanding the Drivers of Perceived PrEP Stigma among Indigenous People in the United States.

Previous research has demonstrated that pre-exposure prophylaxis (PrEP) stigma serves as a common barrier to PrEP use across racial, ethnic, and sexual minority groups in the United States; however, there is a deficit in research focused on Indigenous populations. Therefore, the objective of this study was to identify drivers of PrEP stigma among Indigenous people. A cross-sectional survey was administered to examine PrEP knowledge, attitudes, and perceived barriers to use among Indigenous people in the United States, including PrEP stigma and the following hypothesized drivers: stigma towards drug use, 2SLGBTQ+ identity, and HIV; experienced discrimination; and medical mistrust. Participants reported that people in their communities associate PrEP use with drug use, 2SLGBTQ+ identities, living with HIV, and having multiple sexual partners. They also perceived high levels of stigma around these behaviors and identities in their communities and reported high levels of experienced discrimination and medical mistrust. Higher levels of each hypothesized driver were significantly associated with higher levels of perceived PrEP stigma among the respondents. The results generated from this study provide recommendations for interventions that aim to reduce the influence of these drivers on PrEP stigma.