“I think PrEP would be magnificent”: exploring PrEP awareness, acceptability and access among Indigenous gay and bisexual men in Guatemala

Guatemala is a religious and socially conservative country with one of the largest Indigenous populations in the world. Indigenous communities have experienced centuries of discrimination, resulting in persistent health and economic disparities. In addition, Guatemala lacks legal protections for sexual minorities, placing Indigenous sexual minorities at heightened risk for adverse health outcomes, including HIV. This study explores Indigenous gay and bisexual men's (GBM) attitudes and perceptions of Pre-Exposure Prophylaxis (PrEP), as well as recommendations for future PrEP programming and preparation for long-acting injectable PrEP. In this study, 23 semi-structured, in-depth qualitative interviews were conducted with Indigenous GBM in Guatemala. Although all participants were familiar with HIV, only a small number had prior knowledge of PrEP. Participants first learned about PrEP through friends, healthcare providers, or the internet, and many associated it with concerns about its side effects and long-term health impacts. Despite these concerns, participants believed PrEP could provide important protection for an already vulnerable population and increase sexual freedom among Indigenous GBM, though these changes were viewed both positively and negatively. Participants strongly favored long-acting injectable PrEP and emphasized the need for culturally tailored education campaigns that address the specific fears and concerns of Indigenous communities.