Examining the Association Between Violence and PrEP Use Among Indigenous Gay and Bisexual Men in Guatemala

Indigenous gay and bisexual men (GBM) in Guatemala face high rates of violence and HIV. This study seeks to understand the relationship between exposure to different forms of violence and PrEP use to inform PrEP programming in Guatemala. From June 2023- May 2024, two partner organizations administered a cross-sectional questionnaire to 395 Indigenous Guatemalan GBM. We examined the relationship between violence (physical, sexual, and police violence due to sexual orientation; forced migration and knowing someone missing, injured, or killed in the internal armed conflict; and intimate partner violence [IPV] victimization and perpetration) and PrEP use using logistic regression in R. In multivariable analysis, we found that participants who experienced police violence had 75% greater odds of PrEP use than those who did not experience police violence (aOR:1.73, 95% CI: 1.09, 2.75, p = 0.02). Participants who experienced forced migration during the internal conflict had twice the odds of being current PrEP users, (aOR: 2.02, 95% CI: 1.11, 3.70, p = 0.02). Participants who perpetrated IPV had 80% lower odds of using PrEP (aOR: 0.17, 95% CI: 0.03, 0.65, p = 0.02). Indigenous GBM experience a high burden of violence which may affect their use of PrEP. Future longitudinal research should explore how violence victimization affects perceived HIV risk and resilience, which may explain why Indigenous GBM who experienced violence may be more likely to use PrEP.