Autonomy Support, Medical Mistrust, and Willingness to Discuss Pre-Exposure Prophylaxis (PrEP) Among Ghanaian Immigrants in the United States

African immigrants in the United States experience a disproportionately high HIV burden, yet their prevention needs are often obscured in aggregated data with Black/African Americans, which limits culturally tailored interventions and contributes to low uptake of pre-exposure prophylaxis (PrEP). This study investigated how medical mistrust, autonomy-supportive provider communication (providers acknowledging patients' perspectives, offering meaningful choices and a clear rationale, and supporting self-initiated decision-making) shape Ghanaian immigrants' willingness to discuss PrEP. A cross-sectional web-based survey was conducted between June and July 2021 with 764 Ghanaian immigrants recruited nationwide via community WhatsApp network. Validated Likert-type scales measured autonomy support, medical mistrust, and willingness to discuss PrEP, and linear regression models adjusted for eight sociodemographic variables. Participants (mean age = 29.9 years, SD = 6.84; range 18-61) were mostly male (58.1%) and heterosexual (59.3%). Overall, 35.7% reported willingness to discuss PrEP with a provider, 40.6% were neither willing nor unwilling, and 23.7% were unwilling. Higher autonomy support was associated with greater willingness (β = 0.42, 95% CI: 0.35, 0.49), and greater medical mistrust lower willingness (β = -0.15, 95% CI: -0.22, -0.08); the hypothesized interaction between the two was not statistically significant. Younger participants, non-students, and those with graduate or professional education were more willing to discuss PrEP, whereas gender, marital status, income, and employment showed no statistically significant associations. Autonomy-supportive communication and medical mistrust were therefore independently associated with willingness to discuss PrEP. These findings suggest that strengthening autonomy-supportive communication while addressing medical mistrust may enhance culturally responsive HIV prevention efforts.