Religiosity and Gender Norms as Determinants of HIV and PrEP Stigma among Ghanaian Immigrants in the United States

Beyond biomedical advances, sociocultural forces such as stigma, religiosity, and gender norms continue to drive HIV disparities among African immigrants in the United States. Ghanaian immigrants, a growing subgroup within this population, face unique challenges in HIV prevention as stigma shapes both perceptions of HIV and the use of prevention strategies such as pre-exposure prophylaxis (PrEP). This study examined how religiosity and gender norms are associated with HIV- and PrEP-related stigma in this community. We conducted a cross-sectional survey between May and July 2021 with 764 Ghanaian immigrants recruited across forty-four States through WhatsApp. Religiosity was measured using the 5-item Duke Religion Index, gender norms with the Gender Inequitable Men Scale, HIV stigma with an 11-item validated scale, and PrEP stigma with a 22-item validated scale. Multiple linear regression models were used to assess the associations between religiosity, gender norms, and stigma. Higher religiosity was associated with greater PrEP stigma (adjusted β = 0.27, p < 0.05) and HIV stigma (adjusted β = 0.09, p < 0.01). Endorsement of inequitable gender norms showed stronger associations with both PrEP stigma (adjusted β = 0.63, p < 0.001) and HIV stigma (adjusted β = 0.29, p < 0.001). No significant interaction between religiosity and gender norms was observed. Stigma among Ghanaian immigrants in the U.S. is culturally embedded, shaped by religiosity and inequitable gender norms. Interventions that engage faith leaders and promote gender equity are critical to reducing stigma and ensuring equitable access to both existing and emerging prevention tools, including long-acting injectable PrEP.