Preexposure Prophylaxis for HIV Prevention: Awareness and Interest among a Northern Midwestern US Indigenous Population.

American Indians/Alaska Natives (hereafter referred to as "Indigenous Peoples") experience inequities in rates of HIV infection. Pre-exposure prophylaxis (PrEP) holds considerable potential for reversing HIV inequities among Indigenous Peoples; however, little research has explored PrEP awareness and interest within Indigenous contexts. This research explores PrEP awareness and interest among a population of Indigenous People in the Northern Midwestern United States. We conducted a survey on the reservation lands of a Tribal community in Fall 2022 that included measures of demographics, sociostructural factors, health behaviors, substance use, and PrEP awareness and interest. Eligibility criteria included being aged 18 years or older and having ever used drugs. The analytic sample consisted of surveys from 224 individuals who self-identified as Indigenous and did not report current PrEP use or HIV diagnosis. Univariate and bivariate analyses were conducted to examine differences in PrEP awareness and interest. Approximately one in four (27.7%) participants reported PrEP awareness prior to taking the survey and 17.0% indicated they were interested in taking PrEP. Recent HIV testing was associated with increased PrEP awareness. PrEP interest was significantly associated with reporting: not having health insurance, 2 or more sexual partners in past 6 months, past year STI testing, past year HIV testing, past 6-month drug use, and past 6-month injection drug use. Indigenous participants who reported behaviors associated with increased risk of acquiring HIV were significantly more interested in PrEP utilization. Steps should be taken to increase culturally responsive PrEP awareness and access in Indigenous communities.