Extreme Community PrEP Stigma Perceptions as a Potential Deterrent to PrEP Use Among Black and Latino Men Who Have Sex with Men in the Deep South

Black and Latino men who have sex with men (MSM) in the Deep South have the lowest HIV pre-exposure prophylaxis (PrEP) use rates in the United States, and PrEP stigma may deter PrEP use. However, most research on PrEP stigma is at the interpersonal level, which hinders the development of community-level PrEP anti-stigma campaigns. To address this knowledge gap, we conducted a secondary analysis of an online survey of Black and Latino MSM in the Deep South who are not living with HIV (n = 281). Multinomial logistic regression models were used to assess associations between the Community PrEP-Related Stigma Scale (Community-PSS), its four subscales, and PrEP use (never, former, current), controlling for covariates. We found no evidence of an association between the overall Community-PSS nor three of the four subscales and the likelihood of never PrEP use versus current PrEP use. However, we found that a 1-point increase in the extreme stigma perception subscale (i.e., views that community members believe PrEP users are living with HIV, bad people, or hiding something) was associated with a 16% higher relative risk of never PrEP use versus current PrEP use (p = .019, 95% CI: 1.03-1.32). We also found no evidence of a relationship between Community-PSS nor its subscales and the likelihood of former PrEP use versus current PrEP use. Given these results, extreme stigma perceptions may deter current PrEP use among Black and Latino MSM populations. PrEP campaigns that depict PrEP users as everyday people may be an effective socio-structural approach to increasing PrEP use.